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Obese People Are At An Increased Risk Of Contracting COVID-19, What Do Experts Have To Say

Many research studies have shown that people with underlying medical conditions such as diabetes, kidney disease, lung problem, heart disease, chronic respiratory disease and cancer have a higher risk of getting coronavirus (COVID-19) disease.

But, did you know that obesity is a risk factor of coronavirus disease? Studies have shown that obese people are at an increased risk of becoming critically ill with coronavirus disease [1] [2]. Given the extremely high rates of obesity around the world, it is expected that a high percentage of the population would be at a greater risk of contracting the disease [3] [4] [5].

To back this up, 221 hospitalised patients with COVID-19 aged 45 years were studied in China. 60 patients had comorbidities (the presence of one or more additional conditions), 68 patients had lymphopenia, 11 patients were admitted to the intensive care unit and 25 patients had severe illness. The study reported that severe illness of COVID-19 was directly associated with body mass index (BMI) greater than 28 kg/m2 and type 2 diabetes. The study was published in the journal The Lancet [6].

Another study showed that adults with coronavirus, rhinovirus, metapneumovirus and parainfluenza were more likely to be hospitalised because the patients were underweight and morbidly obese than healthy weight adults [7].

Obesity-related conditions increase the risk of contracting COVID-19. Dr Tulip, Chief Bariatric Surgeon at Dr Tulip's Obesity and Diabetes Surgery Hospital, and a patron of SeekMed said, "It is a common observance that the obese individuals are seen to get breathless on walking for short distances, more prone to pneumonia, asthma. Many suffer from obstructive sleep apnea. This is because obesity interferes with the expansion of the lungs by compressing the chest, lungs and the diaphragm. Also, obesity does not come alone and is associated with diabetes, hypertension, dyslipidemia, infertility etc.

Coming to the COVID-19 situation, the lungs are the organs most affected by COVID‐19. The virus that causes COVID-19 infects people of all ages. However, evidence to date suggests older people (that is people over 60 years old); and those with underlying medical conditions (such as cardiovascular disease, diabetes, chronic respiratory disease, and cancer).

Hence, it is paramount that those who are obese having diabetes, hypertension, having respiratory problems need to take extreme care, consult at the slightest symptoms with a doctor. Video consult is best and safe in these trouble times."

As per a study published in Obesity Reviews, people with obesity who contracted COVID-19 were 113 per cent more likely to require hospitalisation, 74 per cent more likely to require ICU admission and 48 per cent more likely to die [8].

Dr Himika Chawla, Senior Consultant, Endocrinology and diabetology, PSRI Hospital and a Patron of SeekMed said, "There are multiple pathophysiological factors that could contribute in these COVID-19 related complications in obese patients. Firstly, the abdominal fat in obese patients pushes the diaphragm up and reduces the lung volumes and adversely alters the mechanics of lung ventilation. Secondly, obesity is associated with multiple comorbidities like diabetes, chronic heart disease. Thirdly, obesity results in a state of chronic inflammation in the body along with impaired immunity. So the immune cells are both reduced in number and become less effective. Last but definitely not the least, obesity promotes a state of hypercoagulability in the body which is associated with adverse outcomes in COVID-19 patients.

However, even though we increasingly realize that the sickest COVID-19 patients are frequently obese, the burden of obesity is continuously increasing in the current pandemic situation. This could be due to reduced outdoor activities and reduced access to weight loss programs.

Further, there is also evidence to suggest that even small amount of weight reduction goes a long way in improving metabolic health and reduces the chances of severe COVID-19 infection. Thus patients with obesity should wash hands, wear masks, avoid large gatherings and exercise. In addition, assessment by an endocrinologist can be of significant help in identifying the cause of obesity, associated comorbidities and ruling out any hormonal causes of obesity.

Metabolic syndrome or insulin resistance is rapidly increasing and is the most important cause of obesity in the current times. Plus hormonal disorders of cortisol excess, polycystic ovaries disease in women also result in obesity. These diseases can be easily addressed by consultation with an endocrinologist and some blood investigations. Medications to manage these disorders in addition to maintaining a healthy lifestyle can help prevent severe COVID-19 infection and other comorbidities in patients with obesity.

Most importantly, the availability of teleconsultations through global platforms are of immense help for patients who can now easily access medical care from even remote locations without the risk of contracting COVID19 infection by visiting hospitals."

Why Are Obese People At Risk Of COVID-19

Dr Tulip added that there are a number of factors that makes obese people at an increased risk of contracting COVID-19:

1) Mechanical compression: Coronavirus affects many organs, but the worst and most affected is the lungs. Obesity causes substantial changes to the mechanics of the lungs and chest wall, leading to mechanical compression of the diaphragm, lungs, and chest cavity, which can lead to restrictive lung (pulmonary) damage. These changes lead to difficulty in breathing called dyspnoea, which initially is only on exertion, but in later stages leads to heavy breathing even at rest. This makes them more prone to contract the virus.

2) Obesity is associated with impaired immunity.

3) Chronic inflammation: Excess adiposity is also associated with increased production of inflammatory cytokines causing a continuous state of inflammation in an obese person, including lung tissue inflammation and more tendency to develop COVID-19.

4) Insulin resistance and diabetes: It is seen that diabetics are more affected by the coronavirus. Obesity leads to insulin resistance and type 2 diabetes. Insulin is a critical regulator of many cellular pathways. This is another reason which makes the obese more prone to develop the COVID-19 infection.

5) Vascular damage and clotting: Increase in circulating free fatty acids are seen in obesity. Also, the chronic inflammatory state seen in obesity damages the endothelium of blood vessels. Both these factors lead to an increased tendency for blood clotting in the vessels of obese people. This superadds to the increased clotting seen in COVID-19 disease, making the obese people more prone to contract coronavirus.

6) Leptin: Increased levels of leptin are seen in obese patients. High levels of leptin are associated with an increase in pulmonary inflammation, which again predisposes the obese to COVID-19.

To summarise, obesity is a major risk factor to develop coronavirus infection. Obese people once they develop coronavirus infection, it is very difficult to treat them because of the reduced and restricted lung function. Obesity is treatable, whatever be the severity of obesity. It is easier and safer to treat obesity rather than to treat an obese person affected with COVID-19. You can make the right decision - the decision is entirely yours. Prevention is better than cure. Treatment to get rid of morbid obesity even in the COVID-19 pandemic is absolutely safe.

What Is The Current Scenario Of Coronavirus Cases?

As of now, the total confirmed COVID-19 cases have risen to 38,598,588 and the death toll has gone up to 1,094,040 globally. In India, there are 7,301,804 positive cases of COVID-19 and 111,272 deaths have occurred.