Individuals with obesity and COVID‐19: A global perspective on the epidemiology and biological relationships

Abstract

Summary The linkage of individuals with obesity and COVID‐19 is controversial and lacks systematic reviews. After a systematic search of the Chinese and English language literature on COVID‐19, 75 studies were used to conduct a series of meta‐analyses on the relationship of individuals with obesity–COVID‐19 over the full spectrum from risk to mortality. A systematic review of the mechanistic pathways for COVID‐19 and individuals with obesity is presented. Pooled analysis show individuals with obesity were more at risk for COVID‐19 positive, >46.0% higher (OR = 1.46; 95% CI, 1.30–1.65; p < 0.0001); for hospitalization, 113% higher (OR = 2.13; 95% CI, 1.74–2.60; p < 0.0001); for ICU admission, 74% higher (OR = 1.74; 95% CI, 1.46–2.08); and for mortality, 48% increase in deaths (OR = 1.48; 95% CI, 1.22–1.80; p < 0.001). Mechanistic pathways for individuals with obesity are presented in depth for factors linked with COVID‐19 risk, severity and their potential for diminished therapeutic and prophylactic treatments among these individuals. Individuals with obesity are linked with large significant increases in morbidity and mortality from COVID‐19. There are many mechanisms that jointly explain this impact. A major concern is that vaccines will be less effective for the individuals with obesity.

Outcomes of Hospitalized COVID-19 Patients by Risk Factors: Results from a United States Hospital Claims Database

“…14 comorbid conditions during triage may allow for risk stratification and identification of patients who may benefit from increased monitoring and interventions. 14,15 We examined the CDC listed risk factors as a starting point. These risk factors were largely consistent with those reported previously.…”

Epidemiological and immunological features of obesity and SARS-CoV-2

“…Even after adjusting for age and obesity-related comorbidities such as diabetes, hypertension and coronary heart disease, obesity remains a strong independent predictor of excess morbidity and mortality. 1,4,5 These findings although concerning are not entirely unexpected. 6 Obesity and poor clinical outcomes have been described with other viral pathogens, most notably influenza A (H1N1) during the 2009 pandemic, when obesity was associated with increased hospitalizations, need for intensive care support, and deaths.…”

“…6 Obesity and poor clinical outcomes have been described with other viral pathogens, most notably influenza A (H1N1) during the 2009 pandemic, when obesity was associated with increased hospitalizations, need for intensive care support, and deaths. 4,7,8 In addition to the relationship between obesity and clinical outcomes, emerging evidence suggests a link between higher body mass index (BMI) and higher incidence rates of COVID-19 or SARS-CoV-2 infection 4,9,10 suggesting increased BMI may enhance susceptibility to infection. If correct, there would be important implications for individual-level risks and population-level transmission dynamics, particularly among populations with high rates of obesity.…”

Patient Demographics Associated with ARDS Incidence, Hospital Length of Stay and Mortality

“…ARDS Subject Demographics.There is ongoing research to evaluate the implications of obesity within the context of COVID-19. A systematic review by Yang, et al[21] identifi ed a greater severity of COVID-19 in patients with higher BMI, and a recent systematic review by Popkin, et al[22] revealed that obesity placed patients at higher risk for development of COVID-19 with increased hospitalization, ICU admission, and overall mortality. As the COVID-19 pandemic persists, ARDS and COVID-19 induced respiratory failure may be diffi cult to diff erentiate and the clinical management strategies for each variable[23].…”