Chief physician of Szent Imre Hospital: the obese are much more at risk of coronavirus infections

English2020. szept 29.Növekedés.hu

Obese people need to be particularly careful not to get infected with coronavirus, as they are more likely to be hospitalized and ventilated, said Professor Róbert J. Bedros, Chief Medical Director of Szent Imre University Hospital and head of the National Obesity Centre, in an interview with növekedés.hu. According to international data, obese patients under the age of 60 are twice as likely to be admitted to the intensive care unit, and the rate of people with obesity who need mechanical ventilation is even higher. While previously only one in four mechanically ventilated lung patients was overweight, this rate is almost 50 percent for coronavirus cases.

Those in need of hospital treatment for Covid-19 are mainly elderly people and patients who suffer from comorbidities such as hypertension, diabetes, atherosclerosis - this has been known from published data already, but now there is considerable evidence suggesting that regardless of age the obese are also at significant risk.

One in two obese coronavirus patients needs hospital treatment in the US, and the situation is not much better in Europe. Regarding the data, Dr. Róbert J. Bedros, honorary university professor, Chief Medical Director of Szent Imre University Hospital and head of the National Obesity Centre, said to növekedés.hu:

in the case of obese patients, each unit increase in body mass index increases the complications of patients in Intensive Care Units (ICU), i.e., their life prospects deteriorate.

According to Professor Bedros, there may be a number of difficulties with mechanical ventilation due to obesity. One of these is that higher abdominal pressure narrows lung capacity; and in addition,

increased adipose tissue makes the chest harder to move with a mechanical ventilator.

Prof Bedros noted that when an overweight patient needs ventilation, it is also a considerable issue that over 200 kg body weight a special load-bearing bed may be needed, which is not available in all hospitals.

A sedentary lifestyle increases the risk of cardiovascular and metabolic diseases, the chief physician said, adding:

lack of exercise is associated with higher cholesterol levels, increased frequency of insulin resistance and diabetes, and there is also a higher risk of obesity.

Professor Bedros, together with Gábor Simonyi, chief physician of obesity at the National Obesity Centre, examined the relationship between obesity and the coronavirus in a study based on foreign data. According to the study published in the journal Metabolizmus, older age, smoking, diabetes, chronic kidney disease, persistent narrowing of the airways in the lungs, high blood pressure, and other cardiovascular diseases may constitute the biggest risk factors for Covid-19 patients.

Obesity and lack of exercise also increase the risk of severe COVID-19

We can see evidence confirming this statement in data from several countries. According to a study in Italy, processing data from a total of 1,591patients treated in ICU,

the average age was 63 years, and the most common comorbidities were hypertension, cardiovascular disease, and diabetes, whereas lung disease was relatively less typical.

When the coronavirus appeared in the United States, doctors expected rates to be similar to those in Italy. However, when the epidemic hit the US, American experts were surprised to see that a considerable number of younger patients were also admitted to ICU.

After looking into these unexpected figures, they realized that a significant proportion of these younger patients were obese.

The occurrence of severe COVID-19 in younger people in the United States is not surprising, as the rate of obesity is extremely high there. While in the US about 40 percent of adults are obese, this rate is 20 percent in Italy, 24 in Spain and only 6.2 percent in China.
In relation to this, Róbert Bedros pointed out that

in Hungary about 30 percent of the adult population is obese, which means that in this respect our country is in third place in the world.

As he said, Hungarian data have not been scientifically examined yet among patients hospitalized or in ICU. Nonetheless, he believes that figures regarding the obese in Hungary would be similar to those in other countries.

Examining the number of overweight coronavirus patients and the severity of the disease, figures clearly show that obesity poses a greater threat. And this statement applies not only to the elderly, but to all ages, since

a significant proportion of young Covid-19 patients who need hospital treatment are obese.

Big difference among patients on a ventilator

The link between the coronavirus and obesity is further confirmed by an electronic database in New York. According to this, nearly every second obese Covid-19 patient needed hospitalization in the U.S. to date: 37 percent of them later needed intensive care treatment, while 12 percent needed immediate hospitalization.

Obese people under the age of 60 were twice as likely to be treated in ICU as those who were less obese.

The numbers are similar in Europe: in the UK, 44 percent of hospitalized patients were overweight, while in France, 47.5 percent of those in intensive care were obese.

The association between Covid-19 and obesity can also be seen by looking at patients who had to be mechanically ventilated in the past. This comparison shows that the proportion of overweight patients differs significantly from the severe cases experienced in previous years. In non-Covid lung patients, the proportion of obese patients was 25 percent, but the situation is much worse when mechanical ventilation was needed because of the coronavirus.

90 percent of patients on a ventilator have been severely overweight so far. That is, the severity of the Covid infection gradually increases in proportion to the severity of obesity.

It is never too late to change Dr. Bedros summed up the findings of national and international studies, and said that the first step in the treatment of severely overweight people should be to assess and manage the various risk factors, i.e. to prepare the body so that an exercise programme can be started.

After this, depending on the condition of the musculoskeletal system, exercising can be started only gradually, which in this case can mean walking or swimming. Along with the improvement of the fitness condition, the decision about the next steps must be made in each case individually.