Managing patients with obesity in the post COVID-19 world: Time to sharpen the saw

The clash of the dual pandemics – COVID-19 and obesity (Chua et al., 2020) [1], threatens to exponentially increase the rates of obesity, which is a risk factor for severe COVID-19 and death (Garg et al., 2020; Peng et al., 2020; Wu et al., 2020; Kass et al., 2020) [[2], [3], [4], [5]]. We need to urgently find solutions to halt this vicious circle. Where do we begin?Our patients – who are often our best teachers. In my clinical practice, I have observed disparate responses among my patients in response to the pandemic. This highlighted the importance of understanding the factors underlying motivation and provided important clues on what clinicians can do to help our patients create a virtuous circle towards positive health outcomes.     

Association of obesity with illness severity in hospitalized patients with COVID-19: A retrospective cohort study

BackgroundAlthough recent studies have shown an association between obesity and adverse coronavirus disease 2019 (COVID-19) patient outcomes, there is a paucity in large studies focusing on hospitalized patients. We aimed to analyze outcomes associated with obesity in a large cohort of hospitalized COVID-19 patients.MethodsWe performed a retrospective study at a tertiary care health system of adult patients with COVID-19 who were admitted between March 1 and April 30, 2020. Patients were stratified by body mass index (BMI) into obese (BMI ≥ 30 kg/m 2) and non-obese (BMI < 30 kg/m 2) cohorts. Primary outcomes were mortality, intensive care unit (ICU) admission, intubation, and 30-day readmission.ResultsA total of 1983 patients were included of whom 1031 (51.9%) had obesity and 952 (48.9%) did not have obesity. Patients with obesity were younger (P < 0.001), more likely to be female (P < 0.001) and African American (P < 0.001) compared to patients without obesity. Multivariable logistic models adjusting for differences in age, sex, race, medical comorbidities, and treatment modalities revealed no difference in 60-day mortality and 30-day readmission between obese and non-obese groups. In these models, patients with obesity had increased odds of ICU admission (adjusted OR, 1.37; 95% CI, 1.07?1.76; P = 0.012) and intubation (adjusted OR, 1.37; 95% CI, 1.04?1.80; P = 0.026).ConclusionsObesity in patients with COVID-19 is independently associated with increased risk for ICU admission and intubation. Recognizing that obesity impacts morbidity in this manner is crucial for appropriate management of COVID-19 patients.     

Impact of obesity on hospitalizations and mortality,due to COVID-19: A systematic review

The aim of the current review was to assess whether there was an association between obesity and higher levels of hospitalization, poor outcomes and mortality due to the disease of novel coronavirus (COVID-19). Methodology: A systematic review of articles on the novel coronavirus, containing information on obesity and its association with COVID-19 morbidity and mortality. In the bibliographic research, four databases were used, with the terms ['COVID-19′] AND ['hospitalization'] AND ['obesity'] AND ['mortality']. Studies published from 12/01/2019 until 05/01/2020 were included. The research contains inclusive criteria targeting studies of humans adults infected by Sars-Cov-2, with or without comorbidities. This research was selected from publications in Spanish and English languages. Results: 96 articles were identified, 15 being presented in two databases. Twenty articles were included, with a population total estimated from 1 to 7671 patients, with a prevalence of obesity ranging from 13.3% to 68.6%. The association of obesity and mortality has been observed in at least 4 studies, that 85.3% of the population was hospitalized. Among 19 of the 20 studies, more severe forms of the disease were observed and in 14 of them, higher rates of complications among obese people infected with the new coronavirus. Limitation differences in the definition of obesity was observed among publications, of which obesity was considered from a body mass index >25 kg/m². Conclusions: In the current review, obesity and overweight were represented an unfavorable factor for infection of novel coronavirus, where the higher the BMI the worse the outcomes. This occurred by worsening the infection itself, as well as increasing the prevalence of hospitalizations, worst outcomes and greater lethality; especially when co-occurring with other chronic conditions and in the elderly as well. Given this evidence, greater attention is suggested to the obese and overweight population in the face of the current pandemic.     

