Patients with Severe Obesity during the COVID-19 Pandemic: How to Maintain an Adequate Multidisciplinary Nutritional Rehabilitation Program?

Abstract

Background: The COVID-19 pandemic is spreading all over the world, particularly in developed countries where obesity is also widespread. There is a high frequency of increased BMI in patients admitted to intensive care for SARS-CoV-2 infection with a major severity in patients with an excess of visceral adiposity. Patients at risk of severe SARS-CoV-2 acute respiratory syndrome are characterised by the high prevalence of pre-existing diseases (high blood pressure and cardiovascular disease, diabetes, chronic respiratory disease, or cancer), most of them typically present in severely obese patients. Indeed, the biological role of adipose tissue in sustaining SARS-CoV-2 infection is not completely elucidated.

Summary: The forced isolation due to pandemic containment measures abruptly interrupted the rehabilitation programs to which many patients with severe obesity were enrolled. People affected by obesity, and especially those with severe obesity, should continue clinical rehabilitation programs, taking extra measures to avoid COVID-19 infection and reinforcing the adoption of preventive procedures. In this review, the available data on obesity and COVID-19 are discussed along with evidence-based strategies for maintaining the necessary continuous rehabilitation programs. Key Messages: Greater attention is needed for obese and severely obese patients in the face of the current COVID-19 pandemic, which represents a huge challenge for both patients and healthcare professionals. The adoption of new strategies to guarantee adequate and continuous multidisciplinary nutritional rehabilitation programs will be crucial to control the severity of SARS-CoV-2 infection in high-risk populations as well as the worsening of obesity-linked complications. Health authorities should be urged to equip hospitals with tools for the diffusion of telemedicine to maintain physician-patient communication, which is fundamental in chronic and complicated obese patients.

Keywords: Adipose tissue; Bariatric surgery; COVID-19 pandemic; Diet; Obesity; Physical activity; Rehabilitation; Telemedicine.

Fig. 1

Inflammatory cytokines upregulated in the “cytokine storm” of SARS-CoV-2 induced in lung cells are also produced and secreted by adipose tissue, adipocytes, and resident immune cells of obese patients, suggesting a potential “addictive” pro-inflammatory effect. Tumour necrosis factor-alpha (TNF-α), interleukin 6 (IL-6), interferon gamma (INF-γ), INF-γ-induced protein 10 (IP-10 or CXCL10), monocyte-chemotactic protein 3 (CCL7 or MCP-3), monocyte-chemotactic protein 1 (CCL2 or MCP-1), and interleukin 1 receptor antagonist (IL-1ra) were associated with an increased viral load, loss of lung function, lung injury, and a fatal outcome. This figure was generated with images from Servier Medical Art (www.servier.com), licensed under the Creative Commons Attribution 3.0 unported license (http://creativecommons.org/license/by/3.0/).