Obesity during the COVID-19 pandemic: both cause of high risk and potential effect of lockdown? A population-based electronic health record study

M. Katsoulis; L. Pasea; A. G. Lai; R. J.B. Dobson; S. Denaxas; H. Hemingway; A. Banerjee

doi:10.1016/j.puhe.2020.12.003

Obesity during the COVID-19 pandemic: both cause of high risk and potential effect of lockdown? A population-based electronic health record study

M. Katsoulis, L. Pasea, A. G. Lai, R. J.B. Dobson, S. Denaxas, H. Hemingway, A. Banerjee^*

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

28 Citations (Scopus)

Abstract

Objectives: Obesity is a modifiable risk factor for coronavirus disease 2019 (COVID-19)–related mortality. We estimated excess mortality in obesity, both ‘direct’, through infection, and ‘indirect’, through changes in health care, and also due to potential increasing obesity during lockdown. Study design: The study design of this study is a retrospective cohort study and causal inference methods. Methods: In population-based electronic health records for 1,958,638 individuals in England, we estimated 1-year mortality risk (‘direct’ and ‘indirect’ effects) for obese individuals, incorporating (i) pre-COVID-19 risk by age, sex and comorbidities, (ii) population infection rate and (iii) relative impact on mortality (relative risk [RR]: 1.2, 1.5, 2.0 and 3.0). Using causal inference models, we estimated impact of change in body mass index (BMI) and physical activity during 3-month lockdown on 1-year incidence for high-risk conditions (cardiovascular diseases, diabetes, chronic obstructive pulmonary disease and chronic kidney disease), accounting for confounders. Results: For severely obese individuals (3.5% at baseline), at 10% population infection rate, we estimated direct impact of 240 and 479 excess deaths in England at RR 1.5 and 2.0, respectively, and indirect effect of 383–767 excess deaths, assuming 40% and 80% will be affected at RR = 1.2. Owing to BMI change during the lockdown, we estimated that 97,755 (5.4%: normal weight to overweight, 5.0%: overweight to obese and 1.3%: obese to severely obese) to 434,104 individuals (15%: normal weight to overweight, 15%: overweight to obese and 6%: obese to severely obese) would be at higher risk for COVID-19 over one year. Conclusions: Prevention of obesity and promotion of physical activity are at least as important as physical isolation of severely obese individuals during the pandemic.

Original language	English
Pages (from-to)	41-47
Number of pages	7
Journal	Public Health
Volume	191
DOIs	https://doi.org/10.1016/j.puhe.2020.12.003
Publication status	Published - Feb 2021

Keywords

Cardiovascular
Coronavirus
Diabetes
Obesity
Physical activity

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1016/j.puhe.2020.12.003

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@article{1a978e8f66dc4889b80b2888c3b550f5,

title = "Obesity during the COVID-19 pandemic: both cause of high risk and potential effect of lockdown? A population-based electronic health record study",

abstract = "Objectives: Obesity is a modifiable risk factor for coronavirus disease 2019 (COVID-19)–related mortality. We estimated excess mortality in obesity, both {\textquoteleft}direct{\textquoteright}, through infection, and {\textquoteleft}indirect{\textquoteright}, through changes in health care, and also due to potential increasing obesity during lockdown. Study design: The study design of this study is a retrospective cohort study and causal inference methods. Methods: In population-based electronic health records for 1,958,638 individuals in England, we estimated 1-year mortality risk ({\textquoteleft}direct{\textquoteright} and {\textquoteleft}indirect{\textquoteright} effects) for obese individuals, incorporating (i) pre-COVID-19 risk by age, sex and comorbidities, (ii) population infection rate and (iii) relative impact on mortality (relative risk [RR]: 1.2, 1.5, 2.0 and 3.0). Using causal inference models, we estimated impact of change in body mass index (BMI) and physical activity during 3-month lockdown on 1-year incidence for high-risk conditions (cardiovascular diseases, diabetes, chronic obstructive pulmonary disease and chronic kidney disease), accounting for confounders. Results: For severely obese individuals (3.5% at baseline), at 10% population infection rate, we estimated direct impact of 240 and 479 excess deaths in England at RR 1.5 and 2.0, respectively, and indirect effect of 383–767 excess deaths, assuming 40% and 80% will be affected at RR = 1.2. Owing to BMI change during the lockdown, we estimated that 97,755 (5.4%: normal weight to overweight, 5.0%: overweight to obese and 1.3%: obese to severely obese) to 434,104 individuals (15%: normal weight to overweight, 15%: overweight to obese and 6%: obese to severely obese) would be at higher risk for COVID-19 over one year. Conclusions: Prevention of obesity and promotion of physical activity are at least as important as physical isolation of severely obese individuals during the pandemic.",

keywords = "Cardiovascular, Coronavirus, Diabetes, Obesity, Physical activity",

author = "M. Katsoulis and L. Pasea and Lai, {A. G.} and Dobson, {R. J.B.} and S. Denaxas and H. Hemingway and A. Banerjee",

year = "2021",

month = feb,

doi = "10.1016/j.puhe.2020.12.003",

language = "English",

volume = "191",

pages = "41--47",

journal = "Public Health",

issn = "0033-3506",

publisher = "Elsevier",

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TY - JOUR

T1 - Obesity during the COVID-19 pandemic

T2 - both cause of high risk and potential effect of lockdown? A population-based electronic health record study

AU - Katsoulis, M.

