The Lethal Combination of Obesity and COVID-19

By William Dietz

COVID-19 and the prevalence of obesity are pandemics occurring simultaneously, with each contributing to the lethal effects of the other.

Obesity affects every system of the body, and is associated with diabetes, cardiovascular disease, cancers and over 240 other serious conditions. In new data released from the Centers for Disease Control and Prevention, 78 percent of COVID-19 patients requiring admission to an intensive-care unit (ICU) had at least one underlying health condition, many of which were obesity-related diseases. Of people hospitalized but not requiring ICU admission, 71 percent had at least one such condition, compared with 27 percent of people who were not hospitalized. More recent data from New York City indicate that people with both COVID-19 and obesity are two times more likely to be admitted to the hospital, and people with severe obesity are 3.6 times more likely to require critical care.

COVID-19 infection will likely add to the complications associated with obesity. Prior experience suggests that obesity predisposes patients with respiratory viruses to severe illness and higher rates of mortality. For example, obesity and severe obesity were risk factors for hospitalization and mechanical ventilation during the influenza H1N1 virus in 2009. Over half of adults with severe or fatal H1N1 in California were found to have obesity, and almost 40 percent had severe obesity. Many of the H1N1 patients with obesity also had other chronic conditions, such as lung disease, heart disease, or diabetes.

The disproportionate impact that H1N1had on patients with obesity and severe obesity may now be occurring in those with COVID-19, especially in cases with severe mixed infections. Factors that may link obesity and COVID-19 severity include reductions in respiratory volume and the inflammation associated with obesity. While the effects of COVID-19 on patients with obesity are still being explored, the lessons learned from the H1N1 pandemic should be taken seriously by those caring for patients with obesity, and particularly patients with severe obesity. The prevalence of adult obesity has increased since 2009–2010 and now stands at 42 percent. These data indicate that more Americans are at risk for obesity-related complications in today’s pandemic than were at risk during the 2009 pandemic.

Although COVID-19 demands our attention, we need to remember that chronic diseases put our society at greater risk for poor health. For example, estimates are that the COVID-19 pandemic will cause 100,000–240,000 deaths in the U.S. However, obesity is estimated to account for over 300,000 deaths per year. Obesity is a pandemic in its own right. Its treatment and prevention, and the prevention of the systemic inequities that contribute to it, must become priorities as we implement our response to COVID-19.

Congress and the Administration have taken action to increase access to telemedicine, enhance state flexibility under Medicaid, and have appropriated hundreds of billions to combat the COVID-19 pandemic, and yet comprehensive treatment for obesity is still not reimbursed by Medicare or many other health plans. Similar to COVID-19, we must invest in treatment and prevention at the local, state, and federal level. Policy initiatives should include increased support for community infrastructure that supports physical activities like walking and biking, implementing pricing strategies that decrease consumption of ultra-processed foods, ensuring equitable access to healthy foods, passing excise taxes on sugary drinks and sustaining the healthy standards set for school meals under the Obama administration.

In contrast to COVID-19, the obesity pandemic is a longer-term chronic disease, but this difference should not temper the urgency of our response. Hundreds of thousands of lives are at risk. We must act now.

William Dietz, MD, PhD, is director of the Sumner M. Redstone Global Center for Prevention and Wellness at the George Washington University Milken Institute School of Public Health.