Poor Outcomes, Increased Risk of Pulmonary Complications Among Obese Patients With COVID-19

^{By Julie Gould}  

New research findings show that patients who are underweight or obese, and are confirmed to have COVID-19, are at an increased risk for mechanical ventilation and death. Based on this finding, researchers determined that pulmonary complications are a significant contributor for poor outcomes. The study findings were published online in Obesity.  

To better understand the correlation between body mass index (BMI) with clinical outcomes among patients with confirmed COVID-19, we spoke with Tara S Kim, MD, director of weight management programs at Lenox Hill Hospital, and Eun Ji Kim, MD, MS, assistant professor at the Donald and Barbara Zucker School of Medicine.  

What existing data led you and your co-investigators to conduct this research?

Early during the COVID-19 global pandemic, being obese emerged as a risk factor for COVID-19 disease severity including death and mechanical ventilation.  Our goal for this project was to determine whether U.S. populations with obesity, stratified specifically by different obesity type (Obesity class I, II, and III), were at higher risk for COVID-19 infection and it’s complications. 

Please briefly describe your study and its findings. Were any of the outcomes particularly surprising?

We included 10,861 patients with confirmed COVID-19 infection admitted to Northwell Health System from March 1 to April 27, 2020.  Statistical analyses were conducted to examine the association between BMI and clinical outcomes in this patient group.  Results revealed that patients who were overweight (BMI 25-29.9 kg/m2) and populations with obesity class I (30-34.9 kg/m2), obesity class II (35-39.9 kg/m2) and obesity class III (greater than or equal to 40 kg/m2), controlling for other variables, had increased risks of requiring mechanical ventilation.  However, once on a mechanical ventilation, patients with obesity did not have increased risks of death compared to patient with normal weight. This suggests pulmonary complications is a significant contributor of COVID-19 mortality.   

What are the possible real-world applications of these findings in clinical practice?

With the possibility of a prolonged and possible severe “second” wave of COVID-19 infection, it is vital to stratify patients who may be at risk for the need of mechanical ventilation among patients with obesity.  Real world applications include addressing obesity related issues in the outpatient setting by timely diagnosis of the disease, escalation of medical management from outpatient to inpatient setting, and obtaining accurate weight/height on hospital admission. 

Most importantly, addressing obesity epidemic is vital to population and public health in the present and the future, not just during COVID-19 times. 

Do you and your co-investigators intend to expand upon this research?

Yes, we are interested in improving medical management of obesity in outpatient setting, to reduce negative consequences of obesity. Besides COVID-19, obesity has been associated with increased risk of hypertension, diabetes, kidney diseases, fatty liver disease. Therefore, there is a need to tackle the obesity epidemic. 

Reference:

Kim T, Roslin M, Wang JJ, et al. Body Mass Index as a Risk Factor for Clinical Outcomes in Patients Hospitalized with COVID-19 in New York [published online ahead of print, 2020 Oct 31]. Obesity (Silver Spring). 2020;10.1002/oby.23076. doi:10.1002/oby.23076