If I use a CPAP machine due to my sleep apnoea and have symptoms should I use my machine more? 

If you develop COVID-19 you should follow government advice and self-isolate. You can continue using your CPAP machine if comfortable, but it is very important to self-isolate, you will need to sleep in a separate room temporarily. You can continue using CPAP as normal if you don’t have COVID-19. 

Here are the British Thoracic Society recommendations: Guidance on Coronavirus & Obstructive Sleep Apnoea.

These give more information including going into hospital for people using CPAP machines.

As a bariatric patient should I be wearing ID to inform the medical teams if I need to be intubated? 

It is always advisable to ensure that your GP medical records contain the details of your bariatric surgery especially if your surgery was not carried out by the NHS. 

Many medical I.D. tags/bracelets/necklaces are available on the high street, some mobile phones can also be used to record your medical details (this information can be accessed when the phone is locked).

If my obesity and diabetes put me at a high risk of COVID-19 complications where do I go for support? 

We would suggest your GP practice as a good first point of contact.

There is also more information that might be helpful, just click here.

When will bariatric surgery resume? 

During the  COVID-19 pandemic an international group of experts in bariatric surgery developed guidelines to help bariatric centres restart surgery and how to prioritise patients waiting for surgery.

Some bariatric surgery centres have now started to perform bariatric surgery again and we would advise that you contact your local bariatric surgery centre (if you are awaiting surgery) to ask about their own plans. However, capacity is likely to remain limited for the foreseeable future and waiting lists are likely to be substantial.

If you are not yet on a waiting list for surgery, but think you might be interested in this as an option to manage your obesity then we’d advise you speak to your GP to discuss a referral to specialist weight management services. It is usual for patients to see specialist weight management services for a year before going on a waiting list for surgery and many centres are still providing these services remotely so you could still benefit from their help and support during COVID-19.

There is so much advice on the internet and media who should I trust? 

Your first port of call for current information about COVID-19, should always be the Government website – https://www.gov.uk/coronavirus.

We know it can be really confusing with all the information available on the TV, in newspapers, social media and the internet, much of which may not always be accurate or from a reliable source. 

So we have developed this advice resource with this specific question in mind, and for this reason all the questions here have been answered by the members of the Royal College of Physicians – Nutrition, Weight & Health Committee members and Dr. Abd Tahrani, who are all experts in obesity. In addition, all links are to “Trusted Sites” that are reliable and updated in a timely manner. 

What can I do as a person living with obesity, who struggles to lose weight to help lower my risk of complications if I contract COVID-19? (are there breathing exercises I can do to strengthen my lungs)? 

Trying to eat a healthy diet avoiding high sugar drinks and sugar and fat containing snacks and with plenty of fresh fruit and vegetables will also help. If you have any obesity related diseases such as high blood pressure or Type 2 diabetes, then improving blood pressure or glucose levels might help reduce the risk of severe COVID-19. Ultimately weight loss might be needed to reduce the risk, but there is no evidence regarding this yet. No particular breathing exercises are of proven benefit. You might want to try and increase your levels of physical activity as this improves general health. 

Where should I start? I want to lose weight and be healthier.

We would suggest that you discuss this with your GP or practice nurse who can:

  • assess your general health  and how your weight has changed over the years 
  • work out if there are any health issues or medications causing you to put on weight 
  • discuss a plan to help you lose weight that suits you, including referring to specialist weight management services where available.

You may also find some of the links included in this information resource to be useful for support and ideas on managing your weight.

As I understand we are not at a higher risk of contracting the virus, but at risk of developing a more severe case and further complications. What extra precautions should we really be taking as we try to return to daily life?

Yes, you are right that there is no evidence that living with obesity increases the risk of catching COVID-19, but there is some evidence that living with obesity increases the risk of more severe COVID-19. We would advise you to follow the up to date government advice for all people in the UK: https://www.gov.uk/coronavirus.

