Experts: ICU need more likely for Covid-19 patients with obesity

Boston Statehouse

A hospital bed (Nexstar, file)

BOSTON (SHNS) – Patients with obesity may be more than three times as likely to require intensive care if they contract COVID-19 than patients without obesity, one trend among several that medical experts said Tuesday shows a disproportionate impact among individuals with higher body mass indexes.

While they cautioned that scientific understanding of the novel coronavirus causing a global pandemic is still developing, a group of health care experts warned during a webinar that obesity amplifies the virus’s risks.

Massachusetts General Hospital Weight Center Associate Director Dr. Angela Fitch said data from New York City collected earlier in the pandemic indicated that individuals were 3.6 times more likely to be admitted to the intensive care unit if they had a body mass index greater than 35 and were younger than 60.

“Worsening obesity has led to higher ICU admission rates and admissions to the hospital in general,” she said during the event, organized by the Massachusetts Coalition for Action on Obesity. “What obesity does as a disease, as a metabolic disease, is it shifts severity to younger age groups, so those people that are younger tended to have more instances of obesity as to the worsening of their disease.”

About 45 percent of Americans currently struggle with obesity, Fitch said, and projections indicate the rate could rise to about 50 percent by 2030.

In addition to the virus causing more potent effects on those with obesity or related chronic conditions, speakers said Tuesday that people with obesity often tend to delay medical care, largely because of existing social stigma about weight, which then heightens the risks of COVID.

Some patients may avoid seeking help with a COVID case, Obesity Action Coalition President and CEO Joe Nadglowski said, because they are worried they will be denied treatment so medical resources can be rationed for those who do not have chronic illnesses such as obesity.

“Somehow, we have this mistaken belief that if we stigmatize someone or we engage in bias toward someone about their weight, they are more likely to lose weight,” he said. “The actual opposite is true. If you stigmatize someone because of their weight, they are actually more likely to gain weight and be less successful in their efforts.”

Tom Hubbard, vice president of policy research for the Network for Excellence in Health Innovation, said behaviors aimed at protecting against COVID transmission also contribute to the likelihood of weight gain, particularly among nonwhite populations that already face gaps in health care access.

“Staying at home, not having an opportunity for physical activity, losing your job, losing your health coverage, are all things that can be exacerbating the risk of gaining unhealthy weight,” Hubbard said.

Echoing a warning call offered by voices across the medical industry, speakers at Tuesday’s virtual event said many providers and services face risks because of the financial disruption the pandemic — and the shift it prompted away from revenue-generating elective procedures — caused.

Hubbard said some may question whether they can afford to make investments in active treatment of obesity.

One step that could help ease pressure, Fitch said, is ongoing insurance coverage of telemedicine. Gov. Charlie Baker ordered commercial insurers to cover telehealth visits at the same rate as in-person services earlier in the pandemic, and Massachusetts lawmakers are weighing possible legislative extensions to that requirement.

“The more we can get telemedicine coverage of services and continue that coverage post-COVID — because before COVID, there was not as much parity in coverage of those services across the board — the more we can have coverage of those services, the more we can have access to patients,” Fitch said.

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