Obesity, diabetes and COVID-19

The COVID-19 pandemic has brought many worries to us all, but those with diabetes and a higher BMI (Body Mass Index) have been disproportionally hit by the severity of the effects of the virus. Dr Paul Ettlinger of the London General Practice, one of our Clinical Partners, discusses the evidence.

Data from France and the United Kingdom show a disproportionately high prevalence of obesity in patients with COVID-19 admitted to intensive care units when compared with the general population. 10% of ICU patients in the UK have a BMI of 40 (kg/m²) or more. Evidence also shows there is an increased mortality amongst this group. The UK Government advice for this group was particularly stringent in that they should follow strict social distancing measures. This message, however, created confusion and fear amongst many people living with obesity because of the uncertain risk of what actions they should take. The patients or people with a BMI of 30 (kg/m²) were also over-represented in ICU, but not listed as at risk.

Obesity and COVID-19

Sarah Le Brocq (Director of Obesity UK) and others consulted with patients and reported on the physical and mental consequences of living with obesity during the COVID-19 pandemic (Lancet 8(8), 652-654, 1 August 2020).

They heard about genuine, all-consuming fears of contracting COVID-19. Many patients were afraid of not getting sufficient medical support if admitted to hospital, particularly with the increased reports that they were at greater risk of dying. Clarity is required to quantify their risk, both in terms of contracting the virus and its probable impact upon them.

There was considerable anxiety about the capacity of the healthcare system to provide them with appropriate equipment, gowns and beds. There was a distinct fear about the ability to move them and the necessity for proning in the successful treatment of acute respiratory distress. There was also a fear about access to obesity treatments which might be affected by austerity policies following this pandemic and economic crisis.

A further recurring theme was stigma. Many people expressed to the authors a perception of being 'less of a priority than others with the condition' and therefore had a reluctance to seek help. This stigma has a lasting and negative impact on the mental and physical health of people living with obesity.

All responders indicated concerns about mental health. Although some of these were linked to the fear of contracting COVID-19, many related to the impact of isolation, shielding, or social distancing. Those who were in a good place mentally before lockdown appeared to cope better. Unfortunately, this was not the case for many, particularly those who had recently undergone or were awaiting bariatric surgery.

Lockdown presented substantial changes and challenges to maintaining healthy behaviours. Unfortunately, people living with obesity have often had years of battling with weight and experiencing feelings of guilt from perceived failure.

Many responders reported having a fear of weight gain during lockdown, very much related to the effect of anxiety on eating behaviours, often compounded by scrutiny from family members. This fear related to a stigma or shame and prevented them from exercising or shopping for food in ways which did not make them feel self-conscious.

Obesity UK support groups reported increased episodes of secret eating or binge eating. Fortunately, many people have already developed coping strategies and during lockdown they reported using focused and dedicated approaches, including attending remote support groups.

Le Brocq and others have suggested that there should be immediate action to clarify the risk of adverse COVID-19 outcomes for people living with obesity, including specific recommendations for those at greatest risk and the healthcare professionals who support them.

Diabetes and COVID-19

Diabetes is known to be a major risk factor for the development of severe pneumonia or sepsis due to virus infections.

A helpful article about this giving advice was published in the Lancet Diabetes and Endocrinology Journal on April 23 by a 19-member panel led by Stefan Bornstein from Dresden University.

Data from several sources suggest the risk for death from COVID-19 is up to 50% higher in people with diabetes than those without.

Evidence also suggests that risks associated with COVID-19 are greater with poor glycaemic control and it has been found that the virus is associated with an increased risk for diabetic ketoacidosis and new onset diabetes.

The experts stressed that all recommendations and reflections are based on their expert opinion and await the outcome of randomised clinical trials.

In the case of suspected COVID-19 symptoms, it is essential that any patient with any abnormal symptoms of any kind or abnormal sugars or any patient with diabetes seeks medical advice urgently. They should not change their medication without medical advice.