Coronavirus disease 2019 and obesity: one pandemic meets another

To the Editors:

Recent publications on the novel coronavirus disease 2019 (COVID-19) regarding the high-risk populations have focused on the elderly, those with cardiovascular disease, diabetes, and, women during pregnancy. An important article by Dashraath et al¹ that was recently published in the American Journal of Obstetrics & Gynecology provided a thorough summary of the factors that need to be considered for pregnancy, maternal health, and postpartum care during the time of COVID-19, and guidelines on how these factors should be addressed and monitored.¹ However, the factors of overweight and obesity as critical preexisting health conditions, which are growing risk factors in pregnancy, are missing from this important discussion. With the ever-changing global mortality rates associated with COVID-19, which thus far seem to have regional variations, we implore researchers to collectively investigate and consider whether these regional variations in the mortality rates and the severity of COVID-19 could have any links to the prevalence of overweight and obesity. These factors should be investigated because most of the nations with the highest confirmed COVID-19 cases (the United States, Italy, Spain, Germany, France, and Iran; according to data at the time of submission April, 2020) are on the higher end of the overweight and obesity prevalence rates (ranges: 56%–68% overweight and 20%–36% obese according to the 2016 World Health Organization rates).

The alarming rise in the rates of overweight and obesity is a public health challenge that is causing a shift in chronic disease rates and health complications,² especially in pregnancy with or without gestational diabetes. During this time of COVID-19, overweight and obese populations could have a higher susceptibility to develop severe complications, especially linked to respiratory illness. Studies have shown that obesity is associated with pulmonary complications such as pneumonia.^{3 , 4} Obesity has a negative effect on both the respiratory function (eg, owing to reduced lung expansion and narrowing airways) and on the immune function and host defense,⁴ both of which are specifically under threat during the time of COVID-19 and during pregnancy. Adipose tissue dysfunction in overweight and obesity can act as a diseased organ (eg, chronic inflammation). Moreover, much is still unknown about how the severity of respiratory viral infections is compounded by overweight or obesity when coupled with other risk factors or pregnancy. This fast spreading virus could highlight the dire consequences of the rise in the rates of overall compromised health compounded by the exploding overweight and obesity rates.

It is important to consider whether the severity of COVID-19 and the associated mortality rates could increase because of a spread into regions with a higher prevalence of overweight and obesity, which may also be applicable to children (areas where childhood overweight and obesity is high). To best support the mandatory global efforts in identifying and defining the most relevant at-risk populations, we strongly suggest that overweight and obesity should be considered as a high potential variable and a comorbidity or risk factor in the general population.