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        "titulo" => "Obesidad y COVID-19&#46; Un posicionamiento necesario"
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">This position paper has arisen as an initiative of the Sociedad Espa&#241;ola de Endocrinolog&#237;a y Nutrici&#243;n &#40;SEEN&#41; &#91;Spanish Society of Endocrinology and Nutrition&#93;&#44; through their Obesity Working Group &#40;GOSEEN&#41;&#44; and the Sociedad Espa&#241;ola para el Estudio de la Obesidad &#40;SEEDO&#41; &#91;Spanish Society for the Study of Obesity&#93;&#44; with the aim of making it known to the general population&#44; and to health authorities&#44; that people with obesity are part of a group at high risk of coronavirus infection and poor prognosis in the progression of the disease&#44; based on scientific evidence&#46; Other entities involved in the care of these patients have adhered to this position&#58; the Sociedad Espa&#241;ola de Cirug&#237;a de la Obesidad &#40;SECO&#41; &#91;Spanish Society of Obesity Surgery&#93;&#44; the Sociedad Espa&#241;ola de Medicina Interna &#40;SEMI&#41; &#91;Spanish Society of Internal Medicine&#93;&#44; the Sociedad Espa&#241;ola de Diet&#233;tica y Nutrici&#243;n &#40;SEDYN&#41; &#91;Spanish Society of Dietetics and Nutrition&#93;&#44; the Sociedad Espa&#241;ola de M&#233;dicos de Atenci&#243;n Primaria &#40;SEMERGEN&#41; &#91;Spanish Society of Primary Care Physicians&#93;&#44; the Sociedad Espa&#241;ola de Medicina Familiar y Comunitaria &#40;semFYC&#41; &#91;Spanish Society of Family and Community Medicine&#93; and the Sociedad Espa&#241;ola de M&#233;dicos Generales &#40;SEMG&#41; &#91;Spanish Society of General Practitioners&#93;&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">It is our intention to demonstrate that obese patients belong to a vulnerable group that requires greater emphasis on the prevention of infection&#44; close monitoring in case of infection and caring for their health and psychological needs&#44; and therefore&#44; that they should be considered a priority group in the recently started vaccination campaign&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">People with obesity are not only affected by the pandemic due to the fact that they constitute a risk group&#44; but also because of the consequences to their physical and psychological health derived from the mobility restriction measures&#44; the disruptions and delays in healthcare&#44; as with other chronic diseases&#44; and the difficulty of access to bariatric surgery&#44; among others&#46; In this context&#44; the COVID-19 pandemic collides with the obesity pandemic&#44; amplifying the deleterious effects of each of them in a bidirectional way&#44; as will be explained below&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Obesity as a risk factor for worse progression of COVID-19</span><p id="par0020" class="elsevierStylePara elsevierViewall">People with obesity have a 46&#37; higher risk of infection by SARS-CoV-2&#44; compared to people of normal weight&#46; In the event they contract COVID-19&#44; they present twice the risk of requiring hospitalisation&#46; In addition&#44; the risk of severity also increases in people with excess weight&#44; ICU admissions increase by 73&#37; and the need for assisted mechanical ventilation by 69&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> It has been proven that worse prior conditions regarding cardiorespiratory training &#40;cardiorespiratory fitness&#41;&#44; nutritional status and muscular functional status &#40;sarcopaenia&#41;&#44; contribute to a worse evolution of COVID-19&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Unhealthy dietary habits and less physical activity in people with obesity condition a worse immune response and a greater risk of malnutrition and sarcopaenia in the event of coronavirus infection&#46; The chronic inflammatory situation caused by obesity and aggravated by COVID-19 worsens respiratory muscle function and capacity to respond to hypoxia&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">If in addition to the situation of sarcopaenia associated with age and obesity we add the conditions derived from COVID-19 infection&#44; such as anorexia&#44; anosmia&#44; dysgeusia&#44; nausea&#44; vomiting and diarrhoea&#44; it facilitates a progressive malnutrition related to the disease&#46; Thus&#44; the unfavourable combination of sarcopaenia and malnutrition is much more common &#40;and easily overlooked&#41; in people with obesity&#44; which undoubtedly contributes to increasing the severity of COVID-19 infection&#46;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#44;5</span></a> Other conditioning factors associated with obesity&#44; such as the increased risk of thrombosis&#44; poor control of metabolic comorbidities such as diabetes&#44; hypertension or dyslipidaemia&#44; contribute to a worse progression of COVID-19&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Effects of restricted mobility on the health of people with obesity</span><p id="par0035" class="elsevierStylePara elsevierViewall">During the lockdown&#44; between April and May 2020&#44; the combination of a higher food intake and a sedentary lifestyle was the most common rationale for the weight gain that affected almost half of the Spanish population&#44; which ranged between 1 and 3&#8239;kg&#46; Among the risk factors associated with the weight gain during the lockdown&#44; female sex&#44; younger age&#44; previous excess weight and having been locked down in southern Spain should be highlighted&#46; Furthermore&#44; living in small apartments&#44; having a lower level of education and low income are associated with a greater probability of gaining weight&#46; A &#8220;halo effect&#8221; was also observed&#44; in that there was a weight increase in 44&#46;6&#37; of the people around those who had gained weight&#46; After the first few weeks&#44; the purchase of high calorie products such as alcoholic beverages&#44; sweets and snacks increased by more than 50&#37;&#46; Additionally&#44; the lockdown limited access to sports centres and made it difficult to do physical activity outdoors&#44; which together with the lack of routine exercising at home&#44; greatly hindered the ability to