The impact of obesity on COVID-19

and 1,307 deaths. Efforts to “flatten the curve” in order to contain the virus and maintain health care system capabilities were affecting economic growth. Strict containment policies, as introduced in Saudi Arabia and elsewhere, have a high direct economic impact across the economy, particularly on the services component. From both a health and an economic perspective, the reduction of COvID-19 infection and severity rates became a priority concern of both government and industry.

The containment policies linked to the COvID-19 response are likely to have had a detrimental effect on overweight and obesity. Policy responses for mitigating COvID-19 are likely to have caused food system problems, including changes in food availability and consumption patterns. Increases in physical inactivity and remote telework environments may exacerbate current trends in obesity prevalence. In high- and middle-income countries, the demand for packaged processed foods, which are linked to overweight and obesity and other health complications, has increased, particularly in the ready-to-eat and -drink categories (Kantar 2020; Euromonitor Passport 2020). These changes could have long-lasting implications beyond the mitigation of the current SARS-Cov-2 spread and may be detrimental to people’s health.

Furthermore, overweight and obesity have been found to be critical drivers of the COvID-19 pandemic, increasing the chance and severity of the infection. Globally, for persons with COvID-19, there appears to be a strong relationship between having overweight or obesity and the risks of hospitalization and needing treatment in intensive care units (ICUs). A small body of literature even suggests that adults with obesity under the age of 60 are more likely to be hospitalized than those without obesity (Lighter et al. 2020).

This chapter explores the global evidence on the link between obesity and COvID-19 to further emphasize the need for investment in obesity prevention and intervention. Considering the exponential rise in obesity prevalence in Saudi Arabia and globally, understanding the links between obesity and COvID-19 and how obesity increases the risk for severe COvID-19 is critical to ensure the development of appropriate responses to the novel coronavirus.

The chapter is organized as follows: The next section highlights the epidemiological data that provide insight into the link between overweight and obesity and COvID-19, undertaking when possible metanalyses of the published data. The subsequent section provides an overview of the current understanding of how obesity affects the immunological and physiological response to SARSCov-2. The final section summarizes the main conclusions.

THE IMPACT OF OBESITY ON COVID-19

This section summarizes the findings of a literature review on the evidence of the link between obesity and COvID-19. The findings look first at the risk of COvID-19, then at the link between obesity and severity of COvID-19, and finally at the link between obesity and COvID-19 prognosis.

The literature search identified 25 relevant publications on the link between obesity and COvID-19. PubMed, Google Scholar, MedRxiv, BioRxiv, China National Knowledge Infrastructure Data (for Chinese literature), and other literature search engines were used to systematically review all publications in Chinese or English that include data on COvID-19 and body mass index (BMI) or obesity. Abstracts and results available by May 9, 2020, that presented data