The role of obesity in inflammatory markers in COVID-19 patients

Obesity has emerged as a significant risk factor for severe COVID-19 worldwide. Given both COVID-19 infection and obesity have been associated with increased systemic inflammation, we evaluated inflammatory markers in obese and non-obese individuals hospitalized for COVID-19 at Massachusetts General Hospital. We hypothesized that obese patients would have a more exuberant inflammatory response as evidenced by higher initial and peak inflammatory markers along with worse clinical outcomes. Of the 781 patients, 349 were obese (45%). Obese individuals had higher initial and peak levels of CRP and ESR as well as higher peak d-dimer (P < 0.01 for all) in comparison to non-obese individuals, while. IL-6 and ferritin were similar. In addition, obese individuals had a higher odds of requiring vasopressor use (OR 1.54, 95% CI 1.00–2.38, P = 0.05), developing hypoxemic respiratory failure (OR 1.58, 95% CI 1.04–2.40, P = 0.03) and death (OR 2.20, 95% CI 1.31–3.70, P = 0.003) within 28 days of presentation to care. Finally, higher baseline levels of CRP and D-dimer were associated with worse clinical outcomes even after adjustment for BMI. Our findings suggest greater disease severity in obese individuals is characterized by more exuberant inflammation.     

新冠肺炎疫情期间服刑人员焦虑抑郁症状及影响因素分析

目的 探讨新冠肺炎疫情期间服刑人员的焦虑抑郁症状及其影响因素,为制定突发公共卫生事件下的心理干预策略提供参考依据。方法 采用一般情况问卷、焦虑自评量表、抑郁自评量表和简易应对方式问卷对西部数所监狱897名服刑人员进行问卷调查。结果 服刑人员焦虑、抑郁症状检出率分别为42.92%、52.73%,共患焦虑、抑郁占38.91%。担忧自己或家人感染、担忧出狱后生计受疫情影响、身体健康状况越差是焦虑和抑郁的危险因素（OR＞1.000,P＜0.01）,与亲朋联系次数越多是焦虑和抑郁的保护因素（OR＜1.000,P＜0.01）。焦虑、抑郁症状的服刑人员倾向于采取消极应对方式,而无焦虑、无抑郁症状的服刑人员倾向于采取积极应对方式。结论 新冠肺炎疫情期间服刑人员焦虑、抑郁症状较为严重,及时开展有针对性的心理干预策略,排除危险性因素干扰,引导他们采取积极的应对方式,可保护其心理健康。     

新型冠状病毒肺炎患者重症转归风险预测

目的 建立新型冠状病毒肺炎（COVID-19）患者转归为重症的预测模型,为早期、动态地监测患者转归提供更加全面、准确、及时的指标。方法 基于患者的入院检测指标和轻、重症分型,以及检测指标的动态改变（即入院后两次检测指标测量值差）等输入变量,使用XGBoost方法建立预测模型,评估患者在入院之后转归为重症的风险。然后将入选的患者从入院随访至出院,观察其病情转归情况,对模型预测结果进行验证。结果 在100例COVID-19患者的训练集中,筛选出具有较高评分的预测变量并建立模型,计算出预测变量取值的高风险范围：血氧饱和度<94%、外周血白细胞计数>8.0×10⁹个、SBP变化<-2.5 mmHg（1 mmHg=0.133 kPa）、心率>90次/min、有多发小斑片影、年龄>30岁、心率变化<12.5次/min。训练集的模型预测结果的敏感率为61.7%,漏诊率为38.3%;使用模型对测试集进行预测的敏感性为75.0%,漏诊率为25.0%。结论 与传统的预测判断方法（即采用入院时第一次检测的指标和重症入选条件进行评估患者是否为轻、重症）相比,模型的预测考虑到了COVID-19患者的基线生理指标与病情变化指标,因此能够全面、准确地预测患者重症转归的风险,减少重症患者的漏诊率。     

Association of obesity with venous thromboembolism and myocardial injury in COVID-19

IntroductionAlthough both obesity and coronavirus disease 2019 (COVID-19) independently induce inflammation and thrombosis, the association between obesity class and risk of thrombosis in patients with COVID-19 remains unclear.MethodsThis retrospective cohort study included consecutive patients hospitalized with COVID-19 at a single institution. Patients were categorized based on obesity class. The main outcomes were venous thromboembolism (VTE) and myocardial injury, a marker of microvascular thrombosis in COVID-19. Adjustments were made for sociodemographic variables, cardiovascular disease risk factors and comorbidities.Results609 patients with COVID-19 were included. 351 (58%) patients were without obesity, 110 (18%) were patients with class I obesity, 76 (12%) were patients with class II obesity, and 72 (12%) were patients with class III obesity. Patients with class I and III obesity had significantly higher risk-adjusted odds of VTE compared to patients without obesity (OR = 2.54, 95% CI: 1.05–6.14 for class I obesity; and OR = 3.95, 95% CI: 1.40–11.14 for class III obesity). Patients with class III obesity had significantly higher risk-adjusted odds of myocardial injury compared to patients without obesity (OR = 2.15, 95% CI: 1.12–4.12). Both VTE and myocardial injury were significantly associated with greater risk-adjusted odds of mortality.ConclusionThis study demonstrates that both macrovascular and microvascular thromboses may contribute to the elevated morbidity and mortality in patients with obesity and COVID-19.     

