Why the link between Covid-19 deaths and obesity is a cause for concern

Studies show a worrying trend of Covid-19 death rates in countries with high obesity rates.

While it is quite well-known that obesity increases the likelihood of developing other chronic diseases such as diabetes, we tend to (as members of the public) generally know less about the condition and its connection to infectious diseases.

However, the Covid-19 pandemic has started to change that, and new studies are shedding light on the fact that being overweight or obese increases your likelihood of a bad outcome from the novel coronavirus.

There are currently approximately 650 million people living with obesity worldwide – highlighting another potential emerging pandemic that has seemingly been neglected thus far.

Estimates show that, should current trends continue, by 2025, 2.7 billion adults will be overweight and over 1 billion will be affected by obesity.

Obesity is defined as having a body mass index (BMI) of 30 or higher, while having a BMI of between 25 and 30 is classified as overweight. BMI is calculated by dividing an individual’s weight (in kilograms) by the square of their height (in meters). Obesity can be subdivided into three categories:

Class 1: BMI of 30 to <35
Class 2: BMI of 35 to <40
Class 3: BMI of 40 or above (classified as extreme obesity)

Obesity is a multifaceted, complex chronic disease, where the drivers of weight gain are convoluted but include not only social behaviours and factors but also biology and genetics.

Data from a report published earlier this month by the World Obesity Federation (WOF) has shown that being overweight is a predictor of increased complications and even death from Covid-19. The report revealed that a shocking 90% of total deaths worldwide occurred in countries with a high prevalence of obesity. Furthermore, the WOF report shows that death rates from Covid-19 appear to be ten times higher in countries where more than 50% of the population have a BMI of 25 and above.

With data from over 160 countries, not one example was reported of a country where less than 40% of the population was overweight that reported high death rates. Consistently, no country that had a high death rate (over 100 per 100, 000) had less than half of their population overweight.

In a small number of countries, Covid-19 mortality rates seemed to go against the trend, where despite a high prevalence of obesity in adults, reported Covid-19 related deaths remained low, due to their national responses and border control protocols. These countries included New Zealand and some Gulf States, including Qatar.

When it comes to risk factors for hospitalisation, studies from the United States have shown that a BMI of over 30 was shown to increase the risk of Covid-19 hospital admittance by 113% and the chance of Covid-19 patients being admitted to intensive care by 74%.

The risk of dying from Covid-19 increases by 48%, for those with BMIs over 30, and reaches 90% in patients with a BMI over 40. Alarmingly, these figures come irrespective of age, with younger people also being associated with bad outcomes.

Figures from the UK’s Public Health England, have shown that around 30% of Covid-19 related hospitalisations are directly attributed to overweight and obesity, and that the overweight and obese population represent 77% of all critically ill patients.

“Over the past year, #COVID19 has disproportionally hit people with #obesity, who are more likely to be hospitalised & have a higher likelihood of severe disease & death. At the same time, the pandemic has made combating the obesity epidemic even more difficult,” Tedros Adhanom, Director General of the World Health Organisation tweeted on World Obesity Day.

Covid-19 is not the first respiratory infection that has worse overall outcomes for individuals who are overweight and obese.

In fact, overweight populations are generally more susceptible to respiratory diseases as seen with the MERS and H1N1 influenza epidemics where, again, worse outcomes were associated with excess body weight. For this reason, the report by WOF also recommends that people with obesity be considered among the priority groups for Covid-19 vaccination and testing.

Clearly the need to invest in obesity prevention is at an all-time high. It is also time for an urgent public health response. As things stand, no country is on track to meet the targets set by the 2025 WHO and UN Global Targets on preventing childhood and adult obesity.

Tackling obesity

On the positive side, some countries have started to take action.

The UK government announced a new obesity strategy for England last July. This strategy includes a marketing campaign, measures to restrict promotion of and advertising of foods high in fat, sugar and salt content, display of calories on menus in order to facilitate informed choices when eating out, as well as an increase in available weight management services.

In Qatar, the number of people classified as overweight or obese has continued to increase over the past couple of decades. According to the Qatar Public Health Strategy, approximately 70% of Qatari Nationals are overweight, with approximately 41% being classified as obese. While data to support why this is this the case remains scarce, it is widely believed and accepted that it is largely due to sedentary lifestyles and poor diets.

As such, the Qatar Public Health Strategy (2017-2022), in alignment with the National Health Strategy, incorporates a number of healthy lifestyle related objectives in order to tackle the perceived obesity epidemic and other related chronic diseases.

These include: increasing public awareness on the positive health outcomes related to healthy nutrition and physical activity; creating and promoting policies and legislations that tackle food diversity and encouraging healthy eating habits as well as increasing physical activity; encouraging practice of regular physical activity across the country with a particular focus on targeted communities, schools and workplaces; establishing wellness services in primary healthcare centres that focus on providing care to patients who fall under one of the four major risk factors; as well as enhancing private sector collaboration to encourage and promote the production and distribution of healthier food products.

The Public Health Strategy also encourages cross-governmental collaboration as well as sustained investment in public health in order to yield the sought-after population health benefits while reducing downstream healthcare costs.

This falls in line with experts who agree that the only way to truly tackle global obesity is through a multifactorial approach.

Governments and governmental organisations including the health, agriculture, and transport sectors, need to work together to build a coordinated, sustainable, and permanent solution that tackles the root causes of obesity.

Only by prioritising public health, will countries be able to successfully build resilient health systems for the future.

Maha El Akoum, MPH, is a public health professional currently working as Head of Content at World Innovation Summit for Health [WISH].

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