Covid-19: How at risk are people with obesity? Q&A with the Medical Research Council

An expert speaks about Covid-19 and obesity.
An expert speaks about Covid-19 and obesity.
Rehman Asad/NurPhoto via Getty Images
  • Covid-19 is hitting obese people hard, with statistics showing obesity as a regular comorbidity in coronavirus deaths.
  • The Western Cape showed President Cyril Ramaphosa that obesity was one of the most prevalent comorbidities in its deaths.
  • An insider at one major hospital said the vast majority of Covid-19 patients they admitted to their intensive care unit were obese.

South Africa's Covid-19 capital, the Western Cape, showed President Cyril Ramaphosa this month that obesity was one of the most prevalent comorbidities in its hundreds of deaths. Only diabetes, hypertension and HIV were more regularly cited as co-killers.

READ | Diabetes, hypertension, HIV - what Western Cape deaths data shows by age

But obesity may be as dangerous as a pre-condition, because it is not only a risk in and of itself, but also a potential cause of diabetes and hypertension. 

The Western Cape's Department of Health told Ramaphosa that available data thus far showed that 65% of deaths were a result of two or more comorbidities. And a study of global reports suggests obesity is regularly among them

An insider at one major hospital said the vast majority of Covid-19 patients they have admitted to their intensive care unit, were obese – "and this often goes hand in hand with diabetes".

Pressure on lung function

On a global level, information presented by the World Economic Forum includes this analysis on why ventilation may be required in Covid-19 patients admitted to hospital.

"Higher levels of fat in the chest and belly put pressure on the lungs, making it difficult for people with obesity to fill them to capacity under normal circumstances. This reduced breathing capacity may add to respiratory distress in patients with Covid-19.

READ | The first 100 days of Covid-19 in graphics

"Carrying extra weight also means there is higher oxygen demand. Some patients with obesity might breathe too shallowly or too slowly to provide enough oxygen to the body, and some may intermittently cease breathing altogether."

The United States Centre for Disease Control (CDC) also warns obese people are at greater risk, saying severe obesity increases the risk of a serious breathing problem called acute respiratory distress syndrome (ARDS), which is a major complication of Covid-19.

The World Health Organisation (WHO) warns that obesity also contributes to other risks, including other conditions most vulnerable to Covid-19, including chronic diseases such as diabetes, cardiovascular diseases and cancer, as does the Centre for Disease Control.

And the South African health ministry, in its five-year strategy policy to tackle obesity, warned obesity in general represented "a dire threat to the physical and mental health of the South African population".

How do you measure it and who is overweight in SA?

The WHO says body mass index (BMI) is a simple index of weight-for-height that is commonly used to classify overweight and obesity in adults.

It is defined as a person's weight in kilograms divided by the square of their height in meters (kg/m2):

- a BMI greater than or equal to 25 is overweight;

- a BMI greater than or equal to 30 is obesity.

In South Africa, the World Health Organisation reports more than half of adults, 53.8%, are overweight or obese.

News24 put several questions around the link between obesity and the Covid-19 pandemic to South Africa's Medical Research Council (MRC). 

Here, Professor Andre Pascal Kengne, director in the Non-Communicable Diseases Research Unit, explains: 

Can the MRC confirm obesity is a significant comorbidity in SA?

"Excess weight, which includes overweight and obesity is a common health challenge in South Africa where it affects 68% of women and 31% of men aged 15 years and above, according to the latest South African Demographic Health Survey (2016 SADHS). In Africa, South Africa competes only with Egypt in terms of the proportion of the overweight/obese population, while the average body mass in index (a measure of obesity) of the South African population is higher than the world average.

READ | Fear over side-effects of dodgy hand sanitiser

"With regard to Covid-19, there is no suggestion that obese people acquire the infection more than the non-obese. However, once infected, extremely obese people tend to develop more the severe form of Covid-19.

Can the MRC confirm that because obesity is known to cause other illnesses, there may be a significant percentage of South Africans who are obese and have hypertension and diabetes?

"Overweight/obesity is associated with increased risk of mortality and illnesses including type 2 diabetes mellitus, hypertension, dyslipidemia, cardiovascular diseases, dementia and cancers. In 2016 DHS for instance, rates of hypertension were nearly twice in higher obese men and women compared with their non-obese counterparts; while rates of type 2 diabetes were four to five times higher in obese men and women. More than half of people with type 2 diabetes also have hypertension, and in general, obesity-related conditions tend to cluster in the same individual."

Does the MRC know if this "confluence" has been significant in SA deaths?

"SAMRC hasn't yet [received] reliable data on the contribution of various comorbidities to Covid-19-related deaths in the context of South Africa. Such data will be accumulated with the progression of the epidemic. However, there have been indications that hypertension, diabetes mellitus and obesity were common among those who have died from Covid-19 in South Africa. Furthermore, over 90% of deaths from Covid-19 in the country are recorded among those aged 40 years and above, which is the segment of the general population in which obesity and related comorbidities such as diabetes and hypertension tend to co-occur in the same individuals."

Should obese South Africans be concerned?

"Everyone in South Africa (and elsewhere), regardless of whether they are obese or not, should be concerned by the coronavirus infection, and take necessary precautions to avoid the infection. Obese people should further be aware that, should they acquire the infection, their status and other obesity-related conditions they may have (hypertension, diabetes, heart diseases) will make them more prone to develop the severe form of Covid-19. It is of note that conditions like hypertension and diabetes mellitus remain undiagnosed in about half of South Africans who have the disease."

What action should obese South Africans take?

"Obese South Africans should observe the same measures largely popularised to prevent the acquisition of the infection, such as social distancing, regular hand washing with soap and [the] use of hand sanitisers, wearing of facial masks in public, etc. Should they feel any unusual symptoms, they must seek medical advice without delay for [a] diagnosis, should they have acquired the coronavirus infection. Furthermore, obese people who have already been diagnosed with obesity-related conditions and started on treatment, should continue to follow those treatments regularly and comply with their medical visits."

Any other observations?

"It is important for obese people and the general population at large that the lockdown measures implemented as part of the national response strategy to Covid-19, are associated with changes in lifestyle that can promote weight gain and exacerbate obesity in those who are already obese, or push into the overweight/obesity territory people with previously normal weight. It is therefore important for people to make sure that they maintain a balanced diet, and remain physically active during this challenging time."

FURTHER READING | In South Africa, obesity is tackled by a national guideline titled the "Strategy for the Prevention and Control of Obesity in South Africa 2015-2020".

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