Prenatal maternal COVID-19 vaccination and pregnancy outcomes

BackgroundPrenatal maternal physiological changes may cause severe COVID-19 among pregnant women. The Pfizer-BioNTech COVID-19 vaccine (BNT162b2 mRNA) has been shown to be highly effective and it is recommended for individuals aged ≥16 years, including pregnant women, although the vaccine has not been tested on the latter.ObjectiveTo study the association between prenatal Pfizer-BioNTech COVID-19 vaccination, pregnancy course and outcomes.Study designA retrospective cohort study was performed, including all women who delivered between January and June 2021 at Soroka University Medical Center, the largest birth center in Israel. Excluded were women diagnosed with COVID-19 in the past, multiple gestations or unknown vaccination status. Pregnancy, delivery and newborn complications were compared between women who received 1 or 2-dose vaccines during pregnancy and unvaccinated women. Multivariable models were used to adjust for background characteristics.ResultsA total of 4,399 women participated in this study, 913 (20.8%) of which were vaccinated during pregnancy. All vaccinations occurred during second or third trimesters. As compared to the unvaccinated women, vaccinated women were older, more likely to conceive following fertility treatments, to have sufficient prenatal care, and of higher socioeconomic position. In both crude and multivariable analyses, no differences were found between the groups in pregnancy, delivery and newborn complications, including gestational age at delivery, incidence of small for gestational age and newborn respiratory complications.ConclusionsPrenatal maternal COVID-19 vaccine has no adverse effects on pregnancy course and outcomes. These findings may help pregnant women and health care providers to make informed decision regarding vaccination.     

COVID-19 severity in obese patients: Potential mechanisms and molecular targets for clinical intervention

With the global spread of SARS-CoV-2, millions of people have been affected leading to the declaration of coronavirus disease 2019 (COVID-19) as a pandemic by the WHO. Several studies have linked the severity of COVID-19 cases and increased fatality in patients with obesity and other comorbid conditions such as diabetes, cardiovascular diseases, hypertension, and kidney disease. Obesity, a metabolically deranged condition, establishes a low-grade chronic inflammation in the body, which affects different organs and promotes the development of several other diseases. The ways in which SARS-CoV-2 infection aggravates the already overloaded body organs with inflammation or vice versa has perplexed the researchers. As a result, there is an intensified search for the clear-cut mechanism to understand the link of obesity with the increased severity of COVID-19 in obese patients. In this article we have discussed various mechanisms linking obesity, inflammation, and COVID-19 to enhance the understanding of the disease process and help the clinicians and scientists develop potential cellular, molecular and metabolic targets for clinical intervention and management of COVID-19 severity in obese patients.     

Physical activity and the incidence of depression during the COVID-19 pandemic in Brazil: Findings from the PAMPA cohort

We examined the longitudinal association between physical activity (PA) and the incidence of self-reported diagnosed depression in adults in southern Brazil during the COVID-19 pandemic. Data from the PAMPA (Prospective Study About Mental and Physical Health) cohort was used. Data collection for baseline was carried out on June–July 2020, with two follow-up assessments taking place six months apart. An online, self-reported questionnaire assessed depression and PA. Depression was assessed by asking participants whether they were ever diagnosed with depression. We included 441 participants (women: 75.9%; mean age [SD]: 38.0 [13.5]) in southern Brazil. Over the follow-up, 21.8% (95% confidence interval [CI]: 18.1%–25.9%) were diagnosed with depression. Insufficiently active (<150 min per week of physical activity) (Incidence rate [IR]: 61.9; 95%CI: 39.5–102.4; p = 0.047) and active (≥150 min per week of physical activity) (IR: 50.4; 95%CI: 31.9–84.0; p = 0.015) participants had reduced IR of depression per 1000 persons-year at risk compared to inactive ones (0 min per week of physical activity) (IR: 99.9; 95%CI: 79.7–126.8). In the adjusted analyses, participants in the insufficient active (hazard ratio [HR]: 0.58; 95%CI: 0.34–0.98) and active (HR: 0.53; 95%CI: 0.31–0.93) group had a lower risk of developing depression than the inactive group. PA both at and out of home reduced the risk of incident depression (HR: 0.49; 95%CI: 0.25–0.98) compared to no physical activity. Endurance (HR: 0.52; 95%CI: 0.28–0.97) and endurance plus strengthening (HR: 0.40; 95%CI: 0.17–0.95) PA reduced the risk of incident depression compared to none. Being physically active during pandemic, regardless of the amount of PA practiced, reduced the incidence of depression in adults in southern Brazil.     

