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'Excess weight' linked to higher risk of severe complications and death from COVID-19, PHE report concludes

The report from Public Health England also accepted that it was unclear how much the prevalence of obesity had contributed to the severity of COVID-19 in the UK.

Open access article

The Royal Pharmaceutical Society has made this article free to access in order to help healthcare professionals stay informed about an issue of national importance.

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Obese man sitting


Even after adjustments for potential confounding factors, a high body mass index still accounted for increased risk of severe COVID-19 complications

People who are obese or “excessively” overweight are at an increased risk of serious complications and death from COVID-19, compared to those with a healthy weight, a report from Public Health England (PHE) has concluded.

This comes as the government published its latest obesity strategy aimed at helping individuals adopt a healthier lifestyle to protect themselves against COVID-19.

The PHE report brings together findings from UK and international studies published during the COVID-19 pandemic, and offers “evidence-based insights” into the link between excess weight — defined as a body mass index (BMI) range of 25kg/m2 or higher — and COVID-19.

The evidence in the report showed that the risks of excess weight — in terms of being hospitalised with COVID-19, receiving advanced levels of treatment and death — all increased progressively with increasing BMI above the healthy weight range. This was even after adjustments were made for potential confounding factors, such as demographic and socioeconomic factors.

Potential mechanisms for the link between obesity and COVID-19 outcomes, the report said, included the effects of excess adipose tissue on respiratory function, metabolic dysfunction, the cardiovascular system, enhanced inflammatory response and impaired response to infection.

The report also highlighted that there could be an interaction with weight-related comorbidities, such as type 2 diabetes, which are also associated with more severe COVID-19.

However, it acknowledged that there were limitations in the evidence available to date and that it was “currently unclear” as to what extent the relatively high prevalence of excess weight seen in the UK, compared with other countries, may have contributed to the severity of COVID-19 in the UK.

The government’s obesity strategy, launched on 27 July 2020, includes the end of deals such as ‘buy-one-get-one-free’ on food that is high in salt, sugar and fat, a ban on TV and online adverts for these foods before 21:00 and displaying calories on menus. It also includes the expansion of NHS weight management services.

Claire Anderson, chair of the Royal Pharmaceutical Society’s English Pharmacy Board, said that, as the “third largest profession”, pharmacy should be at the centre of the prevention agenda by supporting weight management.

“The pandemic has emphasised that collaborative working across healthcare will be essential for the success of this strategy. We want to see more integrated working across the NHS to ensure the best patient care possible, including more social prescribing referrals and linking up primary care networks further with community pharmacies,” she said. 

“It is becoming more obvious that A&E referrals and GP appointments can be treated elsewhere and pharmacies are well placed to ease pressures on other NHS services by supporting people with general wellbeing issues, such as obesity. We now need the backing from the government and NHS to build on the work our profession continues to do on a daily basis.”

In January 2020, the National Institute for Health and Care Excellence released draft guidance saying community pharmacies could offer support to patients on adopting a healthier lifestyle, including stopping smoking, reducing alcohol consumption and managing weight.


Citation: The Pharmaceutical Journal DOI: 10.1211/PJ.2020.20208217

Readers' comments (1)

  • Not just obesity, but also type 2 diabetes, metabolic syndrome, COPD / cigarette smoking, and ageing-related conditions have a common underlying pathology, namely an oxidative stress (= pro-inflammatory) condition associated with cytokine release.[1–5] And all of these conditions predispose patients to serious outcomes upon infection with the COVID-19 virus (SARS-CoV-2). The picture that is emerging from the literature is that the coronavirus is somehow causing a shift in pro-oxidant / antioxidant status that particular cells / tissues / organs are unable adequately to control through normal redox homeostatic processes, perhaps at the level of the mitochondria. The resulting "cytokine storm",[6] if it occurs in a critical organ such as the lungs or the heart, is life-threatening. Toxicologists have long known that the life-threatening effect of an overdose of paracetamol follows upon glutathione depletion, which triggers release of reactive oxygen species and in turn a cytokine storm in the liver and lungs.[7,8,9]. So, it would appear to me that paracetamol may be the "elephant in the room" notwithstanding early assurances from WHO[10] and the NHS that it is safe to take by COVID-19 patients. In fact, WHO did acknowledge that their assurances were based on historical literature none of which "specifically addressed COVID-19, SARS, or MERS". In other words, their assurances were made BEFORE it was even recognised that SARS-CoV-2 seemingly affects most seriously those who already have a compromised ability to maintain redox homeostasis as a result of their co-morbidities. And it is this same group of patients that are also most likely to be taking paracetamol-containing medication and/or most likley to reach for their paracetamol when they develop a fever. Perhaps the reason why the UK appears to be top of the world league for number of COVID-19-related deaths per million of our population[11] is related not only to the number of overweight / obese / type 2 diabetic / cigarette smoking people in the country but also to the amount of paracetamol being taken by these people?


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