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Patients with COVID-19 and obesity (body mass index [BMI] > 30 kg/m²) have a higher viral load and the virus seems to persist for longer in such individuals, according to novel data exploring how contagious patients are in those with both COVID-19 and obesity.

Dror Dicker, MD, from Hasharon Hospital, Petah Tikva, Israel, briefly presented preliminary results of his work at the opening plenary of this year’s virtual European and International Congress on Obesity (ECOICO) 2020. 

Addressing whether patients with obesity are more contagious than those without, Dicker explained his research shows individuals with a BMI > 30 kg/m² had COVID-19 statuses that became negative 5 days later than those with a BMI < 25 kg/m², which is considered a healthy weight.

“We also know that obese patients have a higher viral load,” said Dicker, an obesity specialist.

“From genetic swabs we know that in adipose tissue the ACE2 levels are higher, so the ability of the virus to enter cells is therefore enhanced,” he explained, noting that this work is novel and, as yet, unpublished. He added that patients with obesity who contract influenza show a similar pattern in terms of higher viral loads and longer durations of infection. 

Ongoing Large Multicenter Trial to Study Obesity and COVID-19

In his research, those with a BMI < 25 kg/m² and COVID-19 took approximately 14 days to fully recover, those with BMI 25-30 kg/m² took around 17 days, and those with a BMI > 30 kg/m² took around 19-20 days.

Dicker said higher BMI and glucose levels are likely the most relevant risk factors in intubated patients leading to worse morbidity. One possible explanation, he said, is that at baseline, patients with obesity have comorbidities, plus there are immunological factors that, together with the cytokine storm typical of severe COVID-19, can increase morbidity and mortality.

A number of trials have linked obesity with worse outcomes in cases of COVID-19. Data on outcomes from Lille University Hospital, in France, were reported by Medscape Medical News in April, and later published in the journal Obesity. These trials found that COVID-19 severity was associated with increased BMI categories, and was greatest in patients with BMI ≥ 35 kg/m² (morbid obesity). The researchers also found that the need for invasive mechanical ventilation was associated with severe obesity and was independent of age, sex, diabetes, and hypertension.

The data were from March and April 2020, when admissions to general and intensive care units (ICU) started to rise sharply across France and elsewhere in Europe. François Pattou, MD, professor of surgery, Faculty of Medicine, at the University of Lille, briefly referred to these findings during the opening plenary session of ECOICO 2020, although technical difficulties limited his presentation.

Other data from New York City, featured in the same Medscape Medical News story, also suggested that obesity might be a risk factor for ICU admission among patients with COVID-19, especially those younger than 60 years. Patients with obesity were twice as likely to be hospitalized for COVID-19 and also had a significantly increased likelihood of ending up in ICU.

A further analysis by French physicians, including Pattou, published in July in The Lancet Diabetes & Endocrinology, showed that among patients analyzed at Lyon University Hospital, ICU patients with COVID-19 were 35% more likely to have obesity than those with severe COVID-19 in the French general population (P = .0034).

Now Pattou is leading a large, international, multicenter trial looking at how BMI and obesity relate to the increased risk of mechanical ventilation in COVID-19. The study is investigating the association between BMI and pneumonia outcomes in critically ill patients with COVID-19 using clinical medical data not administrative data, said Pattou.

The trial has so far recruited over 1400 patients from 21 centers across Europe, the United States, and Israel based on clinical medical data (not administrative databases).

Pattou told Medscape Medical News: “We hope this study will help to better understand the nature, both linear or nonlinear, of the association between BMI and the severity of COVID-19 pneumonia, with a need for intermittent mandatory ventilation, and mortality. Also, we want to clarify the impact of sex and/or age, and metabolic covariates on that association.”

In an ECOICO 2020 press release, he added: “Several months into the COVID-19 pandemic, the increased risk posed by this virus to people living with obesity could not be clearer. Our data show that the chances of increasing to more severe disease increases with BMI, to the point where almost all intensive care COVID-19 patients with severe obesity will end up on a ventilator.”

Pattou and Dicker have reported no relevant financial relationships.

ECOICO 2020. Presented September 1, 2020. Opening Plenary

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