The National Task Force for tackling Covid-19 is vetting a proposal to conduct a research study to understand the links between obesity and the deadly disease.

“On Thursday, we are vetting close to 25 research proposals, of which a recommendation to study the links of obesity to Covid-19 is also included. If the recommendation gets approved, then a multi-centric research will be expedited on this topic,” said a member of the task force, who did not wish to be named.

Currently, recording height and weight, usually referred to as anthropometric data, to calculate the body mass index (BMI) of a patient, is not a routine practice in India. This data is not being collated by the Indian Council of Medical Research (ICMR) as a part of coronavirus surveillance.

The American model

“In the US, though, hospitals fill in electronic records and digitise this basic data, which has helped them form links between obese people being at higher risk for Covid-19. But in the Indian context, this practice is not necessarily followed by clinicians and we believe that a study is needed to link these outcomes,” said the task force member.

India has recorded cases of persons under 60 who are obese having been infected with the coronavirus or having died due to the infection.

For instance, 31-year-old Parth Shah (name changed) from Vadodara, who succumbed to Covid-19 on April 16, weighed 111 kg. “On April 15, he developed breathlessness and was rushed to a nearby hospital. He passed away the next day, while on ventilator. The test result that he was Covid-19 positive arrived nearly four hours after he died,” said a relative of Shah. Shah’s wife, who weighs close to 100 kg, and has also tested positive, but her condition is stable.

Anurag Bhargava, Professor, Department of Medicine of Mangaluru-based Yenepoya Medical College, explained that while links are being drawn between the young dying of Covid-19 having pre-existing co-morbidities like high blood pressure, heart ailments and diabetes, obesity as an underlying factor, which is linked to these co-morbidities, has not been closely looked at.

“In the previous H1N1 pandemic, meta-analysis of data revealed that those with BMI over 30 were at 2.9 times higher risk of death, and risk was particularly high in morbidly obese persons. Now, evidence is also emerging on the association of obesity with severe Covid-19,” he added.

Bhargava’s commentary on the potential link between Covid-19 and obesity is scheduled to appear in Current Science journal.

Cytokine storm

Research suggests, said Bhargava, that more adipose tissue in the obese aids in the onset of a cytokine storm, which is a potentially deadly inflammatory response to the viral infection, that is primarily believed to worsen Covid-19 cases. The commentary noted that obese individuals also have low levels of adiponectin, a protein hormone involved in regulating glucose and aiding fatty acid breakdown, which suppresses the cytokine production.

“Obesity and infections such as Covid-19 may activate the same inflammatory pathways and this additive effect of obesity can induce a cytokine storm in those infected with the virus. There is also a link between obesity and higher risk of thromboembolism, which is the formation of blood clots in the lungs, an effect also observed in Covid-19, which leads to risk of death,” said Bhargava.

He further observed that in the current pandemic, information on nutritional status has been missing in most clinical reports, as has been a systematic review of co-morbidities. “Data is sparse in the Indian context. BMI may be one variable linked to variable mortality rates. We may miss the association of BMI with disease outcomes in the current pandemic unless the current case record forms and the survey tools of the World Health Organisation add information on weights and heights which could even be self reported in the case of sick patients,” he added.

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