key: cord-0890020-inuhtk0d
authors: Flint, Stuart William; Tahrani, Abd A
title: COVID-19 and obesity—lack of clarity, guidance, and implications for care
date: 2020-04-29
journal: Lancet Diabetes Endocrinol
DOI: 10.1016/s2213-8587(20)30156-x
sha: 885db303267b860c7e772db7d4b9606cb6563537
doc_id: 890020
cord_uid: inuhtk0d

nan

Because of its high transmissibility, COVID-19 has challenged health-care systems worldwide, leading to pressure on intensive care beds in Italy with 9-11% of the people infected with COVID-19 requiring intensive care admission. 2 As a result, countries took various actions to flatten the curve to allow health-care systems to cope with the demand.

On 23 March, 2020, the UK Government released "Guidance for social distancing for everyone in the UK". This guidance, among others, is much needed to reduce infection and potential spread of COVID-19. Within this guidance, several factors are identified as increasing a person's vulnerability of severe illness, and as a result, efforts to maintain social distancing is to be more stringent for these groups.

One factor that has been identified as increasing a person's vulnerability of severe illness is a BMI of 40kg/m2 or higher, a cutoff that was also listed as an independent risk factor by the USA Centers for Disease Control and Prevention. Although it is recognised that a higher BMI has been associated with greater risk of type 2 diabetes, cardiovascular disease, and hypertension, all of which are predictors of poor outcomes in COVID-19, 3 to date, no available data show adverse COVID-19 outcomes specifically in people with a BMI of 40kg/m2 or higher. This absence of data might explain why, unlike with other factors identified as reasons for a higher-risk status, there is a paucity of information to explain the reason why people with a BMI of 40kg/m2 or higher, as an independent risk factor, are included as a high-risk group. In comparison, information about the reasons that a person with diabetes is at an increased risk of severe illness have been shared widely between people living with diabetes, healthcare workers, and community support networks.

The scarcity of information regarding the increased risk of illness for people with a BMI higher than 40kg/m² has led to ambiguity and might increase anxiety, given that these individuals have now been categorised as vulnerable to severe illness if they contract COVID-19. Similarly, and of concern, is that the BMI cutoff (≥40kg/m2) might give false safety for people with obesity at lower BMIs. Thus, there is a need for more evidence and information to raise awareness of why a BMI of 40kg/m2 or higher has been identified as a cutoff for increased risk of severe illness as a result of COVID-19, and also for health-care practitioners, organisations, and charities to inform and care for individuals seeking support.

We declare no competing interests.

s.w.flint@leeds.ac.uk

Bearing the brunt of covid-19: older people in low and middle income countries

COVID-19 and Italy: what next?

For the Guidance on social distancing in the UK see https:// www.gov.uk/government/ publications/covid-19-guidanceon-social-distancing-and-forvulnerable-people/ guidance-on-social-distancingfor-everyone-in-the-uk-andprotecting-older-people-andvulnerable-adults For more on the guidance from CDC see