The confluence of the COVID19 pandemic with the obesity epidemic
The current Coronavirus (COVID-19/SARS-CoV-2) pandemic has been declared a Public Health Emergency of International Concern by the World Health Organisation. The same organisation describes the concurrent overweight and obesity epidemic as “one of today’s most blatantly visible – yet most neglected – public health problems”. What would the outcome be when these two problems intersect? We perhaps have caught a glimpse of it from the on-the-ground experience in Italy: there, obesity has been highlighted as one of the most common comorbid conditions for those patients requiring ICU admission.
Much is still unknown about COVID-19 and much knowledge is still to be discovered about the risk factors for the severity of illness it causes. This is seen in the speculation over the role of hypertension, diabetes mellitus and angiotension-2-increasing drugs. We too wish to speculate: in our case that obesity may play a role in predicting the outcome of severity of the disease. This speculation is in keeping with retrospective analysis of obesity as a risk factor for severity of illness in other respiratory viruses including influenza and MERS-CoV.
The exact causative mechanism for greater COVID-19 severity in obesity might be in keeping with the hypothesis raised by Fang, et al., or an immunometabolic disorder such as metaflammation. Interestingly, a link between Angiotensin 2 receptors and adipose tissue is proposed by Jia, et al. From a practical perspective, we know that obesity is also associated with difficult intubation and difficult ventilation and these may further contribute to greater disease severity and to poorer outcomes. We therefore call for formal studies analysing the relationship between disease severity and body mass index or waist to height ratios of patients infected with COVID-19. We do so in the hope that we might better risk stratify patient populations to assist in both disease prevention and treatment strategies.
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Competing interests: No competing interests