ABSTRACT
The "obesity paradox" refers to an association between obesity and better outcomes (contrary to expected worse outcomes) . For example, lower mortality has been observed in diabetes patients with obesity compared to normal/overweight. An analytical cohort of n=5712 patients with diabetes was selected from the RUSH COVID Registry and electronic medical records data, spanning 21 months. Sociodemographic and diabetes characteristics were obtained on or before COVID diagnosis. Severe COVID was defined as fatal or requiring hospitalization. After excluding 23 cases without BMI, univariate and multivariate logistic regression with restricted cubic spline models were conducted to evaluate the association of BMI with severe COVID after adjustment for age, sex, race/ethnicity. The resulting diverse cohort included 37.6% Latino, 37.5% Black, 19.5% White, and 5.3% other;53.7% were women. Type 1 diabetes was identified in n=140, Type 2 diabetes in n=2730, and other/hybrid diabetes in n=2820. After adjustment for sex, age, race/ethnicity, diabetes type, and A1c a U-shaped relationship was observed between BMI and severe COVID with a nadir at BMI=30-45 kg/m2 (see figure) . A similar U-shaped relationship was seen in the association of fatal COVID in British diabetes patients with a nadir at BMI=25-29 kg/m2. The proposed explanation for the "obesity paradox" may be related to unintentional weight loss in diabetes patients with multimorbidity.
ABSTRACT
BACKGROUND: The COVID-19 pandemic led Malaysia to introduce movement control orders (MCOs). While MCOs were intended to slow the spread of COVID-19, the effects of such measures on the noncommunicable disease (NCD) risk factors have not been fully explored. This exploratory study aimed to understand the effect of the MCO on the eating habits and physical activity levels of the urban poor in Malaysia as well as potential health promotion interventions during the COVID-19 pandemic. METHODS: This rapid assessment used a mixed-method approach in three low-cost public flats in Kuala Lumpur targeting the B40, which is the bottom 40% of the economic spectrum. A total of 95 community members participated in a quantitative phone survey, while 21 respondents participated in a qualitative phone survey, including 12 community members and nine community health volunteers (CHVs). RESULTS: The movement restriction imposed during the MCO significantly reduced the frequency and duration of respondents' physical activity. At the same time, respondents reported significantly increased consumption of home-cooked meals. More than half of respondents reduced their consumption of packaged snack foods (53.7%), street desserts (54.7%), fast food (50.5%), soft drinks (50.5%), and 3-in-1 or instant drinks (50.5%) due to limited access during the MCO. B40 communities were receptive to potential interventions to encourage healthier eating and physical activity leveraging digital approaches under the 'new normal'. Reported concerns included internet accessibility and affordability, functionality, and digital literacy. CONCLUSION: The COVID-19 pandemic requires innovation to address diseases and risk factors at the community level. While movement restrictions reduced physical activity, they created opportunities for low-income individuals to have greater control over their diet, enabling them to adopt healthier eating habits. Lifestyle changes experienced by vulnerable populations provide an opportunity for creative and technology-enabled interventions to promote healthy eating and exercise.