Covid-19 and its Relationship with Obesity

I recently came across the article, which speaks (again) about Covid-19 and its relationship with obesity and increased risk for Morbidly Obese population, specifically African-Americans, although it applies to everyone.

African Americans who are older, have a higher BMI or have a history of lung disease are at increased risk for ICU admission with COVID-19, according to a study published in Obesity.

“The COVID-19 epidemic in the United States tracks along well-documented and historical health disparities, with early data suggesting disproportionate morbidity and mortality within the African American community”.

This was a cross-sectional study of all African Americans who tested positive for COVID-19 and were treated at a tertiary academic hospital between March 12 and April 9, 2020 (n = 158; mean age, 57 years; 61% women; mean BMI, 33.2 kg/m2). Those who were admitted to the ICU were considered to have severe disease course (n = 46), while non-severe cases were individuals who went to the emergency department or were admitted to the hospital and later discharged without an escalation in care (n = 112). Patient data were obtained through retrospective electronic medical records and included age, sex, BMI and comorbidities, such as diabetes mellitus, hypertension and obstructive lung disease.

Risk factors for ICU admission were older age (adjusted OR = 1.073; 95% CI, 1.033-1.114; P = .0003), elevated BMI (aOR = 1.115; 95% CI, 1.052-1.182; P = .0002) and presence of obstructive lung disease (aOR = 3.097; 95% CI, 1.137-8.437; P = .0270) as the three most prevalent risk factors for African Americans who were admitted to the ICU with COVID-19.

People admitted to the ICU were older (mean age 62 years vs. 55 years; P = .003) and had a higher BMI (36.5 kg/m2 vs. 31.9; P = .002) than those who were not admitted to the ICU. The odds of ICU admission nearly doubled with each BMI increase of 5 kg/m2 (OR = 1.72; 95% CI, 1.29-2.31) and tripled with each increase of 10 kg/m2 (OR = 2.97; 95% CI, 1.66-5.32).

“Prevention recommendations describe individuals with BMI greater than 40 [kg/m2] as being at ‘high risk’ for severe COVID-19 illness, whereas our results suggest that a lower threshold should be considered for this high-risk category,” researchers wrote.

People admitted to the ICU also had a higher prevalence of diabetes (63% vs. 42%; P = .016) and chronic kidney disease (23.9% vs. 8.9%; P = .012) than African American patients with non-severe cases.

“Appropriate management of obesity and the associated comorbidities of metabolic syndrome, as well as of the social determinants of health that underlie these conditions, is critical to addressing the evolving COVID-19 crisis,” researchers concluded.

Obviously, this article describes the “worst case scenario”, but we at Advanced Laparoscopic Surgeons of Morris would like to use the data from the article as an opportunity to encourage people of all races and genders, who suffer from metabolic syndrome, diabetes, Morbid Obesity (BMI 35 and greater) to consider weight loss surgery as the best option for durable resolution of these co-morbidities and prevention of possible hospital admissions.

Please check our website about sleeve gastrectomy, gastric bypass and their role in resolution of these health issues.

Dr. Alexander Abkin, MD, FACS, FASMBS