Home About us Editorial board Search Ahead of print Current issue Archives Submit article Instructions Subscribe Contacts Login 

 Table of Contents  
REVIEW ARTICLE
Year : 2021  |  Volume : 48  |  Issue : 1  |  Page : 7-9

Obesity and its impact on the different aspects of the COVID-19 infection: Public health perspective


1 Medical Education Unit Coordinator and Member of the Institute Research Council, Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Sri Balaji Vidyapeeth – Deemed to be University, Ammapettai, Nellikuppam, Chengalpet, Tamil Nadu, India
2 Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Sri Balaji Vidyapeeth – Deemed to be University, Ammapettai, Nellikuppam, Chengalpet, Tamil Nadu, India

Date of Submission17-Mar-2021
Date of Acceptance30-Mar-2021
Date of Web Publication5-May-2021

Correspondence Address:
Dr. Saurabh RamBihariLal Shrivastava
Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Sri Balaji Vidyapeeth (SBV) – Deemed to be University, Thiruporur - Guduvancherry Main Road, Ammapettai, Nellikuppam, Chengalpet - 603 108, Tamil Nadu
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jss.jss_21_21

Rights and Permissions
  Abstract 


The coronavirus disease-2019 (COVID-19) pandemic continues to impact the lives of everyone and has influenced the functioning of all the sectors. In general, obesity tends to alter most of the physiological processes in the human body, including the immune system. Thus, it is important to get insights about the effect of obesity on the course of infection, so that morbidity and mortality can be minimized. An extensive search of all materials related to the topic was carried out in the PubMed search engine and World Health Organization website, and a total of 16 articles were selected based on the suitability with the current review objectives. Keywords used in the search include COVID-19 and obesity. It has been reported that obesity plays an important role in different aspects of the infection (viz., increased risk to acquire the infection or more chances to transmit the infection), management, and the worst clinical outcome. To conclude, obesity has to be acknowledged as one of the risk factors for compromising the pulmonary functions and thus should be considered as a high-risk group. In fact, as obesity is an independent risk factor to warrant hospitalization of the COVID-19 patients, it is essential that the medical team anticipates the challenges and manages the obese patients proactively and improves their clinical outcomes.

Keywords: Coronavirus disease-2019 pandemic, obesity, World Health Organization


How to cite this article:
Shrivastava SR, Shrivastava PS. Obesity and its impact on the different aspects of the COVID-19 infection: Public health perspective. J Sci Soc 2021;48:7-9

How to cite this URL:
Shrivastava SR, Shrivastava PS. Obesity and its impact on the different aspects of the COVID-19 infection: Public health perspective. J Sci Soc [serial online] 2021 [cited 2021 Jun 17];48:7-9. Available from: https://www.jscisociety.com/text.asp?2021/48/1/7/315449




  Introduction Top


The coronavirus disease-2019 (COVID-19) pandemic continues to impact the lives of everyone and has influenced the functioning of all the sectors. As on March 16, 2021, a cumulative total of 119,791,453 cases and 2.6 million deaths, amounting to a case fatality rate of 2.2%, have been reported.[1] On the other hand, 39% of the adults were overweight in 2016, while 38 million children <5 years of age were found to be overweight in 2019.[2] In general, obesity tends to alter most of the physiological processes in the human body, including the immune system. Thus, it is important to get insights about the effect of obesity on the course of infection, so that morbidity and mortality can be minimized.[2]


  Methods Top


An extensive search of all materials related to the topic was carried out in the PubMed search engine and World Health Organization website. Relevant research articles focusing on COVID-19 and obesity published in March 2020–November 2020 were included in the review. A total of 21 studies similar to the current study objectives were identified initially, of which five were excluded due to the unavailability of the complete version of the articles. Overall, 16 articles were selected based on the suitability with the current review objectives and analyzed. Keywords used in the search include COVID-19 and obesity. The collected information is presented under the following subheadings, namely, obesity and comorbidities, obesity and COVID-19, obesity impact on management of COVID-19 patients, obesity and COVID-19 deaths, triad of COVID-19 infection, implications for practice, and implications for research.


