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Covid-19 HSE Clinical Guidance and Evidence

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Covid-19 Guidance document - Obesity (CD 19-034 001/03.04.20)

This document has been written by Prof Donal O’ Shea, HSE Clinical Lead and Karen Gaynor, Programme Manager for the National Obesity Management Clinical Programme. It has been approved by the Clinical Advisory Group of National Obesity Management Clinical Programme.


Obesity and COVID-19 Disease Severity

There is emerging evidence that obesity may be linked with COVID 19 disease severity. This is important to consider given the prevalence of obesity in Ireland (23% adults overall, 34% aged 65-75, 28% over age 75).

  • Experience from Italian anaesthesiologists is that obesity is the most frequent co-morbidity in critical care (
  • A retrospective report of 112 patients in China with cardiovascular disease who were admitted to hospital for COVID-19 infection showed that BMI was significantly higher in the group with critical illness, and 88% (18/95) of non-survivors had a BMI > 25, which was significantly higher than the BMI of survivors (
  • Over 70% of 775 individuals admitted to critical care with confirmed COVID 19 in the UK have overweight or obesity
  • Persons with severe obesity who become ill and require intensive care (5% of infections) present challenges in patient management which may lead to poorer outcomes – more bariatric hospital beds, more challenging intubations and ventilation, more difficult to obtain imaging diagnosis (there are weight limits on imaging machines), more difficult to position and transport by nursing staff. And like pregnant patients in ICUs, they may not do well when prone.
  • Public Health England recommends people under 70 with BMI ≥40kg/m2 at higher risk of severe illness due to COVID 19  (
  • The US Centers for Disease Control and Prevention recommend people of any age with severe obesity (BMI >40) are at high risk for severe illness for COVID 19
  • We can expect to see parallels between influenza and COVID 19. During the 2009 H1N1 pandemic, obesity was recognized as an independent risk factor for complications from influenza. People with BMI ≥ 40kg/m2 are considered by the HSE as ‘at risk’ group for influenza. Thus, it is likely that obesity will be an independent risk factor for COVID-19 (The Obesity Society, 2020


Why might people with obesity be at higher risk?
  • Obesity is linked with respiratory difficulties such as sleep apnoea, obesity hypoventiliation syndrome, asthma and cardiovascular disease which can impair oxygen levels in the blood.

  • Obesity is associated with a significantly dysregulated immune system and impaired response to both bacterial and viral illness.
  • Many people with obesity also have other chronic diseases such as diabetes or high blood pressure.
  • Obesity is linked with inflammation, which may cause a more severe inflammatory reaction in the lungs with COVID 19 infection.

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