Coronavirus and obesity: two pandemics have met

Obesity is the second biggest factor for COVID-related hospital admissions; tackling the chronic obesity pandemic will be key to tackling current and future viral pandemics 

In New York, one of the epicentres of the COVID-19 pandemic, the most enduring images of those who have died have been of people who were, though young, afflicted with obesity.  

A study of more than 4,000 patients admitted between 1 March and 2 April 2020 found obesity was the single biggest factor, after age, for COVID-related hospital admissions. Patients aged less than 60 with a BMI between 30 and 34 were twice as likely to be admitted to acute and critical care as individuals who were normal or overweight. The authors hypothesised that, as obesity causes low-grade inflammation and an increase in circulating, pro-inflammatory cytokines, it could play a greater role than coronary disease, cancer, kidney disease, or even pulmonary disease in leading to the worst COVID-19 outcomes. Others point to the role of obesity in mortality differentials between Italy and China and on the role of obesity in fuelling poor outcomes among COVID-19 patients. 

This finding is concerning, as nearly 40 per cent of American adults under the age of 60 have a BMI of 30 or higher and over one third of adults globally (around two billion people) are obese or overweight. The number of adults with obesity in low- and middle-income countries tripled between 1980 and 2008, rising from 250 to 904 million. While Latin America, North Africa and the Middle East have the same obesity rates as Europe, obesity is rapidly rising among the middle- and upper-classes of urban Sub-Saharan Africa and India. Given such extremely high rates, we expect a high percentage of people who are overweight and with obesity will still contract COVID-19.  

Patients with obesity may not be prioritised 

Obesity per se is a key health challenge as it is a risk factor of several high mortality and morbidity non-communicable diseases. The pandemic of obesity, together with undernutrition and climate change, represents one of the three gravest threats to human health and survival.  

However, with obesity increasing the chances of the most detrimental effects of COVID-19, we posit that the obesity pandemic, a key driver of chronic disease worldwide, has now met the global viral pandemic of COVID-19.   

Across several countries, in the context of reduced access due to capacity constraints, prioritising COVID-19-positive patients afflicted with chronic conditions will pose ethical dilemmas. Patients with obesity and multiple comorbidities will be more likely to require intensive care but also have lower capacity to benefit. Decreased capacity to benefit has been used as a prioritisation rule for critical care usage during the pandemic with several countries issuing guidance suggesting patients with chronic complications should not be prioritised for intensive care. 

Fitter populations are better prepared for pandemics 

Boosting the ability of global populations to have greater resistance to viral conditions will require addressing the chronic conditions that make those viral conditions more deadly, as well as increasing their financial implications for health systems. Global cooperation and coordination are key in addressing those chronic conditions. This is as important as tackling the immediate crisis and perhaps is as important in preparing our populations for future pandemics. 

The current crisis is an opportunity to strengthen health systems in order to foster a healthier global citizenry and overcome the silos between infectious and chronic diseases.  

Mitigating and preventing infectious disease, non-communicable diseases and economic inequality are key Sustainable Development Goals. In achieving them, it is instrumental to develop integrated and cross-cutting approaches that acknowledge their intersectionality as well as the potential synergies of achieving these goals in a concerted manner.

Governments, even with the will to cooperate with one another, cannot do it alone. They need engaged citizenry to support the changes in policy that are currently constrained, and, in fact, often governed by the influence of financial and commercial interests in policymaking.   

We would do better as a global community if we were to prioritise several of the recommendations made in The Lancet Commission report on the “global syndemic” of obesity, undernutrition and climate change. Among them: 

• “Strengthen[ing] municipal governance levers to mobilise action at the local level and create pressure for national action” 
• “Strengthen[ing] civil society engagement to encourage systemic change and pressure for policy action at all levels of government to address The Global Syndemic” 
• “Reduce[ing] the influence of large commercial interests in the public policy development process to enable governments to implement policies in the public interest to benefit the health of current and future generations, the environment, and the planet” 

We believe the COVID-19 pandemic, and others that will inevitably follow, would have a less devastating impact on humankind if the recommendations for addressing our chronic pandemic were followed. As governments and policymakers come together across the world to address this crisis, we urge them to strengthen the public health infrastructure and, more importantly, the policy guidelines that might also address the obesity pandemic.