Should those of us who are very overweight, and who have tried and failed many times to lose weight through diet / exercise, consider bariatric surgery to lessen their risk of a poor outcome if they were to contract COVID19? 

The decision to undertake bariatric surgery is a very personal and life-changing one. There is no doubt that bariatric surgery is the most effective treatment for people who live with obesity related illnesses such as type 2 diabetes, and that it is more effective than dieting and exercise alone in helping people manage obesity long-term.  But bariatric surgery should only be undertaken with plenty of support in place pre- and post- surgery to help you get the most from this tool, not just in terms of improving health and for weight management, but also in adjusting to and coming to terms with a new way of life, a new way of eating, and often new relationship with food, your body, your feelings and sometimes those around you. 

Reducing your risk from COVID-19 may be one factor that prompts you to think about bariatric surgery, but it is unlikely to be enough of a motivation on its own to go through surgery.  We don’t have evidence yet that bariatric surgery (or weight loss) reduce the risk of severe COVID-19, although we think that it will. So whether to have or not have bariatric surgery is your choice but this is not dependant on the COVID-19 pandemic. If you are eligible to have bariatric surgery and you are keen on this option, then you need to be referred to the appropriate team to support you in making that decision and we would advise you to start by discussing this with your GP.

Should someone with a high BMI be shielding? 

The details of people who are advised to be shielding can be found here: Guidance on Shielding and Protecting People.

At the moment BMI status alone is not included in the list. However, if you have other health problems you may need to shield, so we would advise you to check the list on the link if you think this may apply to you. We know that people with higher BMI as well as those of older age and with some health problems such as diabetes are more vulnerable to having severe COVID-19, but at present these groups are not advised to shield. Please note that this advice may change in the future.

There is always a sub reference to obesity being a risk factor – where on the scale of risk is obesity? 

Current evidence from studies during COVID-19 (e.g from the OpenSAFELY study) suggests the risk is about double for those with a BMI greater than 40 kg/m2 compared with someone with a BMI ≤ 25 kg/m2. This is equivalent to the risk of uncontrolled diabetes.

Should I be taking vitamin D supplements to protect me from Covid-19?

  • Vitamin D is important to keep bones, teeth and the immune system (the body’s defence against infections) healthy. 
  • Most of our vitamin D is made in the body by the action of sunlight on the skin, and in countries like the UK, the amount of sunlight in autumn and winter months can be too low to keep vitamin D levels up. Some foods (like egg yolks, margarine, some breakfast cereals, oily fish) also contain vitamin D but not enough to meet our needs without making it in the body through sunlight on the skin. 
  • During COVID 19, there has been much interest in whether vitamin D can help protect against infection or reduce the severity in those who already infected. 
  • The current advice is to include vitamin D containing foods within a healthy balanced diet, to safely expose your skin to sunlight daily and if this is not possible or for those at high risk (including those with obesity) to take a daily supplement of 400IU daily, to remain active and try to maintain a healthy weight, and to follow national guidance to limit the spread of COVID-19.
  • A high dose should not be taken without medical advice and supervision. This is because vitamin D is stored in fat tissues in the body and too much accumulating over time can be harmful. Therefore we would advise you to discuss with your GP who can test your level if appropriate as well as advise on the dose to take.
  • General advice on Vitamin D and COVID 19 is available on the British Dietetic Association website, click here

In relation to COVID-19, what would be the advice to someone living with obesity to keep well in the short term?

We would advise to keep following the government up to date advice Government Guidance & Advice.

We would also advise you to try and have as healthy a diet as possible and to be as physically active as possible. You may find some of the other questions and answers here helpful.

The newspapers talked about Boris wanting to help “banish the bulge” or whatever crass language was used, after he recovered from Covid-19. Have healthcare workers heard anything about new initiatives being put in place to offer more support to people living with obesity?

The government recently announced the new Obesity Strategy, which can be found on this link: Government Obesity Strategy 2020.

