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Over the past year, many scientific teams around the world have reported that obese people who contract the coronavirus are particularly likely to become seriously ill.
Now, a large new study, involving nearly 150,000 adults in more than 200 hospitals across the United States, paints a more detailed picture of the link between weight and Covid-19 outcomes.
The study, carried out by a team of researchers from the Centers for Disease Control and Prevention, confirmed that obesity significantly increases the risk of hospitalization and death in people who contract the virus. And among those who are obese, the risk increases as a patient’s body mass index, or BMI, a weight-for-height ratio, increases. Patients with a BMI of 45 or more, which corresponds to severe obesity, were 33% more likely to be hospitalized and 61% more likely to die than those at a healthy weight, the researchers found.
“The results of the study highlight the serious clinical public health implications of an elevated BMI and suggest the continued need for intensive management of Covid-19 disease, particularly in patients with severe obesity, ”said lead author Lyudmyla Kompaniyets, a health economist in the Division of Nutrition, Physical Activity and Obesity at CDC
But the relationship between weight and results is nuanced. Patients with Covid-19 who were underweight were also more likely to be hospitalized than those who were at a healthy weight, although they were not more likely to be admitted to the intensive care unit or to die.
Dr Kompaniyets and his colleagues used a database of Covid-19 cases to identify 148,494 adults who were diagnosed with the disease in US hospitals from March through December. They calculated each patient’s BMI and looked for correlations between BMI and a variety of serious outcomes, including hospitalization, ICU admission, mechanical ventilation, and death.
They found that obesity, defined as a BMI of 30 or more, increased the risk of hospitalization and death. Patients with a BMI of 30 to 34.9 were only 7% more likely to be hospitalized and 8% more likely to die than people with a healthy weight, but the risks increased sharply as the BMI increased.
Providing evidence for this type of “dose-response” relationship makes the study particularly compelling, said Dr. Anne Dixon, director of pulmonary medicine and critical care at the University of Vermont Medical Center, who did not. participated in the research. “What this shows is that the more severe your obesity, the worse the effect. And the fact that it gradually increases with increasing levels of obesity, I think, adds some sort of biological plausibility to the relationship between obesity and the outcome.
The link between obesity and poor outcomes was strongest in patients younger than 65, but it was valid even for older adults. Previous smaller studies have not found strong links between obesity and the severity of Covid-19 in the elderly.
“Potentially because they had more power from this large sample size, they demonstrated that obesity also remains a significant risk factor for death in the elderly,” said Dr. Michaela R. Anderson, a pulmonary medicine and critical care expert at Columbia University Medical Center, who was not involved in the study. “It’s a beautifully done study with a massive population.”
Dr. Kompaniyets and her colleagues have also documented a linear relationship between BMI and the likelihood of needing mechanical ventilation; the higher the BMI, the more likely the patient is to require such a procedure, which is invasive and can lead to serious complications.
The study also found that underweight patients with a BMI of less than 18.5 were 20% more likely to be hospitalized than those who were at a healthy weight. The reasons are not entirely clear, but may be that some of these patients were malnourished or frail or had other illnesses.
According to the researchers, the BMI range associated with the best results was near the dividing line between what is considered healthy and being overweight, in line with some previous research suggesting that a few extra pounds could help protect people when they are overweight. ‘they contract an infectious disease.
“The exact reason why this association exists is currently unknown,” said Dr. Alyson Goodman, pediatrician and medical epidemiologist at the CDC and co-author of the study. One possibility is that having a little extra fat can provide much needed energy stores during a long illness.
The findings underscore the importance of carefully managing the care of severely obese patients and ensuring that obese people have access to vaccines and other preventative measures.
“This only provides further evidence for the recommendation to vaccinate people with high BMI as soon as possible,” said Sara Y. Tartof, infectious disease epidemiologist in the research and evaluation department of Kaiser Permanente, who no. did not participate in the study. .
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