The Obesity Society Issues New Position Statement on COVID-19 Vaccines

Vaccines such as Pfizer, Moderna, Johnson & Johnson and AstraZeneca are designed to prevent severe Coronavirus-19 disease (COVID-19) due to the acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and are highly effective. Efficacy is not different in obese and non-obese people, except for AstraZeneca, which is unknown, according to a new position statement from The Obesity Society (TOS), the leading scientific membership organization promoting the science-based understanding of the causes, effects, prevention and treatment of obesity.

Studies have shown high efficacy in individuals with and without obesity against COVID-19-associated hospitalization and death. Therefore, TOS encourages obese individuals to be vaccinated as soon as possible with one of the available vaccines approved by the US Food and Drug Administration for emergency use.

“Analysis of the efficacy of the COVID-19 vaccine in certain disease subgroups has been difficult because the number of trial participants with the disease was too small. This was not true for obesity. Because the prevalence of obesity among study participants was high and because obesity is highly associated with hospitalization and death in COVID-19, the study results were able to show that, contrary to concerns about reduced vaccine efficacy in obese people, , that the vaccines were just as effective in obese individuals as compared to non-obese individuals,” said Alexandra M. Hajduk, PhD, MPH, an epidemiologist and associate research scientist in the Department of Internal Medicine (Geriatrics) at Yale School of Medicine. in New Haven, Conn. Hajduk is one of the co-authors of the position statement.

Obesity disease is a recognized risk factor for increased morbidity and mortality in individuals with COVID-19 after infection with the SARS-CoV-2 virus. In addition, obesity is associated with conditions that are independent risk factors and predictors of death from COVID-19, including diabetes, cardiovascular, cerebrovascular and lung diseases.

Due to the increased prevalence of serious illness, hospitalization and death, the Centers for Disease Control and Prevention (CDC) identified obesity as a body mass index (BMI) ≥30 kg/m2 as a high-risk medical condition in the COVID-19 pandemic . On December 20, 2020, the CDC’s Advisory Committee on Immunization Practices recommended that individuals ages 16-64 who are obese should be prioritized for vaccination in Phase 1c of the phased assignment to provide guidance for federal, state, and local jurisdictions where vaccine supply was limited.

Authors of the position statement wrote the paper in response to published literature, as well as questions from patients, health care providers, members of the Society, policymakers and others about the efficacy of vaccines in obese individuals against SARS-CoV-2.

“In addition to common misconceptions about obesity disease, speculation about the effectiveness of COVID-19 vaccines in obesity has certainly contributed to vaccine hesitancy in obese individuals. I hope this position statement will not only encourage people with and without obesity to get vaccinated, but also continue conversations about the existing weight bias in our current health policies and the poor coverage and reimbursement of effective treatments for obesity,” said lead author, W Scott Butsch, MD, MSc, director of obesity medicine at the Cleveland Clinic’s Bariatric and Metabolic Institute in Ohio.

In their review, the authors found the following based on each of the vaccines:

Pfizer: In a subgroup analysis of the 13,218 obese participants (BMI ≥30 kg/m2, 31.5% of the study cohort), vaccine efficacy was 95.4% among obese participants compared to 94.8% among non-obese participants . Further stratification by age revealed vaccine efficacy in younger adults (16-64 years) obese (94.9%) and older adults (age ≥65) obese (100%).

Modern: A subgroup analysis of severely obese participants (BMI ≥40 kg/m2; 6.5% of cohort) demonstrated vaccine efficacy of 91.2%, with only one case of severe COVID-19 disease identified among 901 participants with severe obesity, compared with 11 cases among 884 participants in the severely obese placebo group. Post-hoc analysis reported a vaccine effectiveness of 95.8% for obese participants (BMI ≥30 kg/m2; 34.5 percent of the cohort), with 2 COVID-19 cases in the vaccine group and 46 in the placebo group.

Johnson & Johnson: There were 12,492 participants (28.5% of the cohort) with obesity (BMI ≥30 kg/m2) in the study. Vaccine efficacy 14 days after dose one was 66.8% and 65.9%, 28 days after dose one compared to placebo in participants with a BMI 30 kg/m2. There were no deaths attributable to COVID-19 in the vaccine group, while 6 out of 7 deaths from COVID-19 in the placebo group were among obese participants.

