‘Think ahead, be more aggressive’

November 03, 2021

4 minutes to read

Source / Disclosures

Source:

Osterholm MT. In the long-term – considerations for the long-term effects of COVID-19 on obese people. Filed at: ObesityWeek. November 1-5, 2021 (virtual meeting).

Disclosures: Kumar reported receiving consulting fees from Eli Lilly and Gelesis and working in the speakers’ office at Novo Nordisk. Osterholm has not made any relevant financial disclosures.


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Obesity is a “common feature” among many adults who contract COVID-19 and develop more severe illness or are admitted to intensive care, and clinicians must work to better prepare patients and build confidence, according to speakers.

Despite approved vaccines and treatments, COVID-19 remains a part of daily life worldwide, and data suggests that excess weight is associated with worse outcomes for COVID-19. Michael Osterholm, Ph.D., MPH, The trustee professor, McKnight Chair in Public Health, and director of the Center for Infectious Disease Research and Policy (CIDRAP) at the University of Minnesota, said during a keynote lecture during the virtual annual ObesityWeek meeting.

Osterholm is Trustee Professor, McKnight Presidential Chair of Public Health, and Director of the Center for Infectious Disease Research and Policy (CIDRAP) at the University of Minnesota.

“What was remarkable was that you looked at a younger age [groups], those aged 20, 30 and 40 years, we were seeing a significant incidence of serious illness and death in the group that would be classified as obesity,” Osterholm said. “That was amazing, clinically, so early. This has been confirmed with epidemiological studies, and further consideration of the general patient mix. The challenge was how do we try to adapt to that? What are the reasons why we are seeing an increase? We are still trying to understand this, as well as the response to the vaccine among those who are obese. “

Obesity, stigma as risk factors

Obesity is an independent risk factor for more severe disease after infection with COVID-19, even in the absence of other comorbidities, Rekha B. Kumar, MD, MS, An associate professor of clinical medicine and an endocrinologist at Weill Cornell Medical College said during the presentation. She said studies suggest that the underlying pathophysiology associated with obesity alone is likely the underlying inflammation and endocrine disruption of abnormal lung mechanics.

Rika B Kumar

“There is a lot of pathophysiology in obesity unrelated to diabetes, high blood pressure or coronary artery disease that can put a person at greater risk of disease,” Kumar said.

Kumar said that in addition to unknown biological or genetic factors that influence disease severity, adults who are overweight often have negative interactions with the health care system, increasing the risk of marginalization and stigmatization.

“They tend to not have the best relationship with the health care system; they may appear later and be sicker on presentation,” Kumar said.[Disease severity] It’s likely to be a combination of factors, the pathophysiology of obesity and societal factors.”

Osterholm said the care of obese people with other underlying health challenges — even when they don’t have COVID-19 — has also been compromised during the pandemic.

“We’ve seen a lot of health care systems across the country during these big booms go from bent to crash,” Osterholm said. “When we look at people with comorbidities, we also have to look at the number of excess deaths that have occurred, the amount of hospitalization because these people couldn’t get the care they would have had if there hadn’t been a COVID-19 pandemic.”

Long-term COVID risk is higher

A study was published in June in Diabetes, obesity and metabolism It showed that among coronavirus survivors, the risk of hospitalization after the acute phase of the disease was 30% higher among obese people compared to people who were not overweight. The study also showed that the need for diagnostic tests to assess heart, lung, vascular, kidney, gastrointestinal, and mental problems was significantly higher among patients with a BMI of 35 kg/m.2 or greater compared to a person with a normal BMI.

“You would expect to see an increase among people who are obese and potentially have long-term COVID because there has been an increase in the incidence of moderate to severe disease in this population, which has been associated with COVID for a long time,” Osterholm said. “He is [obesity] Confusing, or is this a cause and effect? We’re not quite sure yet. We’ve been trying to understand COVID for so long, how it happens, if it’s a single pathway, what to do about it, and what speculation one might consider to help a person.”

Kumar said she has seen symptoms of COVID for a long time in her patients, including pericarditis, unexplained high heart rate, neurological complications, mental fog and fatigue, and even skin complaints, such as strange sensations on the skin.

Kumar said research is underway on whether losing weight or using weight-loss agents or metformin can reduce the risk of severe COVID-19 disease.

Building trust with patients

Kumar said that before the arrival of the FDA-approved COVID-19 vaccines and monoclonal antibodies, she advised obese people to take extra precautions such as avoiding crowds and social distancing. Now, there are treatment options, but changing information has sometimes made building trust between doctors and patients difficult, she said.

“When we still have questions about the most vulnerable populations, such as weak immunity despite vaccination, we should encourage our patients to continue to take other precautions,” Kumar said. “For obese patients, one thing on the clinical side I find frustrating for patients is getting them vaccinated, but we still tell them to wear a mask and maybe not to travel. People wonder what the point of vaccination is? When we talk about this, we have to be careful.”

Osterholm said researchers and clinicians should take lessons from COVID-19 and use them to prepare for future pandemics that are sure to follow in an increasingly connected community.

“The virus can spread anywhere in the world today to anywhere tomorrow,” Osterholm said. “It’s very different than it was 100 years ago. We’ve had 11 flu pandemics in the last 150 years. The challenge now, today, is to realize how quickly that can happen. [transmitted] around the world.”

Kumar said the biggest lesson about the pandemic is planning.

“We always felt like we were behind from a clinical care perspective, and I still feel that way today,” Kumar said. “Right now, we’re talking about breakouts and vaccinated patients getting sick… We tend to lag behind, but maybe we can use the information we have now about COVID-19 and obesity to think about the future, and maybe be more aggressive in treating these people.”

Reference:

Aminian A et al. Diabetes Obesity Metab. 2021; doi: 10.1111/dom 14454.

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