New Study Shows Overweight, Obesity Associated with Severe COVID-19 Complications

Individuals with a body mass index (BMI) of 25 to < 30 kg/m2 are classified as being overweight, and patients with a BMI > 30 kg/m2 are considered to have obesity.¹ Additionally, individuals with a BMI of > 40 kg/m2 are categorized as having severe obesity.¹ Obesity-related health conditions include heart disease, stroke, type 2 diabetes, and certain types of cancers.

According to the CDC and based on evidence from recent studies, obesity and severe obesity are also conditions that increase the risk of severe illness from COVID-19 at any age.^2,3

CDC Study

One recent CDC study used data from the Premier Healthcare Database Special COVID-19 Release, a hospital database, to evaluate the association between BMI and risk of severe COVID-19 outcomes, such as hospitalization, intensive care unit (ICU) or stepdown unit admission, invasive mechanical ventilation, and death.⁴ Among 148,494 adults 18 years of age and older who received a COVID-19 diagnosis during an emergency department or inpatient visit at 238 US hospitals between March 2020 and December 2020, 28.3% were overweight and 50.8% had obesity.⁴

Overweight and obesity were risk factors for invasive mechanical ventilation, and obesity was a risk factor for hospitalization and death, especially among adults < 65 years of age.⁴ Risks for hospitalization, ICU admission, and death were lowest among patients with BMIs of 24.2 kg/m2, 25.9 kg/m2, and 23.7 kg/m2, respectively, and then increased dramatically with higher BMIs.⁴

This study further emphasizes and builds upon previous evidence that obesity is linked to higher rates of COVID-19 hospitalizations and deaths. Study limitations include that only patients with reported height and weight were evaluated, and risks were assessed only among hospital patients, which could differ from evaluating all COVID-19 patients.⁴

Public Health Implications

According to a recent report from the World Obesity Federation, countries with more than 50% of the population classified as overweight have COVID-19 mortality rates 10 times higher compared with countries with an overweight prevalence below 50%.⁵ Health care providers can play an important role in preventing and managing patients with obesity, which includes education about lifestyle modifications that include healthy eating and regular physical activity. Patients with obesity and severe obesity should also be prioritized for COVID-19 vaccines across the country.

According to a report by the Kaiser Family Foundation, as of February 16, 2021, at least 29 states included obesity as one of the high risk conditions for phase 1c of the vaccine rollout.⁶ Clinicians should continue to educate patients about the importance of mask wearing, social distancing, and handwashing as additional COVID-19 prevention strategies.

REFERENCES

• CDC.Defining overweight and obesity.Last reviewed March 3, 2021.Accessed March 13, 2021.https://www.cdc.gov/obesity/adult/defining.html
• CDC.People with certain medical conditions.Updated February 22, 2021.Accessed March 13, 2021.https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-with-medical-conditions.html
• O’Hearn M, Liu J, Cudhea F, Micha R, Mozaffarian D.Coronavirus disease 2019 hospitalizations attributable to cardiometabolic conditions in the United States:A comparative risk assessment analysis.J Am Heart Asssoc.2021; 10(5):e019259. doi: 10.1161/JAHA.120.019259.
• Kompaniyets L, Goodman AB, Belay B, et al. Body Mass Index and Risk for COVID-19–Related Hospitalization, Intensive Care Unit Admission, Invasive Mechanical Ventilation, and Death — United States, March–December 2020. MMWR Morb Mortal Wkly Rep 2021;70:355–361. DOI: http://dx.doi.org/10.15585/mmwr.mm7010e4.
• World Obesity Federation.COVID-19 and obesity:The 2021 Atlas.Accessed March 13, 2021.https://www.worldobesityday.org/assets/downloads/COVID-19-and-Obesity-The-2021-Atlas.pdf
• Kates J, Dawson L, Tolbert J.Kaiser Family Foundation.The next-phase of vaccine distribution:High-risk medical conditions.Published February 16, 2021.Accessed March 13, 2021.https://www.kff.org/policy-watch/the-next-phase-of-vaccine-distribution-high-risk-medical-conditions/