maintain an active lifestyle&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Finally&#44; not knowing that obesity is a poor prognostic factor in COVID-19 is also related to having limited knowledge about the harmful health consequences of excess weight&#46; This lack of knowledge is greater in young people under 24 years of age&#44; in those who have gained more than 3&#8239;kg and in people with fewer financial resources&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Although children and adolescents are groups at lower risk of developing serious illness from COVID-19&#44; they are affected by the familial&#44; educational and social repercussions of the pandemic that ultimately promote obesity&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Psychological impact of the pandemic on patients with obesity</span><p id="par0050" class="elsevierStylePara elsevierViewall">The association between obesity and mental health disorders is a well-known phenomenon&#46; The prevalence of depression is at least 25&#37; higher among people with obesity&#44; who also have a higher risk of anxiety and eating disorders&#46; There is a two-way relationship between obesity and depression&#46; Therefore&#44; obesity&#44; especially severe obesity&#44; is a predisposing factor for mental illness&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">In this context&#44; the outbreak of the COVID-19 pandemic&#44; with particularly harmful effects in people with obesity&#44; has heightened mood disturbances&#46; These disturbances translate into social isolation&#44; stress&#44; sleep deprivation and chronodisruption&#44; sedentary lifestyle and eating disorders&#44; including increased alcohol intake and the appearance of other addictions&#44; all of which are factors that are also implicated in the development of obesity&#46; Fear of infection for oneself and for close relatives over the course of outbreaks has a relevant effect on mental stress&#46; Isolation is especially impactful in elderly people&#44; and even more so if they have dementia&#44; as they feel disconnected from their family environment and from their usual health monitoring&#44; which increases the risk of physical and mental deterioration&#46; The changes in work activity caused by the pandemic increase unemployment and stress&#44; with the consequent increase in the socioeconomic gap that contributes to the obesogenic environment&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9&#44;10</span></a></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Impact of delayed access to bariatric surgery on people with obesity</span><p id="par0060" class="elsevierStylePara elsevierViewall">During the current situation arising from COVID-19&#44; many surgical procedures have been suspended&#44; among them&#44; bariatric surgery&#46; In addition to the need to reorganise resources to cope with the pandemic&#44; surgery in patients with COVID-19 presents a high risk of complications&#46; Reorganisation of healthcare services should include planning for bariatric surgery&#44; as delays can have serious or fatal consequences&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">11&#44;12</span></a> Up to 50&#37; of patients on the bariatric surgery waiting list develop a new complication of obesity and 1&#46;5&#37; die while waiting for the surgery&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> Furthermore&#44; weight loss and the improvement of complications associated with obesity after bariatric surgery can reduce the risk of severe illness if they contract COVID-19&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">Thus&#44; in addition to the need to treat cases of complications from a previous bariatric surgery&#44; it is recommended that priority be given to patients with poor control of comorbidities &#40;diabetes&#44; sleep apnoea&#44; etc&#46;&#41; and to those in whom obesity contraindicates performing another vital treatment&#44; such as a transplant&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">In general&#44; a waiting list time of no more than six months should be guaranteed for surgeries for benign pathologies&#46; However&#44; in the case of bariatric surgery&#44; this time is much longer&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> The restart of bariatric surgery has been relegated to the bottom of the list of elective surgical procedures&#44; indicating inequity&#44; systematic bias and discrimination towards people with obesity&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">It is also possible that the drop in health monitoring has also affected patients previously treated with bariatric surgery&#44; who are at high risk of nutritional deficiencies&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Furthermore&#44; the COVID-19 pandemic has led to the cancellation and&#47;or delay of consultations planned for the evaluation and treatment of obesity&#44; both in primary and specialised care&#46; As a consequence&#44; the exposure time to obesity and its metabolic and non-metabolic complications will increase&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">People with obesity&#44; a priority group for vaccination against COVID-19</span><p id="par0085" class="elsevierStylePara elsevierViewall">For all the reasons stated above&#44; people with obesity&#44; especially those with higher degrees &#40;BMI &#8805;35&#8239;kg&#47;m<span class="elsevierStyleSup">2</span>&#41;&#44; should be considered a priority group for vaccination against COVID-19&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Funding</span><p id="par0090" class="elsevierStylePara elsevierViewall">No funding was received for drafting this position paper&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Conflicts of interest</span><p id="par0095" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflict of interest related to this publication&#46;</p></span></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Bret&#243;n I&#44; de Hollanda A&#44; Vilarrasa N&#44; Rubio Herrera MA&#44; Lecube A&#44; Salvador J&#44; et al&#46; Obesidad y COVID-19&#46; Un posicionamiento necesario&#46; Endocrinol Diabetes Nutr&#46; 2021&#59;68&#58;573&#8211;576&#46;</p>"
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