  Obesity and Comorbidities Top


Based on the extent, duration, and distribution (android or gynecoid), obesity can either cause or exacerbate the development of a wide range of comorbidities (viz., hypertension, diabetes mellitus, and cardiovascular diseases).[3],[4] The findings of recent studies have revealed that the simultaneous presence of cardiovascular disease, hypertension, diabetes mellitus, and chronic lung diseases has been linked with the development of serious forms of COVID-19 infection and higher rates of mortality.[3],[5] Thus, obesity can potentially account for higher rates of suffering, impairment in the quality of life, and death among COVID-19 patients.[3],[4],[5]


  Obesity and Coronavirus Disease-2019 Top


The available research findings suggest that obese people are more prone to acquire the COVID-19 infection. This is because of the presence of angiotensin-converting enzyme 2 (ACE2) receptors which are present in adipose tissues of the lungs (and heart).[6] The spike protein of the causative virus binds with these ACE2 receptors and damages the cells. Obviously, in obese people, the presence of these ACE2 receptors is on the higher side, making them more prone for the acquisition of infection.[6] In fact, it has been even reported that obese people are more contagious than lean COVID-19 patients. This has been explained by the fact that obesity increases the duration of viral shedding and reduction in the production of interferons (which generally plays an important role in reducing the rate of replication of the RNA of the causative virus).[7]


  Obesity Impact on the Management of Coronavirus Disease-2019 Patients Top


We must acknowledge the fact that obesity has been linked with different respiratory complications (such as more demand for ventilator support, increased work of breathing, inefficiency in respiratory muscles, and reduced respiratory compliance), which can significantly affect the line of management of COVID-19 patients.[8] In fact, upon analyzing the patients who lost their lives to the COVID-19 infection in a study done in Italy, it was reported that most of the patients were obese who succumbed to the infection.[9] These observations were suggestive that obesity tends to have a significant direct impact even in the management and prognosis of COVID-19-positive patients and thus health professionals have to be more cautious.[8],[9],[10]


  Obesity and Coronavirus Disease-2019 Deaths Top


Obesity has been associated with the development of complications and mortality among COVID-19 patients.[11],[12],[13],[14],[15] The findings of case series reporting findings from 221 patients revealed that the severe form of COVID-19 was associated with a body mass index of more than 28 kg/m2.[13] On a similar note, the findings of a study revealed that death was more common among people with morbid obesity, regardless of presence of other comorbidities.[14] Moreover, the results from another study done among cohort of inpatients in the New York city revealed that severe obesity is one of the major risk factors for the worst clinical outcome.[15]


  Triad of Coronavirus Disease-2019 Infection Top


In the COVID-19 infection, a triad of obesity, the causative virus, and hypercoagulability (or thrombosis) have been identified.[16] In fact, it has been identified that despite the use of systemic anticoagulants, COVID-19 patients are at more risk to develop venous thromboembolism or disseminated intravascular coagulation.[16],[17] Such an association results in abnormal coagulation parameters and eventually culminates for poor prognosis of the infection.[16],[17],[18]


  Implications for Practice Top


The discussion of all the above parameters clearly suggests that more attention should be dedicated toward those COVID-19 patients who are obese. As the outcome of the patients varies based on the anthropometric parameters (body mass index), it is advised that all such measurements should be made. Moreover, as obese patients also tend to have the presence of various comorbidities, they have more chances of complications and mortality and thus the health professional team should be adequately prepared to deal with the complications or additional considerations (viz., higher needs of mechanical ventilation, difficulty with intubation, positioning of the patient by the nursing staff, requirement of special beds, and transport facilities). In other words, it won't be wrong to record that obese patients can be flagged as a high-risk group of individuals, who require additional care, support, and considerations for a better clinical outcome.


  Implication for Research Top


The above discussion shows the role of obesity in different aspects of the infection (viz., increased risk to acquire the infection or more chances to transmit the infection), management, and the worst clinical outcome. However, there is an immense scope for the clinicians to understand and establish the association between obesity and different other aspects of the infection. The need of the hour is to conduct a number of studies, preferably multicentric and that too in different population groups and categorize the risk of complications or fatality based on different ranges of body mass index. Moreover, there is also a scope to gain insights into the role of obesity in the requirement of invasive ventilation and the measures which a clinician should take proactively to avert the progression of the disease into severe forms.