防控新型冠状病毒肺炎居家隔离期间青少年焦虑、抑郁情绪现况及影响因素研究

目的 调查防控新型冠状病毒肺炎(新冠肺炎)疫情居家隔离期间青少年焦虑、抑郁情绪,并探讨其影响因素.方法 采用整群抽样方法,对山东、陕西、辽宁、河南、福建省的6所中学的学生以班级为单位进行焦虑、抑郁情绪的问卷调查.采用x2检验、多因素Logistic回归分析影响青少年焦虑、抑郁情绪的相关因素.结果 共纳入11430名青少...     

Association of Sources of COVID-19 Information with Vaccine Uptake,Preventive Behaviors,and Perceived Severity of COVID-19

ObjectiveTo investigate the association of using informal sources and reliance on multiple sources of information with actual COVID-19 vaccine uptake, the number of doses of vaccine received, COVID-19 testing, essential preventive measures, and perceived severity of COVID-19.DesignRetrospective cross-sectional study.Setting and ParticipantsOur study sample consisted of 9584 community-dwelling Medicare beneficiaries, representing a weighted 50,029,030 beneficiaries from the Winter 2021 Medicare Current Beneficiary Survey COVID-19 Supplement.MethodsTwo key independent variables were whether a respondent relied on a formal source (ie, traditional news, government guidance, or health care providers) or an informal source (ie, social media, Internet, or friends/family) the most for the COVID-19 information and the total number of information sources a respondent relied on.ResultsCompared with beneficiaries relying on formal sources of information, those relying on informal sources of information were less likely to receive COVID-19 vaccine (odds ratio [OR], 0.65; 95% CI, 0.56–0.75) and COVID-19 testing (OR, 0.85; 95% CI, 0.74–0.98), to engage in preventive behaviors (OR, 0.61; 95% CI, 0.50–0.74), to have high perception of COVID-19 severity, and were more likely to be unvaccinated vs 2 doses of vaccine (relative risk ratio [RRR], 1.64; 95% CI, 1.41–1.91). Relying on more information sources was significantly associated with higher odds of actual vaccine uptake (OR, 1.21; 95% CI, 1.17–1.26), COVID-19 testing (OR, 1.11; 95% CI, 1.07–1.15), engagement of essential preventive behaviors (OR, 1.33; 95% CI, 1.25–1.42), having high perception of COVID-19 severity, and with lower likelihood of being unvaccinated vs 2 doses of vaccine (RRR, 0.82; 0.79–0.85).Conclusions and ImplicationsThe COVID-19 pandemic has made communicating information about coronavirus more important than ever. Our findings suggest that information from formal sources with expertise and more balanced sources of information were key to effective communication to prevent from COVID-19 infection among older adults.     

新冠疫情常态化时期健康教育人员焦虑抑郁状况及影响因素研究

目的 调查分析新冠疫情常态化时期深圳市健康教育人员工作负荷及工作满意度情况及其对焦虑抑郁的影响,为促进健康教育人员心理健康提供参考。方法 2020年11月—2021年1月,通过深圳健康教育与促进中心对深圳10个区的2 811名专职健康教育人员工作负荷、工作满意度、生活行为方式、心理健康等进行问卷调查。采用logistic回归探究工作负荷、工作满意度对焦虑抑郁状况的影响。结果 健康教育人员工作负荷、工作满意度得分分别为（18.29±4.60）分、（71.22±11.28）分,焦虑、抑郁检出率分别为20.5%、31.3%。工作负荷总分18～20(OR = 1.817, 95%CI: 1.239～2.663)、＞20(OR = 3.620, 95%CI: 2.503～5.234)的人更易发生焦虑;工作负荷总分15～17(OR = 1.402, 95%CI:1.049～1.874)、18～20(OR = 1.545, 95%CI: 1.136～2.102)、＞20(OR = 1.744, 95%CI: 1.286～2.366)的人更易发生抑郁。工作满意度总分越高,焦虑、抑郁风险越低。结论 健康教育人员焦虑、抑郁检出率较高,工作负荷与工作满意度是其重要影响因素,应合理安排工作时间、适当降低工作负荷、提高工作满意度以改善和促进健康教育工作人员心理健康。     

