A Collision of Pandemics: How Obesity and Diabetes Put you at Risk for COVID-19

This page will be updated as new information becomes available [Last update: 05.06.20]

The global rise in obesity prevalence, the association with an increased risk of death, morbidity (i.e. chronic diseases), and accelerated aging worldwide alarmingly suggests that obesity has become a pandemic.  A recent study has reported that a total of 107.7 million children and 603.7 million adults had obesity in 2015.

It’s 2020 and we are now experiencing a collision of two pandemics: epidemiological and clinical characteristics of patients with COVID-19 have been reported and, based on what we know now, obesity-related conditions seem to worsen the effect of COVID-19. The Centers for Disease Control and Prevention (CDC) reported that those at high-risk for severe illness from COVID-19 include people of all ages with underlying medical conditions, such as obesity and diabetes, particularly if not well controlled.

People with obesity represent a specific population during COVID-19 pandemic

Currently, there is not enough data to show whether people with obesity are more likely to be infected than the general population. But based on records on other viral infections (e.g. influenza, the Middle East respiratory syndrome coronavirus (MERS-CoV)), and according to a recent study,  people with obesity have a greater severity risk.

In addition, it is important to understand that people with obesity represent a specific population of Intensive Care Unit (ICU) patients. Persons with obesity who become ill and require intensive care present challenges in patient management as it is more difficult to intubate patients with obesity, it can be more challenging to undergo diagnostic medical imaging (due to weight limits on imaging machines), patients are more difficult to position and transport by nursing staff and they may not do well when under prone position ventilation. 

As more data come out about hospitalizations and infection rates, the European Association for the Study of Obesity (EASO) highlights that “It is paramount that people with obesity avoid infection”, recommending that people with obesity shelter at home during this time.

On the other hand, the current COVID-19 pandemic may lead to an increase in obesity rates as the need for self-isolation will prompt many to rely on processed food with longer shelf life and high-sodium canned food. In addition, weight-loss surgeries are being strictly postponed. The stay at home strategy will also impact mobility and enforce physical inactivity, which will likely increase the risk of metabolic disease. 

If you don’t see it, you won’t eat it

More than ever, it is important to avoid high-calorie snacks. At home, the temptation to eat more and unhealthier is higher. Period. Let’s face it!

The World Obesity Federation considers that obesity is a chronic relapsing condition and the current pandemic may pose new challenges. For instance, did you know that food stimuli such as smell, seeing the packaging of highly pleasurable food, and even hearing crunchy sounds influence our food choice? The problem is that the impact of food stimuli is greater in people who are vulnerable to weight gain. 

Controlling weight gain at home

How do I control this nightmare of likely weight gain while I stay at home? Here are 10 ways:

1. Get around temptation. Avoid having ‘tempting’ foods at home; keep food out of sight; avoid having snacks on your desk;
2. Adjust your daily food plan according to your current level of physical activity. If you are exercising significantly less, try to eat less; 
3. Keep the same meal schedule, whether it is breakfast, lunch, dinner, plus a mid-morning or afternoon snack;
4. Make sure to eat different fruits and vegetables. Given that different groups provide different proportions of vitamins and minerals, try to vary the fruits and veggies you eat in order to receive complementary micronutrients;
5. Avoid a sudden increase in fruit consumption. It can lead to an imbalance in the supply of macro and micronutrients and too much sugar in your bloodstream;
6. Freeze. Freeze. Freeze. Prepare soup in advance and freeze it in small containers. It will help you get rich nutrients from vegetables and legumes and will provide hydration in the long run. If you lack freezer space, try to prepare a concentrated soup version, adding more water after defrosting;
7. Control caloric intake. Avoid sodas and other sugary drinks, alcoholic beverages, as well as energy-dense foods, such as cakes, cookies and savory snacks (e.g. potato chips);
8. Have a bottle of water on hand. Try to maintain your hydration levels by drinking tap water or home filtered water. Be creative and prepare lemonades with fresh herbs like mint. No added sugar here!
9. Be creative. Create healthy foods with a crunchy texture (e.g. crispy kale chips; mix sugar-free cornflakes or pumpkin seeds with plain yogurt);
10. Avoid feeling guilty. Now is not the time to stress out about food. To cope with all this pandemic uncertainty, why not choose one small guilty pleasure? Try to split it throughout the week. For example, go for the nut-rich, dark chocolate (>60% cocoa). Chewing hazelnuts will make you eat it slowly, giving you a sense of pleasure, and by the time you finish it, you will be more likely to eat less (just eat one square/piece of chocolate per day). You can always balance with some home cardio physical activity (yes, I mean burpees and squats!).

Are people with diabetes more likely to get COVID-19?

Currently, there is not enough data to show whether people with diabetes have a higher susceptibility to COVID‐19, but it seems that the risk of both infection and severe disease is higher in diabetic patients. 

According to the American Diabetes Association, people with diabetes face a higher chance of experiencing worse outcomes, i.e., severe symptoms and complications when infected with a virus. For example, one of the most important metabolic reactions during hospitalization is resistance to insulin and hyperglycemia (higher blood glucose levels) due to stress hormones and inflammatory mediators. Given that hyperglycemia worsens the prognosis, it will be important to have controlled blood glucose levels during hospitalization to monitor the progress of the illness and avoid aggravation. COVID-19 is not primarily a metabolic disease, but metabolic control of glucose, lipid levels, and blood pressure are key in COVID-19 patients. 

What do I do if I’m diabetic and get infected with the virus?

The International Diabetes Federation recommends that “people with diabetes plan ahead of time what to do before they get ill”. Given that people with diabetes may see their glycemic control deteriorate during the COVID-19 infection, it is important to have their health care provider’s contact information at hand as well as make sure to have an adequate stock of medications and supplies for monitoring blood glucose at home, so that they do not need to leave the house if they become ill. 

If you have diabetes you may want to contact your health care provider for advice on how to monitor your blood glucose, get adequate refills for medications (especially insulin), and what adjustments you may need to do in your medication or diet.

What should I do during a stressful situation to improve my decompensated diabetes?

Follow the next steps if you have diabetes and become ill, even if your blood sugar levels are within the target range:

• Keep hydrated: drink extra calorie-free fluid (120 to 180 ml every half an hour; e.g. water, tea) and try to eat normally;
• If it is not possible to take in 50 grams of carbohydrates through food, drink a sugary beverage but be careful your blood sugar levels don’t rise too much;
• Monitor your blood glucose: test blood glucose every four hours, and keep track of the results;
• Weigh yourself every day: losing weight while eating normally is a sign of high blood glucose;
• Monitor your temperature: check your temperature every morning and evening. A fever may be a sign of infection;
• Take diabetes medication as usual. Insulin treatment should never be stopped. If you are on insulin, also monitor your ketone bodies;
• Important: follow your healthcare team recommendations!

Take home message

Some important lessons have been learned with regard to controlling the pandemic. While data are emerging, it seems that obesity and diabetes worsen the effect of COVID-19. Hence, it is important to plan ahead of time, control weight gain at home, control blood glucose levels, and keep taking your usual medication. It is also essential to accept the need for frequent hand washing, wearing surgical masks, regardless of whether one has respiratory symptoms or not.