  Conclusion Top


Obesity has to be acknowledged as one of the risk factors for compromising the pulmonary functions and thus should be considered as a high-risk group. In fact, as obesity is an independent risk factor to warrant hospitalization of the COVID-19 patients, it is essential that the medical team anticipates the challenges and manages the obese patients proactively and improves their clinical outcomes.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
World Health Organization. Weekly Operational Update on COVID-19 – 16 March 2021; 2021. Available from: https://www.who.int/publications/m/item/weekly-operational-update-on-covid-19---16-march-2021. [Last accessed on 2021 Mar 17].  Back to cited text no. 1
    
2.
World Health Organization. Obesity and Overweight – Key Facts; 2020. Available from: https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight. [Last accessed on 2021 Mar 17].  Back to cited text no. 2
    
3.
Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: A retrospective cohort study. Lancet 2020;395:1054-62.  Back to cited text no. 3
    
4.
Wu Z, McGoogan JM. Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: Summary of a report of 72 314 cases from the Chinese Center for Disease Control and Prevention. JAMA 2020;323:1239-42.  Back to cited text no. 4
    
5.
Sanchis-Gomar F, Lavie CJ, Mehra MR, Henry BM, Lippi G. Obesity and outcomes in COVID-19: When an epidemic and pandemic collide. Mayo Clin Proc 2020;95:1445-53.  Back to cited text no. 5
    
6.
Hoffmann M, Kleine-Weber H, Schroeder S, Krüger N, Herrler T, Erichsen S, et al. SARS-CoV-2 cell entry depends on ACE2 and TMPRSS2 and is blocked by a clinically proven protease inhibitor. Cell 2020;181:271-80.  Back to cited text no. 6
    
7.
Honce R, Karlsson EA, Wohlgemuth N, Estrada LD, Meliopoulos VA, Yao J, et al. Obesity-related microenvironment promotes emergence of virulent influenza virus strains. mBio 2020;11:e03341-19.  Back to cited text no. 7
    
8.
Hu C, Jia W. Diabetes in China: Epidemiology and genetic risk factors and their clinical utility in personalized medication. Diabetes 2018;67:3-11.  Back to cited text no. 8
    
9.
Onder G, Rezza G, Brusaferro S. Case-fatality rate and characteristics of patients dying in relation to COVID-19 in Italy. JAMA 2020;323:1775-6.  Back to cited text no. 9
    
10.
Huang R, Zhu L, Xue L, Liu L, Yan X, Wang J, et al. Clinical findings of patients with coronavirus disease 2019 in Jiangsu province, China: A retrospective, multi-center study. PLoS Negl Trop Dis 2020;14:e0008280.  Back to cited text no. 10
    
11.
Caci G, Albini A, Malerba M, Noonan DM, Pochetti P, Polosa R. COVID-19 and Obesity: Dangerous liaisons. J Clin Med 2020;9:2511.  Back to cited text no. 11
    
12.
Albashir AA. The potential impacts of obesity on COVID-19. Clin Med (Lond) 2020;20:e109-13.  Back to cited text no. 12
    
13.
Hussain A, Mahawar K, Xia Z, Yang W, El-Hasani S. Obesity and mortality of COVID-19. Meta-analysis. Obes Res Clin Pract 2020;14:295-300.  Back to cited text no. 13
    
14.
Kalligeros M, Shehadeh F, Mylona EK, Benitez G, Beckwith CG, Chan PA, et al. Association of obesity with disease severity among patients with coronavirus disease 2019. Obesity (Silver Spring) 2020;28:1200-4.  Back to cited text no. 14
    
15.
Palaiodimos L, Kokkinidis DG, Li W, Karamanis D, Ognibene J, Arora S, et al. Severe obesity, increasing age and male sex are independently associated with worse in-hospital outcomes, and higher in-hospital mortality, in a cohort of patients with COVID-19 in the Bronx, New York. Metabolism 2020;108:154262.  Back to cited text no. 15
    
16.
Docherty AB, Harrison EM, Green CA, Hardwick HE, Pius R, Norman L, et al. Features of 20133 UK patients in hospital with covid-19 using the ISARIC WHO Clinical Characterisation Protocol: Prospective observational cohort study. BMJ 2020;369:m1985.  Back to cited text no. 16
    
17.
Wang T, Chen R, Liu C, Liang W, Guan W, Tang R, et al. Attention should be paid to venous thromboembolism prophylaxis in the management of COVID-19. Lancet Haematol 2020;7:e362-3.  Back to cited text no. 17
    
18.
Tang N, Li D, Wang X, Sun Z. Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia. J Thromb Haemost 2020;18:844-7.  Back to cited text no. 18
    




 

Top
 
 
  Search
 
Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

 
  In this article
Abstract
Introduction
Methods
Obesity and Como...
Obesity and Coro...
Obesity Impact o...
Obesity and Coro...
Triad of Coronav...
Implications for...
Implication for ...
Conclusion
References

 Article Access Statistics
    Viewed424    
    Printed14    
    Emailed0    
    PDF Downloaded44    
    Comments [Add]    

Recommend this journal