When are the private hospitals likely to open up again?

During COVID-19 an international group of experts in bariatric surgery developed guidelines to help bariatric centres restart surgery and how to prioritise patients waiting for surgery.

Some bariatric surgery centres have now started to perform bariatric surgery again and we would advise that you contact your bariatric surgery centre to ask about their own plans. However, capacity is likely to remain limited for the foreseeable future and waiting lists are likely to be substantial. We would advise that wherever your surgery is performed (private or NHS hospital) good preparation for your surgery and long term follow-up are both very important.

If you are not yet waiting for surgery, but think you might be interested in this as an option to manage your obesity then we’d advise you speak to your GP to discuss what specialist weight management services might be available to you both in private and NHS hospitals, Many centres are still providing some services remotely so you could still benefit from their help and support during COVID-19 while awaiting surgery.

I have asthma and I was recently told at my asthma review that my weight (BMI 46) was effectively ‘squeezing’ my lungs and making it more difficult for me to breathe, I’m also pre-diabetic.

We understand your concern and we agree that your health conditions will put you at potentially increased risk. Nonetheless, we will strongly recommend following the government guidance and social distancing to keep the risk as low as possible.

I’ve read all the data I can find online and it seems to suggest that the less excess weight you carry the better the outcomes so any weight loss will likely be helpful and the more the better. Many of the risk factors can’t be changed, but as weight can be I’ve been giving it my best efforts.

Well done on your weight loss; as you know weight loss has many health benefits as well as benefits on quality of life. Whether weight loss improve Covid-19 outcomes is currently unknown.

Are we classed as high risk if BMI is over 40 as I’ve not been notified but had seen it on government page? Are there high numbers of people with high BMI dying of this?

The government guidance includes people with BMI over 40 as a vulnerable group, but not extremely vulnerable, which is the group that has been advised to shield. People with obesity compared to normal weight people are at increased risk of being infected with COVID-19, of being admitted to hospital, of requiring ventilation and of dying.

I’m finding the idea of being lighter helping my chances of survival quite motivating and wanted to know if I continue to lose will it help?

Well done on your weight loss; as you know weight loss has many health benefits as well as benefits on quality of life. Whether weight loss improve Covid-19 outcomes is currently unknown.

I’m 44, BMI 37, no comorbidities and fairly fit as I ordinarily go to the gym multiple times per week. I know that emerging data suggests that obesity alone (i.e. irrespective of whether there are other comorbidities too) predicts poorer outcomes in terms of coronavirus, any idea of how much excess risk my weight will put me at? I work in the NHS and have direct contact with COVID positive patients for context. For this reason, the risk I carry has been on my mind a fair bit lately, and I’m currently trying to lose more weight.

You are correct. Obesity alone increases the risk of developing severe COVID-19 and of dying. The risk is linear, by this we mean the higher a person’s BMI the greater their risk. A large study from the UK showed that for people with a BMI of 40 or more the risk of dying was twice that of people with normal weight. However, this is an average risk. An individual’s risk will depend on their health and maintaining a healthy diet, being physically active and getting adequate sleep are likely to reduce these risks.

Obesity & COVID-19 – why are people with a BMI of 40 at greater risk?

Obesity alone increases the risk of developing severe COVID-19 and of dying. The risk is linear, by this we mean the higher a person’s BMI the greater their risk. A large study from the UK showed that for people with a BMI of 40 or more the risk of dying was twice that of people with normal weight. However, this is an average risk. An individual’s risk will depend on their health and maintaining a healthy diet, being physically active and getting adequate sleep are likely to reduce these risks.

We don’t know exactly why obesity increases the severity of COVID-19 as this is a new infection and we are still learning about the effect it has on people. Some of the current theories (ideas) being explored at the moment can be found here. However, more research is needed to better understand how obesity affects COVID-19 and to explore these theories further.

Further information and resources: