Severe Obesity Linked to COVID-19 Mortality: What Can Be Done?

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Severe Obesity Linked to COVID-19 Mortality: What Can Be Done?

Severe obesity itself – and not just demographic factors or co-morbidities – increases the risk of death with COVID-19, according to a new study. Researchers say the findings are especially worrisome because the risks are especially great among males younger than 60. A linked commentary advises on how pharmacists can help.

PASADENA, CA – Severe obesity is especially deadly for COVID-19 patients, according to a new study that found the risk was most concerning among those who are male and 60 years old or younger.

The report in Annals of Internal Medicine point out that, while obesity, race/ethnicity, and other related characteristics appear to be high-profile risk factors for adverse coronavirus disease 2019–associated outcomes, the links have not been clear.

Kaiser Permanente Southern California-led researchers sought to determine the adjusted effect of body mass index (BMI), associated comorbidities, time, neighborhood-level sociodemographic factors, and other factors on risk for death due to COVID-19.

The retrospective cohort study was conducted at Kaiser Permanente Southern California, a large integrated health care organization. The study team reviewed records for 6,916 members diagnosed with COVID-19 from Feb. 13, 2020, to May 2, 2020.

Results indicate a J-shaped association between BMI and risk for death, even after adjustment for obesity-related comorbidities.

Researchers point out that, compared with patients with a BMI of 18.5 to 24 kg/m2, those with BMIs of 40 to 44 kg/m2 and greater than 45 kg/m2 had relative risks of 2.68 (95% CI, 1.43 to 5.04) and 4.18 (CI, 2.12 to 8.26), respectively.

“This risk was most striking among those aged 60 years or younger and men,” the authors write. “Increased risk for death associated with Black or Latino race/ethnicity or other sociodemographic characteristics was not detected.”

Noting that their study was limited because deaths occurring outside a health care setting and not captured in membership files might have been missed, researchers conclude, “Obesity plays a profound role in risk for death from COVID-19, particularly in male patients and younger populations. Our capitated system with more equalized health care access may explain the absence of effect of racial/ethnic and socioeconomic disparities on death. Our data highlight the leading role of severe obesity over correlated risk factors, providing a target for early intervention.”

In a linked commentary, David A. Kass, MD, of the Johns Hopkins School of Medicine, writes, “The consistency of this new study and prior research should put to rest the contention that obesity is common in severe COVID-19 because it is common in the population. Obesity is an important independent risk factor for serious COVID-19 disease.”

Kass suggests that higher risks in younger patients likely is not because obesity is particularly damaging in this age group but likely due to other serious comorbidities that evolve later in life become dominant risk factors. He also posits that males are particularly affected because they tend to have greater visceral adiposity, which contributes to metabolic and vascular disease, than females.

“As a cardiologist who studies heart failure, I am struck by how many of the mechanisms that are mentioned in reviews of obesity risk and heart disease are also mentioned in reviews of obesity and COVID-19,” Kass explains. “The top mechanisms include restrictive pulmonary physiology and sleep apnea, diabetes and dyslipidemia, immune dysfunction with depressed anti-inflammatory signaling (for example, adiponectin) and increased proinflammatory signaling (for example, leptin, interleukin-6, and tumor necrosis factor-α), endothelial dysfunction, and renin–angiotensin stimulation that stimulates hypertension and worsens lung inflammation and alveolar damage.”

He raises the question of what health professionals can do about the situation, noting, “Severe and morbid obesity is sufficiently common in the United States to have become part of our social fabric. That makes messaging about its health risks difficult but does not change the fact that they are real. The data consistently show major risks at BMIs greater than 35 kg/m2, and at that level, weight reduction is difficult and certainly is not achieved rapidly.”

He recommends that pharmacists and other healthcare professionals especially promote protective measures for the obese.

“Therefore, social distancing; altering behaviors to reduce viral exposure and transmission, such as wearing masks; and instituting policies and health care approaches that recognize the potential effects of obesity should be implemented,” Kass writes. “These actions should help and are certainly doable.”

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