According to the World Health Organization, more than 650 million adults in 2016 were obese. In addition, 39% of adults over age 18 years old were overweight. It has been estimated that at least 2.8 million people die each year because of being either overweight or obese. 1 These grim statistics are even more prominent in the United States. According to the National Center for Health Statistics, 42.5% of US adults over the age of 20 have obesity as reported in the 2017-2018 National Health and Nutrition Examination Survey, while an additional 31% are overweight. 2 Thus, almost three quarters of the adult population in the United States are currently overweight or have obesity!
While most physicians understand the significant links between obesity, coronary heart disease, diabetes, and the metabolic syndrome, many health care professionals do not recognize that obesity also predisposes individuals to multiple complications from COVID-19. Thus, during this terrible pandemic of COVID-19, the twin epidemic of obesity has exacerbated both the degree and severity of illness and resulted in substantial increases in mortality. 3
While the metabolic complications of obesity (eg, coronary heart disease, diabetes, metabolic syndrome, and even some cancers) are well known to practitioners of lifestyle medicine, the link between obesity and COVID-19 is less well known. Since obesity is in many ways the quintessential lifestyle-related disease, it is important for all physicians to counsel individuals who are overweight and those with obesity that they are substantially increasing their risk of the terrible complications related to the ongoing COVID-19 pandemic.
‘. . . many health care professionals do not recognize that obesity also predisposes individuals to multiple complications from COVID-19.’
The following facts about the relationship between obesity and COVID-19 are listed by the Centers for Disease Control and Prevention and should be a part of all clinical discussions with patients who are either overweight or have obesity. 3 Specifically,
Obesity increases the risk of severe illness from COVID-19. Individuals who are overweight may also be at increased risk.
Obesity may triple the risk of hospitalization due to COVID-19 infection.
Obesity decreases lung capacity and reserve and can make ventilation more difficult.
Obesity has been linked to impaired immune function.
As obesity increases there is a parallel increase in the risk of death from COVID-19.
Obesity may be linked to lower vaccine responses for numerous diseases (tetanus, influenza, and hepatitis B) and perhaps COVID-19, although to date there are no significant data suggesting individuals with obesity have less response to the vaccines.
Obesity has also been clearly demonstrated to be associated with hypertension, diabetes, and coronary heart disease (CHD), all of which have been shown to increase the health risk from COVID-19 infection.
Obesity is also a significant component of health equity. For example, Black adults have the highest prevalence of self-reported obesity (39.8%) followed by Hispanic adults (33.8%) and non-Hispanic White adults (29.9%). 3 Hispanic and non-Hispanic Black adults are 3 to 4 times as likely to suffer worse outcomes from COVID-19, compared with Caucasians. 4 The COVID-19 pandemic has highlighted the continuing inequity in health care on minority groups that live with a greater burden of obesity and related factors. 5
With these grim statistics in mind, it is important for all practitioners of lifestyle medicine to emphasize that habits and actions, such as maintenance of a healthy body weight, significantly impact the likelihood of adverse outcomes from COVID-19. Cornerstones of lifestyle medicine such as eating a healthy diet, engaging in regular physical activity, getting enough sleep, and coping with stress are all important not only for general health but also specifically to lower the risk of obesity and its association with adverse consequences from COVID-19.
Thus, while steps such as mask wearing, hand washing, social distancing, and obtaining vaccination when available, remain critically important to lowering the risk of adverse consequences of COVID-19, so do the basic tenants of lifestyle medicine. The relationship of obesity to adverse consequences of COVID-19 should remind us all of the value of the central tenants of lifestyle medicine to not only improve the daily life of individuals but, in fact, perhaps to preserve life itself!
Contributor Information
James Rippe, University of Massachusetts Medical School, Worcester, Massachusetts.
John P. Foreyt, Baylor College of Medicine, Houston, Texas.
References
- 1.World Health Organization. Obesity. Accessed January 4, 2021. https://www.who.int/health-topics/obesity#tab=tab_1
- 2.Fryar CD, Carroll MD, Ogden CL. Prevalence of overweight, obesity, and severe obesity among adults aged 20 and over: United States, 1960-1962 through 2015-2016 by Division of Health and Nutrition Examination Surveys. Accessed January 4, 2021. https://www.cdc.gov/nchs/data/hestat/obesity_adult_15_16/obesity_adult_15_16.pdf
- 3.Centers for Disease Control and Prevention. Obesity, race/ethnicity, and COVID-19. Accessed January 4, 2021. https://www.cdc.gov/obesity/data/obesity-and-covid-19.html
- 4.Belanger MJ, Hill MA, Angelidi AM, Dalamaga M, Sowers JR, Mantzoros CS. Covid-19 and disparities in nutrition and obesity. N Engl J Med. 2020;383:e69. [DOI] [PubMed] [Google Scholar]
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