Patients who are overweight or obese at risk of more severe COVID-19

Patients who are overweight or obese have more severe COVID-19 and are highly likely to require invasive respiratory support, according to a new international study. CREDIT i yunmai

Patients who are overweight or obese have more severe COVID-19 and are highly likely to require invasive respiratory support, according to a new international study.

The research, led by the Murdoch Children’s Research Institute (MCRI) and The University of Queensland and published in Diabetes Care, found obese or overweight patients are at high risk for having worse COVID-19 outcomes. They are also more likely to require oxygen and invasive mechanical ventilation compared to those with a healthy weight.

MCRI researcher Dr Danielle Longmore said the findings, which highlighted the relationship between obesity and increased COVID-19 disease burden, showed the need to urgently introduce strategies to address the complex socio-economic drivers of obesity, and public policy measures such as restrictions on junk food advertising.

“Although taking steps to address obesity in the short-term is unlikely to have an immediate impact in the COVID-19 pandemic, it will likely reduce the disease burden in future viral pandemics and reduce risks of complications like heart disease and stroke,” she said.

The study looked at hospitalised SARS-CoV-2 patients from 18 hospitals in 11 countries including China, America, Italy, South Africa and The Netherlands.

Among the 7244 patients aged 18 years and over, 34.8 per cent were overweight and 30.8 per cent were obese.

COVID-19 patients with obesity were more likely to require oxygen and had a 73 per cent greater chance of needing invasive mechanical ventilation. Similar but more modest results were seen in overweight patients. No link was found between being overweight or obese and dying in hospital from COVID-19.

Cardiovascular and pre-existing respiratory diseases were associated with increased odds of in-hospital deaths but not a greater risk for needing oxygen and mechanical ventilation. For patients with pre-existing diabetes, there was increased odds of needing invasive respiratory support, but no additionally increase in risk in those with obesity and diabetes.

Men were at an increased risk of severe COVID-19 outcomes and needing invasive mechanical ventilation. In those aged over 65 years, there was an increased chance of requiring oxygen and higher rates of in-hospital deaths.

The University of Queensland’s Dr Kirsty Short, who co-led the research, said almost 40 per cent of the global population was overweight or obese.

“Obesity is associated with numerous poor health outcomes, including increased risk of cardiometabolic and respiratory disease and more severe viral disease including influenza, dengue and SARS-CoV-1,” she said.

Dr Short said while previous reports indicated that obesity was an important risk factor in the severity of COVID-19, almost all this data had been collected from single sites and many regions were not represented. Moreover, there was a limited amount of evidence available about the effects of being overweight or obese on COVID-19 severity.

“Given the large scale of this study we have conclusively shown that being overweight or obese are independent risk factors for worse outcomes in adults hospitalised with COVID-19,” she said.

MCRI Professor David Burgner, who co-led the research, said the data would help inform immunisation prioritisation for higher-risk groups.

“At the moment, the World Health Organization has not had enough high-quality data to include being overweight or obese as a risk factor for severe COVID-19 disease. Our study should help inform decisions about which higher-risk groups should be vaccinated as a priority,” he said.

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The conditions of 70% of people with chronic pain have worsened during the pandemic

The typical profile of participants in this study was that of a woman aged between 30 and 59 who had been suffering pain for the last seven years

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The pandemic has impacted significantly on people who suffer chronic pain. A study performed by the eHealth Lab, a research group affiliated with the Faculty of Health Sciences and the Universitat Oberta de Catalunya’s eHealth Center, has shown that 70% of the people with chronic pain have seen their condition worsen in terms of severity, frequency of episodes and interference in their daily activities.

A total of 502 patients took part in the study; 88% were women aged between 30 and 59, with long-duration chronic pain (mean duration, 7 years). Most participants (87.6%) had pain in more than one point; the most frequent locations were the abdomen, lower back and neck. The participants answered online surveys, designed in accordance with the IMMPACT (Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials) methodology, and the CPGQ (Chronic Pain Grade Questionnaire) was used to compare changes in the pain perceived by the patients since lockdown began.

The pandemic worsens pain

The results showed that job insecurity, worries about the future, the number of people living in the same dwelling, having someone close who has died of COVID-19, or fear of becoming infected with the virus may be related with a worsening of the pain.

The study also shows that the pandemic has favoured the emergence of new pain triggers. While stress and weather changes were the most frequently mentioned triggers before the pandemic, during lockdown a large number of participants have mentioned worrying about the future, sleep problems, insecurity, negative thoughts, sadness, loneliness, insufficient physical activity and fear of contagion as triggers.

New ways of coping with pain

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The pandemic has also changed how a significant proportion of patients manage their pain. More than half (54.5%) have changed how they cope with it: “The study has shown that since the state of emergency began, more than half of the patients have used rest to manage their pain, and a similar percentage have increased the consumption of medication. Both could have counterproductive effects,” explained Rubén Nieto, professor and researcher at the UOC’s eHealth Lab. However, with the pandemic, people have also started turning to a new positive way to combat pain. Indeed, 48.2% have included stretching exercises as a new tool for dispelling pain.

ICTs, an opportunity for the future

“When there is a chronic pain problem, it is important that people be able to learn to live with it, focusing on achieving their life goals, with or without pain. It is difficult to eliminate the pain altogether, but it is possible to learn to cope with it and live with it. Biopsychosocial interventions may be useful, in which holistic approaches to pain management are used”, explained Rubén Nieto, who is a specialist in understanding, assessing and treating pain problems from a multidimensional viewpoint.

Unfortunately, most people do not have access to these interventions, as few centres offer this type of treatment, and health professionals receive little specific training in pain management, according to Nieto. However, ICTs are emerging as a useful tool for taking this type of treatment to chronic pain patients: “ICTs provide an opportunity for combating pain and improving well-being, since they can facilitate access to evidence-based interventions at an affordable cost. And they can increase personal autonomy and empowerment”, explained Nieto, who focuses part of his research on applying new technologies to health problems. “We need to learn from the experience gained from the pandemic in the use of ICTs in health,” he continued. “The possibilities are limitless, from the classic teleconsultation to solutions based on artificial intelligence. But first we must plan and test their use.”


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