Obesity in Critical Illness & COVID-19: A Very Bad Combination

This is a difficult subject to discuss because we all have people we love who suffer from issues that have led to them having a higher weight than what they should and, in turn, carry the diagnosis of obesity. This post is not intended to shame anyone. But there’s definitely a link between obesity and severe COVID.

As healthcare professionals, we care for these folks and have to have a great understanding of how obesity changes the physiology and management of patients when they are critically ill. I am not here to suggest policies or solutions to the obesity issues throughout the world as that is beyond the scope of this post and, to be honest, my knowledge.

We have seen too many people during the events of the last 2 years lose their lives as their obesity altered their immune response along with a litany of other physiologic components that made them more likely to meet their demise from you-know-what. Add to that the complications from HTN, DM2, CAD, OSA, OSH, and everything that comes along with it.

In addition, I do not want to misguide this as a hit piece against people who do not have the means to eat healthier or have other issues which are prohibitive to weight loss. In ways that are beyond the scope of this post, society could do a thing or two to help these individuals. I will never pretend to have all the answers. That being said, we all know we could take a bit of personal responsibility and do a little better in combating both obesity and COVID-19. Last update on 12/19/21.

Analyzing the data of Obesity and COVID

I have been meaning to write/talk/post about the link between obesity and COVID-19. Those of us who have been taking care of these folks over the last year and a half know quite well that there’s a relationship between the two. It seems as if health officials and such have not put forth the appropriate effort to discuss this to the degree that many of us have felt they should.

There are now three peer reviewed papers, and I’m sure many others in the pipeline, that have come out recently which I would like to share with you all. The citations are below and please read these data for yourself and do not trust me. Published on 7/16/21 but in the January issue of CCM out of Denmark, Kooistra et al. found that patients with a BMI ≥ 35 has a 15% greater odds of mortality than their BMI 18.5–25 counterparts (OR 1.15 (0.79–1.67)).

Gao et al. found in a prospective study in England that as the BMI increased in their over 6 million person cohort that as the BMI increased, as did their risk of hospitalization and death from COVID.

Sjögren et al. published a paper out of Sweden this October which showed that patients with a higher BMI had higher risks of death and longer hospitalizations than their counterparts who were of normal BMI. Patients with a BMI > 35 had double the risk of dying or a prolonged stay in the ICU.

I will work on this a bit more when I have time. For now, check out the citations below about obesity and COVID-19. In addition, I have written a ton of other COVID-19 content that is all evidence-based with citations HERE. I find it very odd that when you search on PubMed for Obesity + COVID, there are not many papers published in major journals as of 12/2021.

The Dosing of Medications of COVID patients due to obesity

UPDATED ON 03/27/22
Barletta JF, Erstad BL. Drug dosing in hospitalized obese patients with COVID-19. Crit Care. 2022 Mar 14;26(1):60. doi: 10.1186/s13054-022-03941-1. PMID: 35287690; PMCID: PMC8919144.
Link to Article

Reviewing Obesity in the Critically Ill NOT pertaining to COVID

In the December issue of CHEST, Anderson et al. published a review of the impact of obesity in critical illness. These data come as no surprise to those of us who care for these folks. We’ve battled extremely difficult airways during the pandemic due to enlarged necks. Our ventilators have struggled to appropriately provide pressures necessary to oxygenate several patients simply because of the weight on their chest, amongst other factors. Due to high BMI’s, some patients are not candidates for certain potentially life-saving therapies.

It is worth repeating that this is not meant to be a hit-piece against folks who are obese although some will inevitably see it as such. That’s just the way society is today. Unfortunately these are facts. Obesity is unhealthy. This is an opportunity to educate, using medical evidence, on why combating this particular pandemic is so important to society. We need to offer help and resources to those who need it rather than shame them.

Citations for Obesity in Critical Illness and COVID

Kooistra, Emma J. MD; Brinkman, Sylvia MSc; van der Voort, Peter H. J. PhD; de Keizer, Nicolette F. PhD; DKooistra EJ, Brinkman S, van der Voort PHJ, de Keizer NF, Dongelmans DA, Kox M, Pickkers P. Body Mass Index and Mortality in Coronavirus Disease 2019 and Other Diseases: A Cohort Study in 35,506 ICU Patients. Crit Care Med. 2022 Jan 1;50(1):e1-e10. doi: 10.1097/CCM.0000000000005216. PMID: 34374504; PMCID: PMC8670082.
Link to Article

Gao M, Piernas C, Astbury NM, Hippisley-Cox J, O’Rahilly S, Aveyard P, Jebb SA. Associations between body-mass index and COVID-19 severity in 6·9 million people in England: a prospective, community-based, cohort study. Lancet Diabetes Endocrinol. 2021 Jun;9(6):350-359. doi: 10.1016/S2213-8587(21)00089-9. Epub 2021 Apr 28. PMID: 33932335; PMCID: PMC8081400.
Link to Article

Sjögren L, Stenberg E, Thuccani M, Martikainen J, Rylander C, Wallenius V, Olbers T, Kindblom JM. Impact of obesity on intensive care outcomes in patients with COVID-19 in Sweden-A cohort study. PLoS One. 2021 Oct 13;16(10):e0257891. doi: 10.1371/journal.pone.0257891. PMID: 34644316; PMCID: PMC8513867.
Link to Article

Anderson MR, Shashaty MGS. Impact of Obesity in Critical Illness. Chest. 2021 Aug 5;160(6):2135–45. doi: 10.1016/j.chest.2021.08.001. Epub ahead of print. PMID: 34364868; PMCID: PMC8340548.
Link to Article

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