March 30, 2020
By Harold Edward Bays MD, FOMA, FTOS, FACC, FACE, FASPC, FNLA
Coronavirus (COVID-19) and Obesity
Patients with the disease of obesity are at increased risk for adverse outcomes from viral upper respiratory tract infections. It is too early to know the degree by which the coronavirus (COVID-19) will disproportionately affect individuals with obesity. But generally, Obesity Medicine specialists should be aware that obesity often leads to chronic diseases (e.g., diabetes, hypertension, dyslipidemia, cardiovascular disease, gastrointestinal reflux, cancer, and other obesity-related chronic diseases). These obesity-related chronic diseases contribute to worsening health outcomes, which are health outcomes further worsened with the addition of a viral lung infection.
Specific to obesity, an increase in body fat can often result in adiposopathy or “sick fat,” which along with abnormalities of hormone function, can also lead to abnormalities of immune function. Disruption of the immune system can make patients with obesity more susceptible to infections, contribute to more severe symptoms, and delay recovery time. This is especially so regarding upper respiratory tract/lung infections. Individuals with obesity may already have lung dysfunction, breathing abnormalities (reduced tidal volume and reduced forced expiratory volumeFEV1), and sleep apnea. Patients with obesity and day or nighttime hypoxia may have little margin to tolerate further hypoxia, making upper respiratory tract/lung infections especially perilous.
Obesity can also contribute to debilitation, immobility, and orthopedic challenges. This may limit access to appropriate medical care. Similarly, patients with obesity are often treated with multiple drugs (polypharmacy), which not only complicates drug treatments (due to potential drug interactions), but also adds to the health care costs. This is yet another factor that may limit access for appropriate medical care.
Overall, with regard to Obesity and Coronavirus (COVID-19), patients with obesity and obesity medicine providers should follow guidance provided by the US Centers for Disease Control (https://www.cdc.gov/coronavirus/2019-ncov/index.html). In addition, patients with obesity and their health care providers should also be mindful of the challenges listed above, many which are often unique to the disease of obesity.
COVID-19 and Stress
In addition, among the more insidious and under-recognized complications of COVID-19 among those with and without infection is an increase in mental stress. Mental stress can substantially worsen diabetes mellitus, hypertension, and cardiovascular disease. Increased mental stress can also impair immune function. Through worsening chronic illnesses and impairing immune function, mental stress is almost certainly increasing the susceptibility of patients to COVID-19 infection, and worsening their outcomes after infection occurs.
With specific regard to obesity, mental stress also often worsens obesity. The mental stress of COVID-19 is especially problematic because mental stress often leads to worsened nutrition (preference for “comfort food”) and potentially reduces physical activity. The potential for worsening nutrition and reduced physical activity may be compounded by the ubiquitous recommendations that people “stay home.” For many, “staying home” may expose patients to less healthful eating options (especially if less healthful foods are disproportionately available at home), and may promote reduced physical activity (for those told not to leave the home). The potential of worsening of obesity as the result of increased mental stress from COVID-19 has the very real potential to further worsen obesity related chronic diseases (e.g., diabetes mellitus, hypertension, immunopathies, cardiovascular, and lung disease). This further increase the risk of COVID-19 infection and worsens COVID-19 outcomes.
During this most unique of times, Obesity Medicine Specialists, and all clinicians, should be especially mindful of the potential impact of stress on obesity and obesity related chronic disease. During any patient encounter, patients should be informed how to recognize signs of mental stress, and how it is as a potential threat to their health (e.g., increased risk for COVID-19 infection and worsened outcomes once infected). Patients with obesity should be given specific guidance how to safely maximize optimal nutrition and physical activity – especially during times wherein mental stress an even greater pandemic than COVID-19, and especially during times wherein “staying home” is mandatory.