Association between body-mass index,patient characteristics,and obesity-related comorbidities among COVID-19 patients: A prospective cohort study

ObjectiveObesity is a major risk factor for adverse outcomes after COVID-19 infection. However, it is unknown if the worse outcomes are due to the confounding effect of demographic and obesity-related comorbidities. The study objective is to analyze associations between body mass index, patient characteristics, obesity-related comorbidity, and clinical outcomes in COVID-19 patients.MethodsIn this prospective cohort study, we chose patient records between March 1st, 2020, and December 1st, 2022, in a large tertiary care center in southeast Wisconsin in the United States. Patients over the age of 18 who tested positive were included in the study. Clinical outcomes included hospitalization, intensive care unit (ICU) admission, mechanical ventilation, and mortality rates. We examined the characteristics of patients who had positive clinical outcomes. We created unadjusted logistic regression models, sequentially adjusting for demographic and comorbidity variables, to assess the independent associations between BMI, patient characteristics, obesity-related comorbidities, and clinical outcomes.ResultsFrom a record of 1.67 million inpatients and outpatients at Froedtert Health Center, 55,299 (BMI: 30.5 ± 7.4 kg/m², 62.5 % female) tested COVID-19 positive during the study period. 17,580 (31.8 %) patients were admitted to hospitals, and of hospitalized patients required ICU admission. 1038 (36.3 %) required mechanical ventilation, and 462 (44.5 %) died after a positive test for COVID-19. We found female patients show a higher hospitalization rate, while male patients have a higher rate of ICU admission, mechanical ventilation, and mortality. Obesity-related comorbidities are associated with worse outcomes compared to simple obesity without comorbidities. In logistic regression models, we found four similar V-shaped associations between BMI and four clinical outcomes. Patients with a BMI of 25 kg/m² are at the lowest risk for clinical outcomes. Patients with a BMI lower than 18 kg/m² or higher than 30 kg/m² are associated with a higher risk of hospitalization, ICU, mechanical ventilation, and death. After adjusting the model for demographic factors and hypertension and diabetes as two common comorbidities, we found that demographic factors do not significantly increase the risk. Obesity alone does not significantly increase the risk of severe clinical outcomes. Obesity-related comorbidities, on the other hand, resulted in a significantly higher risk of outcomes.ConclusionObesity alone does not increase the risk of worse clinical outcomes after COVID-19 infection. It may suggest that the worse clinical outcomes of patients with obesity are mediated via hypertension and type 2 diabetes. Patients with obesity and comorbidities have a higher risk of poor outcomes. Obesity-related comorbidities, including hypertension and diabetes, are independently associated with poorer clinical outcomes among COVID-19 patients. At a BMI of more than 30 kg/m² or less than 18 kg/m², we found an increase in the risk of severe COVID-19 outcomes leading to hospitalization, ICU, mechanical ventilation, and death. The increased risk of severe outcomes is not attributed to patient characteristics but can be attributed to hypertension and diabetes.     

The COVID-19 pandemic and weight management: Effective behaviors and pandemic-specific risk factors

BackgroundObesity and comorbid conditions are associated with worse outcomes related to COVID-19. Moreover, social distancing adherence during the COVID-19 pandemic may predict weight gain due to decreased physical activity, increased emotional eating, and social isolation. While early studies suggest that many individuals struggled with weight management during the pandemic, less is known about healthy eating and weight control behaviors among those enrolled in weight loss programs.MethodsThe present study evaluated weight management efforts among weight loss program participants during the COVID-19 pandemic. Participants’ (N = 55, 90.9% female, 36% white, M_age = 49.8) demographics and body mass index were collected two months prior to the COVID-19 statewide shutdown. During the lockdown, an online survey assessed health behaviors, coping, COVID-19 experiences (e.g., social distancing, loneliness), and weight gain. Logistic regressions examined demographics, health behaviors, and COVID-19 factors as predictors of weight gain.ResultsMost participants (58%) reported gaining weight during COVID-19. Weight gain was predicted by challenges with the following health behaviors: physical activity, monitoring food intake, choosing healthy foods, and emotional eating. Loneliness and working remotely significantly related to emotional eating, physical activity, and choosing healthy foods.ConclusionsLoneliness and working remotely increased the difficulty of weight management behaviors during COVID-19 among weight loss program participants. However, staying active, planning and tracking food consumption, choosing healthy foods, and reducing emotional eating protected against weight gain. Thus, these factors may be key areas for weight management efforts during the pandemic.