AU - Pasea, L.

AU - Lai, A. G.

AU - Dobson, R. J.B.

AU - Denaxas, S.

AU - Hemingway, H.

AU - Banerjee, A.

PY - 2021/2

Y1 - 2021/2

N2 - Objectives: Obesity is a modifiable risk factor for coronavirus disease 2019 (COVID-19)–related mortality. We estimated excess mortality in obesity, both ‘direct’, through infection, and ‘indirect’, through changes in health care, and also due to potential increasing obesity during lockdown. Study design: The study design of this study is a retrospective cohort study and causal inference methods. Methods: In population-based electronic health records for 1,958,638 individuals in England, we estimated 1-year mortality risk (‘direct’ and ‘indirect’ effects) for obese individuals, incorporating (i) pre-COVID-19 risk by age, sex and comorbidities, (ii) population infection rate and (iii) relative impact on mortality (relative risk [RR]: 1.2, 1.5, 2.0 and 3.0). Using causal inference models, we estimated impact of change in body mass index (BMI) and physical activity during 3-month lockdown on 1-year incidence for high-risk conditions (cardiovascular diseases, diabetes, chronic obstructive pulmonary disease and chronic kidney disease), accounting for confounders. Results: For severely obese individuals (3.5% at baseline), at 10% population infection rate, we estimated direct impact of 240 and 479 excess deaths in England at RR 1.5 and 2.0, respectively, and indirect effect of 383–767 excess deaths, assuming 40% and 80% will be affected at RR = 1.2. Owing to BMI change during the lockdown, we estimated that 97,755 (5.4%: normal weight to overweight, 5.0%: overweight to obese and 1.3%: obese to severely obese) to 434,104 individuals (15%: normal weight to overweight, 15%: overweight to obese and 6%: obese to severely obese) would be at higher risk for COVID-19 over one year. Conclusions: Prevention of obesity and promotion of physical activity are at least as important as physical isolation of severely obese individuals during the pandemic.

AB - Objectives: Obesity is a modifiable risk factor for coronavirus disease 2019 (COVID-19)–related mortality. We estimated excess mortality in obesity, both ‘direct’, through infection, and ‘indirect’, through changes in health care, and also due to potential increasing obesity during lockdown. Study design: The study design of this study is a retrospective cohort study and causal inference methods. Methods: In population-based electronic health records for 1,958,638 individuals in England, we estimated 1-year mortality risk (‘direct’ and ‘indirect’ effects) for obese individuals, incorporating (i) pre-COVID-19 risk by age, sex and comorbidities, (ii) population infection rate and (iii) relative impact on mortality (relative risk [RR]: 1.2, 1.5, 2.0 and 3.0). Using causal inference models, we estimated impact of change in body mass index (BMI) and physical activity during 3-month lockdown on 1-year incidence for high-risk conditions (cardiovascular diseases, diabetes, chronic obstructive pulmonary disease and chronic kidney disease), accounting for confounders. Results: For severely obese individuals (3.5% at baseline), at 10% population infection rate, we estimated direct impact of 240 and 479 excess deaths in England at RR 1.5 and 2.0, respectively, and indirect effect of 383–767 excess deaths, assuming 40% and 80% will be affected at RR = 1.2. Owing to BMI change during the lockdown, we estimated that 97,755 (5.4%: normal weight to overweight, 5.0%: overweight to obese and 1.3%: obese to severely obese) to 434,104 individuals (15%: normal weight to overweight, 15%: overweight to obese and 6%: obese to severely obese) would be at higher risk for COVID-19 over one year. Conclusions: Prevention of obesity and promotion of physical activity are at least as important as physical isolation of severely obese individuals during the pandemic.

KW - Cardiovascular

KW - Coronavirus

KW - Diabetes

KW - Obesity

KW - Physical activity

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DO - 10.1016/j.puhe.2020.12.003

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AN - SCOPUS:85099690454

SN - 0033-3506

VL - 191

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JO - Public Health

JF - Public Health

ER -

Obesity during the COVID-19 pandemic: both cause of high risk and potential effect of lockdown? A population-based electronic health record study

Abstract

Keywords

UN SDGs

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