The World Health Organization declared COVID-19 a global pandemic in March 2020. As time went on, a number of conditions were linked to more severe symptoms and hospitalization including age and a diagnosis of hypertension, diabetes, or cardiovascular disease [mfn]https://pubmed.ncbi.nlm.nih.gov/32217618/[/mfn].
Furthermore, the European Association for the Study of Obesity identified overweight as an independent risk factor. These experts found that obesity was likely to lead to greater illness, increased complications, and a greater need for intensive care treatment.
Bariatric surgery has proven to be an effective way to treat obesity in adults and adolescents. However, the pandemic disrupted healthcare systems across the globe in several ways and one key development was that surgeries considered elective were canceled or rescheduled.
Weight-loss surgery fell into this category. However, it was argued that this shouldn’t be the case since obesity and its related comorbidities were linked to more severe COVID-related outcomes.
In this article, we’ll look at some of the research into bariatric surgery and the novel coronavirus which has emerged so far. First, let’s review how bariatric surgery was approached at the start of the pandemic.
Weight-Loss Surgery Considered Elective
In many countries, bariatric surgery was canceled or delayed for patients since it was deemed optional rather than medically necessary. However, in an article published in Obesity Surgery, The University of Minnesota’s Henry Buchwald suggested that metabolic surgery should be seen as urgent and performed as soon as feasible.
The author pointed out that surgery transforms morbid obesity into lesser obesity, overweight, or even normal weight. It also helps to address related conditions such as type 2 diabetes, hypertension, and hyperlipidemia which can all lead to atherosclerotic cardiovascular disease.
Buchwald also noted that bariatric surgery can reverse non-alcoholic steatohepatitis, restore normal menstruation and reproductive function, and improve mental ability.
In addition, he saw the surgery as curative since it can reverse obesity when combined with lifestyle changes. As a result, Buchwald says it is “reasonable to assert that it is lifesaving”.
He pointed out that COVID-19 is most severe and more likely to cause death in individuals who are older and those with certain risk factors.
While age can’t be changed, obesity and its comorbidities such as type 2 diabetes, cardiovascular diseases, and hypertension can be treated with surgery.
Weight Loss Following Metabolic Surgery May Reduce COVID-19 Severity
Multiple studies show that people who undergo bariatric surgery may be better protected against severe COVID-19 symptoms than individuals with obesity who have not undergone surgery.
One group of researchers found that people with obesity who lost significant weight – even via surgery – gained some protection against severe COVID-19 outcomes [mfn]https://jamanetwork.com/journals/jamasurgery/fullarticle/2787613[/mfn].
This cohort study involved adults with a body mass index of 35 or higher who had weight loss surgery between January 1, 2004, and December 31, 2017, at the Cleveland Clinic Health System.
Steven E. Nissen, MD and his colleagues found that people who had bariatric surgery prior to the pandemic returned a similar rate of positive COVID-19 test results as people with a similar baseline body mass index who hadn’t undergone surgery.
How the Two Groups Differed
While the patients who had surgery still had a mean BMI that was in the obese range when they tested positive, they had almost half the risk of being hospitalized as the control group. The latter had a mean BMI of 46.3.
The individuals who had weight-loss surgery were 63 percent less likely to need supplemental oxygen and 60 percent less at risk of having a severe case of COVID-19.
The researchers also suggested that the additional benefits of bariatric surgery helped to improve outcomes for patients. These include improved breathing and lung function and a reduction in comorbidities such as sleep apnea, hypertension, and cardiovascular disease.
Support for These Findings
Another study determined that prior bariatric surgery reduced the risk of admission to the emergency room, extended stay in the intensive care unit, mechanical ventilation, and death in COVID-positive patients.
These researchers carried out a cross-sectional retrospective analysis of a New York City-based academic institution’s COVID-19 database.
A cohort of 124 COVID-19-positive patients with a history of bariatric surgery was compared to a control cohort of COVID-19-positive patients who were eligible for surgery but hadn’t undergone it.
Megan Jenkins and colleagues found that even when they adjusted for BMI and obesity-related co-morbidities, patients who had bariatric surgery still had a significantly lower risk of being admitted to the emergency room.
An Italian Perspective
Meanwhile, Italian researchers found that individuals who underwent bariatric surgery seemed to contract less severe COVID-19 infection than those eligible but still suffering from obesity.
They conducted a telephone survey among 594 patients from six major bariatric centers in Emilia-Romagna from April to August 2020. The analysis ultimately included 353 individuals who had undergone surgery and 169 obese individuals who had not had an operation.
The rate of COVID-19 was almost the same across the two groups.
However, people who had bariatric surgery showed a lower incidence of most COVID symptoms including loss of smell, alteration in taste, and rapid onset of fever. Hospitalization was more likely in individuals who had not undergone weight loss surgery.
Why These Findings Are Significant
In commenting on the results of the Cleveland Clinic Health System study, Paulina Salminen, MD, PhD, of the University of Turku in Finland and colleagues said that research should reframe the way bariatric surgery is viewed, particularly during the pandemic.
This team recommended that metabolic surgery be seen as medically necessary rather than elective.
They pointed out that in many countries, weight-loss surgery was being seen as something that could be postponed without severe consequences.
However, the researchers said such an approach ignored the fact that severe obesity was both “life-limiting” and “life-threatening”.
They also described obesity and COVID-19 as an “intertwined double pandemic”.
Patients Scheduled for Bariatric Surgery During the Pandemic Were Adamant About Getting It
Many people were hesitant about going to the hospital or visiting a doctor’s office during the pandemic.
According to a 2020 study published in the Morbidity and Mortality Weekly Report, an estimated 41 percent of adults in the United States delayed or avoided urgent, emergency, or routine medical care because of COVID-19 concerns.
However, many patients who were desirous of getting bariatric surgery were determined to get it even during the pandemic.
A national survey was conducted online to assess the impact of the pandemic on patients’ decisions to get weight-loss surgery.
Information was collected from 906 bariatric patients from April 9, 2020, to April 28, 2020.
Despite the risk of becoming infected by COVID-19, 443 individuals or 48.9 percent of the respondents decided to undergo surgery.
The researchers determined that bariatric patients had a high level of awareness about the advantages of undergoing weight-loss surgery.
The majority of those awaiting an operation at the time of the survey were positive about it even though they would be at increased risk of infection.
According to the researchers, a large proportion of patients was determined to get treatment even in the midst of the pandemic since they were aware that obesity and related disease increased the likelihood of severe COVID-19 symptoms.
Talk to the Team at Renew Bariatrics If You Want to Address Your Obesity
The research points to a clear link between obesity and worsened outcomes following a diagnosis of COVID-19. However, it’s also apparent that weight loss can significantly reduce the likelihood of severe disease.
If you’ve been considering bariatric surgery, reach to our weight loss experts to schedule a consultation and learn how we may be able to help you improve your health.