Pulse Oximeter

COVID-19 ICU Admissions Double with Obesity

As the COVID-19 pandemic progresses, we are learning that facts are stubborn. Sometimes they make us uncomfortable, but still they are stubborn. Such is the case with the fact that obesity and COVID-19 don’t mix well. New data from NYU Langone Health tell us that the risk of ICU admissions are nearly twice as high for patients with class 1 obesity (BMI 30-34). For patients with class 2-3 (BMI > 35) the risk is 3.6 times higher. New data coming from France tell a similar story.

Obesity doesn’t put a person at risk for catching the new coronavirus. But once infected, a person with obesity does have a higher risk of more severe symptoms.

Hospital and ICU Admissions

Jennifer Lighter and colleagues studied patient records for 3,615 individuals who came to the emergency department at NYU Langone. All of these patients were positive for COVID-19. In this cohort, 21 percent had class 1 obesity, while 16 percent had class 2-3 obesity.

Lighter et al found that 37 percent of these patients were admitted into the hospital for regular acute care. Another 12 percent went into the ICU. For patients less than 60 years old, the odds of going into the acute care were twice as high for individuals with class 1 obesity. For admission to the ICU, the odds were 1.8 times higher. With class 2-3 obesity, the risk was 2.2 times higher for acute care admission and 3.6 times higher for ICU admissions. The p-values for these differences ranged from 0.006 to 0.0001.

In other words, it seems unlikely that the elevated risk for needing more intensive care is coincidental.

Needing a Ventilator

In France, Arthur Simonnet and colleagues studied 124 patients in a hospital ICU. In this cohort, 69 percent of the patients required mechanical ventilation. The observed need for ventilation rose with BMI – independent of age, diabetes, and hypertension. For patients with a BMI greater than 35, the odds for needing a ventilator were seven times higher and that difference was significant (p < 0.02).

So What?

Having first written about this increased risk for people with obesity five weeks ago, we’ve seen a range of reactions. All are understandable, but some are more helpful than others. For some people living with obesity, the reaction is anxiety. “Great. One more thing for me to worry about.” Others tell us that they’d rather know their risks and take extra care.

Some folks have reacted skeptically, suggesting that these observations about risk might be coincidental. For example, one said that “70 percent of the people who blink in the UK are overweight or obese. Statements such as these, while technically accurate, are misleading and over-inflate the impact of high-weight status.” We disagree, though we understand the point they’re making.

The least reasonable rhetoric is speculation that people with higher weights who have COVID-19 will be given less care. Certainly, it is true and deplorable that we encounter a lot of anti-fat bias in routine clinical care. That’s wholly unacceptable.

But these data make it plain that people with obesity and COVID-19 are getting more care – not less – in a hospital setting. The people delivering that care are putting themselves at risk to do so. They deserve credit and support – not suggestions that they’re doing anything less than the best they can for their patients.

These are challenging times and we all need to pull together as best we can.

Click here for the study by Lighter et al and here for the study by Simonnet et al. For further perspective on this subject, click here.

Pulse Oximeter, photograph © Quinn Dombrowski / flickr

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April 11, 2020

5 Responses to “COVID-19 ICU Admissions Double with Obesity”

  1. April 11, 2020 at 10:35 am, Stephen Phillips said:

    Ted
    The two studies you have cited provide compelling evidence that obesity may exacerbate the need for intensive care and ventilation compared to patients with BMI < 25. Perhaps another deleterious consequence of obesity. More research that supports the findings of these studies are essential before we can verify the validity of the this hypothesis.

  2. April 12, 2020 at 4:17 pm, Francois Pattou, MD said:

    Where does this French study comes from ? CHU Lille (France) is a referral center for 4 millions people, where metabolic diseases are studied at the European Genomic Institute of diabetes (EGID, Univ Lille Inserm Pasteur Lille).

    Why was the role of obesity not demonstrated before ? Simply because BMI is often barely captured in medical charts. Early reports just did not mention BMI. Obesity had been quoted but its distinct role among other related diseases, like diabetes or hypertension, was unknown.

    What did the authors find ? When patients started to arrive in ICU, the unusual proportion of young and otherwise healthy subjects with obesity was striking. Researchers and clinicians teamed up to screen all available data. The picture was rapidly clear: obesity played a distinct and independent role. Our report was peer reviewed and released within 48 hours in Obesity.

    What are the implications ? France rapidly took specific rules to protect those suffering from obesity, in the burden of the Covid epidemic.

    What is next ? First next step will be to see our results confirmed in independent, larger cohorts. Second, to understand the mechanisms involved beyond obesity, and propose new avenues for treating Covid.

  3. April 12, 2020 at 4:49 pm, Ted said:

    Thank you, Francois, for adding your expert perspective and thank you for publishing this important work.

  4. April 12, 2020 at 6:36 pm, Sean Phelan said:

    Ted, I’ve enjoyed working with you and appreciate your work. I also appreciate your commentary on the recent findings-people at higher risk for severe symptoms should take that into consideration when deciding on the measures they will take to avoid exposure. I don’t, however, understand the negative reaction to people who suggest that this research has the potential to harm people with obesity. Thinking through and commenting on the implications of research is the job of scholars. Our front line health workers are facing impossible decisions and sometimes vague guidance on how to make those decisions. Given the evidence that people in general have anti-fat attitudes and that biases influence care quality and decision-making, combined with the instructions to maximize years of life, it is reasonable to question whether this new evidence will influence decision making in a way that disadvantages people with high BMIs. If someone’s research, advocacy, and life’s purpose focuses on supporting the needs and rights of those people, why would they not offer their warning and guidance to health care workers who are trying to make the most equitable decisions possible?

  5. April 13, 2020 at 6:34 am, Ted said:

    Thank you, Sean, for raising an important question in such a thoughtful manner. Thanks also for gently pointing out that I was not totally clear when I wrote about some of the speculation about poor treatment for people with obesity and COVID-19 and said that the speculation is unreasonable.

    I agree with you. It’s a good idea to offer guidance about making equitable healthcare decisions under conditions of inadequate healthcare resources.

    What I think is unreasonable is to shout in all caps that doctors, who are doing their best to deliver good care in harsh conditions, are “LITERALLY CAUSING” the deaths of people with obesity. That’s just wrong, in my opinion.

    As a footnote to this discussion, I think it’s worth considering what is the most important disparity to focus upon. Disparity of care in the ICU? Or a lifetime of disparate care causing poor health and eventually prompting the need for ICU care? My inclination is to focus on the latter. But it’s perfectly reasonable to think that we must focus on both.

    I hope you’ll share more of your thoughts about this in an appropriate forum.