AstraZeneca: Obese participants (BMI ≥30 kg/m2) made up 19.4% and 20.3% of each study cohort and were the most common comorbid condition. In an interim subgroup analysis of participants with one or more comorbidities, vaccine effectiveness was 73.4%, but in the updated subgroup analysis, vaccine effectiveness was 62.7%. Specific data on the efficacy and safety of vaccines in obese individuals have not yet been published.

The following recommendations are currently endorsed by TOS regarding vaccine efficacy in obese individuals:

TOS has confidence in the FDA-approved vaccine trials, and the CDC’s Advisory Committee on Immunization Practices has updated interim recommendations for vaccine allocation in the US populations indicated, including those individuals who are obese and severely obese. TOS recommends that obese individuals be vaccinated for COVID-19 prevention, in line with CDC recommendations, as obesity is clearly associated with an increased risk of a more severe course of COVID-19 disease and death. There is no definitive way to determine which COVID vaccine is “best.” Current FDA-approved COVID-19 vaccines from Pfizer, Moderna, and Johnson & Johnson were all highly effective against COVID-19-associated hospitalization and death in studies, and were found to be as effective in obese individuals as they were in normal-weight individuals. weight. TOS advises obese individuals to accept any available vaccination. Publication of the long-term efficacy results of vaccines, stratified by obesity status, in peer-reviewed journals is needed and strongly encouraged. Currently, available peer-reviewed data do not support the hypothesis of reduced humoral responses to the SARS-CoV2 vaccine in obese people. TOS recommends considering obesity (BMI >30kg/m2) and severe obesity (BMI ≥40kg/m2) as a significant risk of more severe course and outcome of COVID-19 when developing care plans for patients with COVID-19. 19. TOS is a strong supporter of evidence-based weight management therapies that support healthy BMI and the promotion of COVID-19 prevention strategies, including prioritizing vaccines. TOS strongly advocates policies that ensure access to such treatments, including adequate and equitable coverage for behavioral, medical, device and surgical treatments for obesity.

TOS plans to monitor emerging vaccine efficacy data and will release an updated evidence-based position statement in the future.

“As new, more transmissible variants of SARS-CoV2 emerge, including the Delta variant, vaccination efforts to help limit the spread of disease become even more urgent. These vaccines work in individuals with and without obesity. We want to end this pandemic. Let’s make sure we get vaccinated,” said Catherine Kotz, PhD, FTOS; professor, University of Minnesota (Integration Biology and Physiology), associate director of research, Geriatric Research, Education and Clinical Care, Minneapolis VA Health Care System; and president of The Obesity Society. Kotz is co-author of the position statement.

“Collecting data on obesity and the risk of the severity of COVID-19 is shocking, alarming and tragic. As obese individuals are at greater risk of severe COVID-19, in a sense they have even more to gain from getting vaccinated, avoiding heartbreaking outcomes. By getting vaccinated we protect ourselves and each other; let’s get vaccinated!” says Ania M. Jastreboff, MD, PhD, associate professor, Yale University School of Medicine, an endocrinologist and physician-scientist in obesity medicine and vice chair of the TOS Clinical Care Committee. Jastreboff is the senior author of the position statement.

Reference: “COVID-19 Vaccines Are Effective in Obese People: A Position Statement from The Obesity Society” Jul 7, 2021, Obesity.

Other authors of the position statement include Michelle I. Cardel, of WW International, Inc., New York, NY; William T. Donahoo of the Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, Gainesville, and Department of Medicine, University of Florida College of Medicine, Gainesville; Theodore K. Kyle of ConscienHealth, Pittsburgh, Pa.; Fatima Cody Stanford of Massachusetts General Hospital, Department of Medicine (Neuroendocrine Unit), Department of Pediatrics (Division of Endocrinology), Nutrition Obesity Research Center at Harvard, Harvard Medical School, Boston, Massachusetts; and Lori M. Zeltser of Naomi Berrie Diabetes Center, Department of Pathology & Cell Biology, Columbia University Irving Medical Center, New York, NY.