While evidence is still emerging around risk the risk of obesity for COVID itself, evidence suggests that obesity may be a risk factor for severe outcomes and complications of COVID-19. For instance, a report by the CDC in the US suggests that 48% of people hospitalised with COVID-19 were also affected by obesity and a study in France found that people in critical care with COVID-19 were 1.89 times more likely to have obesity than the general public. More information available here.
It is not yet clear why there is a link between COVID-19 and obesity, however an increased susceptibility to respiratory problems, inflammation, immunological disturbances and altered microbiomes disturbance in people living with obesity may all be contributing factors. Obesity also has a number of NCD co-morbidities such as diabetes, cancer and heart disease which have also been shown to increase risk of severe COVID-19 outcomes. More information available here.
The reality is that obesity is a complex disease that takes years to develop, but we could potentially see weight gain amongst adults and children for some time after the lockdown, particularly amongst the most vulnerable groups.
It is likely that diets will change as a result of lockdown measures, self-isolation and quarantine. Stockpiling of food occurred early on in a number of countries, and we are also seeing some increases in food prices, such as for fruit and vegetables. Changes in shopping patterns are also likely to impact on diets, with a move towards foods with longer shelf life which often, but not always, are higher in fat, sugar and salt. Physical activity is also likely to be impacted by the restrictions, not only due to people having less opportunities to exercise but because they are less active during the day. Furthermore, social distancing is likely to have an impact on mental health which we know can also contribute to overweight and obesity.
As with many pre-existing health conditions, we are seeing delays in treatment and support for people living with obesity. However, the impact of obesity on the health system at this time is also due in part to health systems already being poorly designed to meet the needs of people with obesity, due to insufficient recognition that it is a disease and a number of misconceptions. Part of this relates to practical challenges such as having appropriate equipment and transport, but also links to lack of trained practitioners and weight stigma amongst health care professionals. More information available here.
Existing research highlights that children tend to gain weight during the summer, when school is not in session. As a consequence, experts have been concerned about the impact of lockdowns due to COVID-19 on childhood obesity rates. A preliminary study in Verona, Italy, found that in the early stages of the lockdown, children reported eating more meals, more ultra-processed foods high in fat, sugar and salt, had reduced levels of physical activity and increased screen time. The first thousand days are also of concern, and women and children experiencing malnutrition now and for the foreseeable future are at much greater risk for later overweight and obesity. More information available here.
As data emerges on the risks of COVID-19 complications associated with obesity, countries are starting to include people with obesity on their list of vulnerable populations who should take extra precautions. It is not yet clear what BMI cut-offs are most appropriate, however France has opted for BMI >30, while UK and Mexico are using BMI >40. By including obesity on the vulnerable list, it prioritises people with obesity for testing and care and demonstrates the links between obesity and COVID-19 outcomes are being recognised. As strict lockdown measures ease, the conditions listed on vulnerable lists will become more relevant and have a greater impact on behaviours for those affected. More information available here.
During this time, it is more important than ever that people with obesity have access to the care they need during lockdown. This means that health services should continue deliver obesity services as needed, and restrictions on telemedicine lifted to ensure support is accessible. COVID-19 is likely to exacerbate stress and existing mental health conditions across the general population, but people living with overweight and obesity may be particularly vulnerable. The use of cognitive behavioural therapy techniques, telemedicine, eHealth and increasing access to virtual support groups to support both physical and mental health recovery are increasingly being encouraged by the medical community.
In the longer term, governments need to recognise the importance of addressing obesity, and the need to prevent and manage obesity to ensure population health and resilience. Obesity should be recognised as a disease in its own right, and included in national NCD plans alongside diabetes, cancer and CVD. Commitments to addressing childhood obesity should also be prioritised. There is an urgent need for health systems to be better equipped to treat obesity, for health care professionals to have access to obesity training, and for strong population policies such as front of pack labelling and sugar-sweetened beverages taxes to be implemented more widely. More information here.
The challenges related to COVID-19 are particularly great due to the existing vulnerabilities of the fragile health systems in LMICs. This is likely to be significantly exacerbated by the double burden of malnutrition (undernutrition and overweight) which is prevalent, often in the same community, family and even individual. Furthermore, vulnerabilities of the food system which are being exposed by COVID-19 are likely to hit LMICs the hardest, and high levels of poverty and densely populated settlements which make social-distancing near impossible will also contribute to the challenges.
It is more important than ever that people with obesity have access to information and resources to support them. There is a wide range of resources and materials available which can be viewed here.