Call to Action on Obesity Amidst COVID-19 Pandemic

March 04, 2021

Editor's note: Find the latest COVID-19 news and guidance in Medscape's Coronavirus Resource Center.

Hundreds of thousands of deaths worldwide from COVID-19 could have been avoided if obesity rates were lower, a new report says.

An analysis by the World Obesity Federation (WOF) found that of the 2.5 million COVID-19 deaths reported by the end of February 2021, almost 90% (2.2 million) were in countries where more than half the population is classified as overweight.

The report, released to coincide with World Obesity Day, calls for obesity to be recognized as a disease in its own right around the world, and for people with obesity to be included in priority lists for COVID-19 testing and vaccination.

"Overweight is a highly significant predictor of developing complications from COVID-19, including the need for hospitalization, for intensive care and for mechanical ventilation," the WOF notes in the report.

It adds that in countries where less than half the adult population is classified as overweight (body mass index > 25 mg/kg2), for example, Vietnam, the likelihood of death from COVID-19 is a small fraction — around one tenth — of the level seen in countries where more than half the population is classified as overweight.

And while it acknowledges that figures for COVID-19 deaths are affected by the age structure of national populations and a country's relative wealth and reporting capacity, "our findings appear to be independent of these contributory factors. Furthermore, other studies have found that overweight remains a highly significant predictor of the need for COVID-19 healthcare after accounting for these other influences."

As an example, based on the UK experience, where an estimated 36% of COVID-19 hospitalizations have been attributed to lack of physical activity and excess body weight, it can be suggested that up to a third of the costs — between $6 trillion and $7 trillion over the longer period — might be attributable to these predisposing risks.

The report said the prevalence of obesity in the United Kingdom is expected to rise from 27.8% in 2016 to more than 35% by 2025.

Rachel Batterham, lead adviser on obesity at the Royal College of Physicians, commented: "The link between high levels of obesity and deaths from COVID-19 in the UK is indisputable, as is the urgent need to address the factors that lead so many people to be living with obesity.

"With 30% of COVID-19 hospitalizations in the UK directly attributed to overweight and obesity, and three quarters of all critically ill patients having overweight or obesity, the human and financial costs are high."

Window of Opportunity to Prioritize Obesity as a Disease

WOF says that evolving evidence on the close association between COVID-19 and underlying obesity "provides a new urgency...for political and collective action."

"Obesity is a disease that does not receive prioritization commensurate with its prevalence and impact, which is rising fastest in emerging economies. It is a gateway to many other noncommunicable diseases and mental-health illness and is now a major factor in COVID-19 complications and mortality."

The WOF also shows that COVID-19 is not a special case, noting that several other respiratory viruses lead to more severe consequences in people living with excess bodyweight, giving good reasons to expect the next pandemic to have similar effects. "For these reasons we need to recognize overweight as a major risk factor for infectious diseases including respiratory viruses."

"To prevent pandemic health crises in future requires action now: we call on all readers to support the World Obesity Federation's call for stronger, more resilient economies that prioritize investment in people's health."

There is, it stresses, "a window of opportunity to advocate for, fund and implement these actions in all countries to ensure better, more resilient and sustainable health for all, "now and in our postCOVID-19 future."

It proposes a ROOTS approach:

  • Recognize that obesity is a disease in its own right

  • Obesity monitoring and surveillance must be enhanced

  • Obesity prevention strategies must be developed

  • Treatment of obesity

  • Systems-based approaches should be applied

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