key: cord-0887633-23veqqkr authors: Akbas, Feray; Usta Atmaca, Hanife title: Obesity and COVID-19: Time to Take Action date: 2020-11-09 journal: Obes Facts DOI: 10.1159/000511446 sha: 0884087cc95f732615ecf0e22341b2f79d7edafe doc_id: 887633 cord_uid: 23veqqkr nan Akbas and Usta Atmaca: Obesity and COVID-19 www.karger.com/ofa might contribute to this situation. The defective immune system in obesity creates susceptibility to infections, including viral infections. In fact, several adipogenic viruses have been described, and obesity-associated immune suppression might play a key role for the prognosis of viral infections seen in people with obesity [9] . Several other mechanisms are suggested to explain the poor outcomes in concomitance of obesity and COVID-19 infection, such as altered adipose tissue hormones, complement components, vasculature, and alveolus. It is also hypothesized that insulin resistance, but not fat mass, could be responsible for poor COVID-19 outcomes in patients with obesity [10] . On the other hand, obesity-related diseases such as type 2 diabetes, hypertension, hyperlipidemia, cardiovascular, and cerebrovascular diseases are also sources of concern in COVID-19 infection prognosis and concomitant with obesity, they may increase the severity of the disease [11] . Thrombotic incidents are common in COVID-19 patients and chronic inflammation and impaired fibrinolysis that underlie the thrombosis seen in obesity might cause increased thromboembolism risk in this population [12, 13] . Increased weight is also associated with the development of acute respiratory distress syndrome, especially in patients with severe obesity (BMI > 40 kg/m 2 ). Both obesity and acute respiratory distress syndrome appear to have alterations in inflammation, endothelial dysfunction, and oxidative stress, which increase the risk for respiratory failure [14, 15] . Decreased pulmonary capacity in obesity facilitates the need for mechanical ventilation, and intensive care unit admissions are increased among critical COVID-19 patients with obesity [16, 17] . Additionally, obesity is a risk factor for hospital admissions in younger COVID-19 patients. Although patients who are younger than 60 years old are accepted to have a lower risk for COVID-19 disease severity, younger populations are expected to be affected more than previously reported in populations with a high prevalence of obesity [18, 19] . The immune system and metabolic state are both major determinants for survival of COVID-19 infection, and as we summarized here, people with obesity present frailty by those means. Thus, as clarified in the position statement of EASO, it is vital to consider the needs of individuals living with obesity during the COVID-19 pandemic and take all precautions needed for this vulnerable group to decrease the morbidity and mortality. WHO. Coronavirus disease (COVID-19) Situation Report -107: Data as received by WHO from national authorities by 10: 00 CEST China Medical Treatment Expert Group for Covid-19. Clinical Characteristics of Coronavirus Disease 2019 in China Clinical determinants for fatality of 44,672 patients with COVID-19 Clinical characteristics of 145 patients with corona virus disease 2019 (COVID-19 Obesity and COVID-19 Severity in a Designated Hospital in Shenzhen Clinical Characteristics of Covid-19 in New York City Inflammation, Frailty and Cardiovascular Disease COVID-19, immune system response, hyperinflammation and repurposing antirheumatic drugs Viral Infections and Interferons in the Development of Obesity. Biomolecules When Two Pandemics Meet: Why Is Obesity Associated with Increased COVID-19 Mortality? Med (N Y) Risk Factors Associated with Clinical Outcomes in 323 COVID-19 Hospitalized Patients in Wuhan, China Incidence of venous thromboembolism in hospitalized patients with COVID-19 Mechanisms of thrombosis in obesity Obesity and acute lung injury Body mass index is associated with the development of acute respiratory distress syndrome LICORN and the Lille COVID-19 and Obesity study group. High prevalence of obesity in severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) requiring invasive mechanical ventilation Association of Obesity with Disease Severity Among Patients with Coronavirus Disease Obesity could shift severe COVID-19 disease to younger ages Obesity in patients younger than 60 years is a risk factor for Covid-19 hospital admission The authors have no conflicts of interest to declare. All authors listed have contributed sufficiently to the paper to be included as authors.