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Infectious Diseases

Updated 01 July 2020

Obese Covid-19 patients may have to be hospitalised for longer, new research says

Obesity has been identified as a risk factor that makes one more vulnerable to Covid-19. It may also prolong a patient’s stay in hospital.

  • Co-morbidities such as diabetes and hypertension increase one's risk of serious Covid-19
  • Obesity is also a risk factor, and obese Covid-19 patients may require longer hospitalisation, mostly due to liver dysfunction
  • Unfortunately, increased time in hospital can have far-reaching effects 


As we're learning more about Covid-19, we know that certain co-morbidities such as diabetes and hypertension may increase one's risk of contracting a more serious level of the disease.

Unfortunately, obesity is also one of the factors that can put us at a higher risk. A previous study covered by Health24 in May 2020 investigated the risk of Covid-19 in the obese.

The researchers said that obese patients with Covid-19 may have nearly three times the risk of developing what is known as a pulmonary embolism.

But now, a new study, published in the International Journal of Obesity, found that obesity could be a double whammy: not only are you likely to suffer more serious or even fatal consequences from Covid-19, but you are also likely to be hospitalised for longer – which could lead to further complications later on.

What exactly counts as 'being obese'?

Obesity is defined as a medical condition where a person carries excess weight or body fat that may affect their health and increase their risk for chronic conditions such as hypertension or diabetes.

While some medical experts and scientists have mentioned that this method isn’t always accurate, many medical guidelines still rely on the so-called Body Mass Index (BMI), where both your height and weight are taken into account – a BMI between 25 and 29.9 is overweight and if it's 30 or more, you're defined as obese.

According to research covered by Health24 in 2019, led by Qibin QI, an associated professor at the Albert Einstein College of Medicine in New York, good health is not necessarily determined by your BMI, but more by fat distribution – in other words, where your body fat is located. Excess stomach fat (visceral fat) close to the organs, for example, is considered more dangerous than fat in the lower body.

But in the meantime, BMI is still used as the main gauge for healthy weight.

Obese Covid-19 patients and their liver function

The clinical epidemiological analysis looked at obese Covid-19 patients and the way abnormal liver function contributed to a longer stay in hospital.

According to the authors, liver damage during Covid-19 infection in these patients could lead to a worse prognosis than other patients. They included 58 patients (22 women and 36 men) who were diagnosed with Covid-19, all with a BMI higher than 24, thus identifying them as overweight to obese.

It was found that hospital stay was longer for those who were overweight or obese, and that extra attention and precautions were needed during their clinical treatments.

Abnormal liver damage has been reported in many hospitalised patients with Covid-19, which can be caused by viral infection of the liver cells. SARS-CoV-2 doesn’t only adhere to the cells of the lungs as previously thought, but can impact the body in many other ways.

The authors mentioned that while compromised liver function was an important clinical characteristic of some Covid-19 infections, there are very few studies exploring the effect of liver co-morbidities.

The authors then used Kaplan-Meier analysis to show that obese or overweight patients with affected liver function were more likely to be hospitalised with Covid-19 than those with a healthy weight.

The effects of being hospitalised for longer

Hospital care is meant to help patients fight Covid-19, but a prolonged hospital stay can have far-reaching effects on patients, which can further impact their future health.

According to Dhruv Khullar, a physician and medical contributor to the New York Times, patients who experienced ICU and intubation as part of their Covid-19 treatment can experience effects long after recovery. Debilitation, memory loss, anxiety, weakness and depression are common side effects long after patients have been discharged.

While not all obese patients with Covid-19 may be intubated or require respiratory assistance, the longer their stay in hospital, the more likely they will have a harder time completely recovering from Covid-19 and experience almost a sort of “post-traumatic stress syndrome” long after being discharged.

It is therefore important that clinicians recognise this and monitor patients even after they have been discharged.

Extra precautions for those most at risk

The authors suggest that individuals who are obese and might be suffering from pre-existing liver conditions should be monitored more closely. Even in those who contract mild Covid-19, extra precautions should be taken during clinical treatments.

'I’m obese – what should I do during the pandemic?'

With so many ways to determine your health, as well as confusion around BMI, it’s important to realise that everyone's body composition is unique. If you're concerned about your current weight and health, your best course of action is to consult your doctor or a dietitian for a personalised health assessment so that you can follow an eating plan and exercise routine that is right for you.

During the current Covid-19 situation, it’s important to take stock of your health to ensure that your blood pressure and blood glucose levels are normal and that you have no co-morbidities.

According to Dr Karl Nadolsky, chairman of the American Association of Clinical Endocrinologists’ (AACE) Obesity and Nutrition Diseases State Network, and an assistant professor of medicine at the University of Michigan, there are some steps you can take to protect yourself if you are obese:

  • Take physical distancing measures seriously and stay at home as much as possible.
  • Wear a face mask to lower your risk of contracting Covid-19.
  • Practise stringent hand hygiene to avoid infection.
  • Recalibrate your eating and exercise plan. Don’t focus on appearance, but focus on your overall health to protect you against Covid-19. Start with small, realistic changes.
  • Instead of giving in to crash diets and fad solutions, invest in regular consultations with a dietitian.

READ | Obesity and Covid-19: Researchers find major risk for deadly blood clots in the lungs 

READ | Obesity ups odds for severe Covid-19 in younger patients 

READ | I need to lose weight: Where do I start? 

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