Letter to the Editor
COVID-19 AND OBESITY
Obesity Phenotype is a
Predictor of COVID-19
Disease Susceptibility
Jon D. Samuels
TO THE EDITOR: After having read your
recent Editorial, “COVID 19 and the Patient
with Obesity – The Editors Speak Out” (1),
I wish to share my personal experience. I am
an anesthesiologist working on the frontline
of the coronavirus (COVID-19) pandemic
at a busy New York City tertiary care teach-
ing center, Weill Cornell Medical College,
New York-Presbyterian Hospital. As Director
of the Bariatric Anesthesia division and an
airway expert, I was assigned to the COVID-
19 intubation team in March 2020. We are at
ground zero of the public health care crisis,
intubating as many as 15 to 20 patients in a
24-hour period. I began to field calls from
other physicians, asking, “Could you help
out? We have a 150-kg patient.” A few of my
colleagues came to me for technical advice.
Upon closer inspection, I noted that most of
my patients were male, over age 60, had exten-
sive medical comorbidities, and had obesity.
They overwhelmingly possessed the classic
obstructive sleep apnea (OSA) phenotype (2):
older male, high BMI (in kilograms per meter
squared), hypersomnia, airway abnormalities,
and metabolic syndrome with abdominal obe-
sity as assessed by waist circumference and
1368     Obesity | VOLUME 28 | NUMBER 8 | AUGUST 2020
waist to hip ratio (2), and they often had long-
standing hypertension, diabetes, and cardiac
and renal disease.
Patients with obesity class III and full expression
of the OSA phenotype, OSA Subtype B2, are
already known to have a high prevalence of car-
diovascular disease risk, obtain less benefit from
noninvasive positive pressure ventilation, and
require medical management of comorbidities.
Such patients have high risk for all-cause, car-
diovascular, and cancer mortality (3) and often
present with a deconditioned proinflammatory
profile (3). The Centers for Disease Control and
Prevention classes patients with obesity at risk
for flu (1), and ostensibly COVID-19 complica-
tions, as has been shown in the 2009 influenza
A infection. As pointed out in the Editorial (1),
these patients are at risk for infections, partic-
ularly respiratory infections, and for influenza-
like illness despite vaccination (4). This may
also prove to be the case with COVID-19.
Patients with severe obesity appear to be highly
represented in the severe COVID-19 disease
population. In order to determine the actual
representation, national or international retro-
spective large-scale medical studies of hospital
admissions of admitting and discharge diagno-
ses on COVID-19 patients need to be conducted.
Several such studies are ongoing (5) and they
have indicated that the most frequent comor-
bidities represented in the severe COVID-19
infected population are hypertension, obesity,
Obesity
and diabetes. These studies offer a regional
perspective and are helpful, although they have
limitations. It is difficult to compare data in
disparate health care systems without uniform
definitions of quality and outcome. Risk strati-
fication of data points should allow resources to
be deployed in the most cost-effective manner
and focus attention on the most fragile cohort of
patients during the healing phase of the disease.
What is now needed is to harmonize the data
and put them together into a large data set from
which conclusions may be drawn.O
Disclosure: The author declared no conflict of interest.
© 2020 The Obesity Society
References
1. Ryan DH, Ravussin E, Heymsfield S. COVID 19 and
the patient with obesity – the editors speak out. Obesity
(Silver Spring) 2020;28:847.
2. Zinchuk A, Yaggi HK. Phenotypic subtypes of OSA: a
challenge and opportunity for precision medicine. Chest
2020;157:356-362.
3. Neidich SD, Green WD, Rebeles J, et al. Increased risk
of influenza among vaccinated adults who are obese. Int
J Obes (Lond) 2017;41:1324-1330.
4. Finer N, Garnett SP, Bruun JM. COVID-19 and obesity
Clin Obes. 2020;10:e12365. doi:10.1111/cob.12365
5. Richardson S, Hirsch JS, Narasimhan M, et al.
Presenting characteristics, comorbidities, and outcomes
among 5700 patients hospitalized with COVID-19 in
the New York City area. 2020;323:2052-2059.
Department of Anesthesiology, Weill Cornell College of
Medicine, New York-Presbyterian Hospital, New York,
New York, USA. Correspondence: Jon D. Samuels
(jos2001@med.cornell.edu)
doi: 10.1002/oby.22866
www.obesityjournal.org