Controlled obesity status: a rarely used concept, but with particular importance in the COVID-19 pandemic and beyond

Abstract

Obesity is a chronic disease that causes and aggravates several other diseases, and early reports suggest it is an important risk factor for COVID-19 severity. Although a deeper understanding of this relationship is vital, it is also important to inform the general public about the risks and, ideally, offer strategies to mitigate the risks. As “resolution” of obesity in the short-term is not feasible, it is indeed possible that smaller weight losses and increase in physical activity can actually reduce the risks. In this context, we propose that a term called “controlled obesity” be more often used and studied, in which those who have lost over 10% of their maximal weight and, ideally, are physically active are considered healthier. This context can have much broader usefulness, beyond the pandemics, as evidence points that weight loss over 10% can significant reduce overall health risks, irrespective of final BMI.

Obesity and COVID‐19 in Latin America: A tragedy of two pandemics—Official document of the Latin American Federation of Obesity Societies

“…As a chronic disease, obesity cannot be reversed in the short term and many have pointed out that awareness of the relationship between obesity and COVID‐19 severity can lead to fear and panic 74–76 . However, there is evidence that modest weight loss can lead to several health benefits 96,97 . This evidence regarding reduced severity of infection is almost nonexistent, but biological plausibility exists.…”

“…In a recent review, Lockhart and O'Rahilly suggest that IR is a major driver of increased risk, and if true, modest weight loss can improve it within days 7 . The concept of ‘controlled obesity’ could be a simple message as well amidst the pandemic and beyond 97 . We are aware, however, that even modest weight losses can be difficult to achieve, and the main focus is to inform that the absolute increase in risk posed by obesity can be at least partially modifiable.…”

“…Greater weight losses (11%–16%) can reduce inflammation and would probably have further clinical benefits, 96,97 but this is hard to achieve without proper treatment, and the implementation of a multidisciplinary approach and telemedicine access should be provided to those who seek clinical advice. On the other hand, those patients who have already achieved significant weight loss in the past and are successful maintainers (including those who underwent bariatric surgery) could be reassured that their risk is likely lower at their reduced body weight and that they should continue their efforts in weight maintenance 90 .…”

“…Several other questions emerge regarding food quality, psychological health and effective ways to encourage PA 64,65,97,102–104 ; some of them are listed in Table 3.…”

Proposal of an obesity classification based on weight history: an official document by the Brazilian Society of Endocrinology and Metabolism (SBEM) and the Brazilian Society for the Study of Obesity and Metabolic Syndrome (ABESO)

“…"Resolution" of obesity is rarely achieved with clinical treatment. Indeed, a substantial number of studies have clearly shown that clinically achievable weight loss reduces health risks independent from the final weight (13)(14)(15). Several guidelines worldwide recommend a weight loss of 5%-10% (3,(16)(17)(18)(19), but no guideline, as far as we know, has proposed to identify and classify individuals who had lost weight in the past and were able to maintain the loss.…”