- Prevalence of obesity in the United States is ~40%.

- In patients (n=265) with COVID-19 admitted to ICU at Johns Hopkins, University of Cincinnati, New York University, University of Washington, Florida Health, and University of Pennsylvania hospitals, 58% were male and the median BMI was 29.3.

- There is an inverse correlation between age and BMI--younger individuals that were admitted to the hospital for COVID-19  were more likely to be obese than older individuals that were admitted to the hospital for COVID-19. 

- Severe obesity has been found to be related to ICU admission in COVID-19 patients in these study centers in the United States

Obesity in COVID-19 Patients in the United States

- A case study investigating the severity of COVID-19 infection in patients with obesity  in Shenzhen, China 

Obesity in COVID-19 patients in China

• The primary goal of study was to assess the relationship between obesity classes according to BMI and the severity of COVID-19 symptoms, in Italy.

• The study was conducted in Veneto, a region close to Lombardy where the first case in Italy was discovered.

• The mean age of the study was 70.5 ± 13 years (n=92) and 61.9% were males.

• Patients were separated into 3 groups based on their BMI categories: normal weight, overweight, and obese.

• It was found that younger patients were overweight/obese in comparison to the older patients who were of normal weight.

• It was also found that, after adjusting for sex, age, and comorbidities, overweight and obese patients more frequently required assisted ventilation and/or intensive or semi-intensive care than patients of normal weight.


Obesity in COVID-19 Patients in Italy

•	The primary goal of study was to assess the relationship between obesity, type 2 diabetes, and hypertension with severe COVID-19, in Mexico.

•	Data was collected from all over Mexico using the Mexican Institute of Epidemiological Diagnosis and Reference; 18,443 tested negative, 3,844 tested positive, and 1,306 were positive for other respiratory viruses.

•	Positive cases were compared to negative cases and those who were positive for other respiratory illnesses.

•	Patients who tested positive had a higher proportion of obesity (17.4%), diabetes (14.5%), and hypertension (18.9%).

•	Patients with obesity had a 1.43-fold chance of developing severe COVID-19, patients with diabetes had a 1.87-fold chance of developing severe COVID-19, and patients with hypertension had a 1.77-fold chance of developing severe COVID‐19.

•	Obesity, diabetes, and hypertension were all significantly related to severe COVID-19 development in comparison to patients without these preexisting conditions.

Obesity in COVID-19 Patients in Mexico

• The primary goal of study was to assess the relationship between obesity and mortality of COVID-19 patients in France.

• The study was conducted in Paris and involved 5795 patients aged 18-79 years. The patients involved in the study were those that were admitted from February 1st to April 30th, 2020.

• Patients were separated into 3 groups based on their BMI categories: normal weight, overweight, and obese.

• After 30 days, 891 deaths occurred out of the patients admitted to the Paris hospitals.
 
• Patients in the obese range of BMI were more likely to die - BMI of 30-35: 1.89x increased mortality rate, BMI of 35-40: 2.79x increased mortality rate, and BMI of >40: 2.55x increased mortality rate.

• The results of this study show that COVID-19 patients with obesity have double the mortality rate compared to COVID-19 patients without obesity.


Obesity in COVID-19 Patients in France

• The primary goal of the study was to assess the relationship between obesity and risk of hospitalization in patients with severe cases of COVID-19.

• The study was conducted in the UK. The data was obtained from all over the UK through biobanks and the study population was 334,329.

• BMI was used as an indicator for obesity and out of the study population, 640 patients were hospitalized for COVID-19.

• For overweight, obese stage 1, and obese stage 2 patients, the incidence of getting hospitalized was much higher than the normal weight cases. 

• In all of these cases, an upward linear trend for hospitalization was observed with increasing BMI.

• Overall, obesity seems to be a significant risk factor for COVID-19 hospitalization.


Obesity in COVID-19 Patient in The United Kingdom

- China
- Italy
- Spain
- United States
- France
- United Kingdom
- Mexico

University of Michigan - Ann Arbor

Smith College

Ohio State University, Columbus

University of Texas at Austin

- Risk of infection
- Effects by geographical location
- Proposed disease mechanisms that contribute to morbidity and mortality
- COVID-19 complications and outcomes

Focuses of Obesity in COVID-19 Patients

- Implication of Obesity In Patients with COVID-19 
- Obesity in COVID-19 Patients by Geographic Location 
- Risk of Cytokine Storm in Obese COVID-19 Patients
- Higher Concentrations of IL-17 and TNF-α Lead to Greater Respiratory Damage
- Association of Obesity and Age with severe cases of COVID-19
- Association of Obesity and Hospital Stay Length

Obesity as a Comorbidity of COVID-19 

Obesity in COVID-19 Patients by Geographic Location

- ACE2 expression
- RAS activity
- cytokine storm
- endothelial dysfunction

Proposed Mechanisms Related to Obesity that Contribute to COVID-19 Morbidity and Mortality

- In-hospital mortality 
- Risk of intubation 
- Acute kidney injury 
- Acute respiratory distress syndrome 
- Acute cardiac injury 

Effects of Obesity on COVID-19 Complications and Outcomes 

Researchers have found individuals with body fat higher or lower than normal had a higher risk of disease infection. 

Body Fat Status and Increased Risk of Infection 

In populations with a high prevalence of obesity, such as the United States, COVID-19 will affect younger populations more than reported in other countries with lower prevalences of obesity. For example, in a large study of COVID-19 ICU patients in Italy, the median age was 63 years, with only 13% of patients younger than 51 years old and a prevalence of obesity of only 20% compared to the US' 40%.



Implications of Obesity in Patients with COVID-19

Association of Obesity and Age with severe cases of COVID-19

- Obesity prolongs the hospital stay in patients affected by COVID-19, and may impact on SARS-COV-2 shedding

Association of Obesity and Hospital Stay Length

Metabolic characteristics of obese patients include higher levels of proinflammatory cytokines. Additionally, blood plasma levels of cytokines are higher in COVID-19 patients compared to healthy individuals. Due to these combined risk factors, obese patients infected with SARS-CoV-2 have a higher risk of hypercytokinemia where there is an influx of cytokines in the blood within a short amount of time; thus, leading to organ failure, severe lung damage, and significantly increased likelihood of death. 

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