A complex interplay: COVID-19 and obesity

While no one is immune to the effects of COVID-19, patients with obesity are at increased risk for exacerbated infection and predisposition to severe related illness.

In fact, obesity has been identified as the greatest risk factor for severe COVID-19 illness — and the correlation between the two is quite complex.

Patients with obesity are at greater risk for related comorbidities, such as hypertension, diabetes, chronic kidney disease, CVD and atherosclerotic disease — the thickening or hardening of arteries. In patients with severe/fatal COVID-19, the most prevalent chronic comorbidities are obesity and hypertension, followed by diabetes, CVD, respiratory disease, cerebrovascular disease, malignancy, kidney disease and liver disease.

Severe COVID-19 is more likely to occur in patients with obesity at different stages for several reasons but not limited to:

• An abundance of ACE2 receptors in adipose tissue causes more access to viral entry.
• A large amount of active oxygen free radicals leads to altered lipid peroxidation and organ damage by oxidative proteins. Specifically predisposed are the lung, heart, liver and kidney.
• Inhibition of anti-inflammatory markers and promotion of inflammatory markers.
• Overall immune upregulation.
• Increased prothrombotic environment.

Mechanical effect of obesity

In addition to these predispositions, patients with obesity tend to be more socially isolated due to weight stigma, and when infected with SARS-CoV-2, are likely to suffer from the additive effect of stigma from the pandemic, resulting in a significant delay in disease diagnosis and early management.

While a spectrum of factors come into play for patients with obesity and severe COVID-19, health care providers can play a transformational role for patients by highlighting ways in which they can promote health — from nutrition and physical activity to treatment options and stress management.

Focus on nutrition

Depending on the severity of illness, these guidelines are recommended:

• Consume protein with each meal.
• Consume whole-grain bread, pasta, rice or cereal at each meal.
• Eat vegetables and fruits at each meal.
• Drink 8 to 10 cups of fluid per day (eg, water, diluted fruit juice, milk, nutrition supplement).
• Consider intermittent fasting to reduce an oxidative or proinflammatory state by improving glucose homeostasis.

Promote physical activity

There is a strong correlation between physical activity and major health outcomes, and increasing daily step counts proves to have a positive impact on mortality and cardiovascular risk. Encourage patients to increase both non-exercise activity thermogenesis (NEAT) and moderate physical activity.

Review pharmacotherapy options

For those who qualify, early use of medication for weight management has proven highly successful. After informing patients of the treatment options available to them, health care providers should counsel regular medication intake and encourage a minimum 30-day medication supply at all times.

Encourage stress management

Patients are experiencing higher levels of stress during the COVID-19 pandemic for a variety of reasons, including changes in work status, caring for school-aged children at home and disruption of daily routine. Health care experts can provide patients with tools and resources to cope with stress and meet with them frequently via telemedicine visits to track progress.

Our knowledge of COVID-19 is always evolving, especially as it relates to chronic diseases. To learn the latest from the best in obesity treatment, join Obesity Medicine Association’s upcoming spring conference, offered both in-person in Atlanta and virtually. OMA also offers a variety of digital tools, webinars and educational resources for providers to help keep patients healthy throughout the COVID-19 pandemic. To learn more about OMA or to become a member, visit https://obesitymedicine.org/join.