Obesity and COVID-19 in Latin America: A tragedy of two pandemics—Official document of the Latin American Federation of Obesity Societies
Corresponding Author
Bruno Halpern
Executive Committee, Latin American Federation of Obesity Societies (FLASO), Executive Committee, Santo Domingo, Dominican Republic
Obesity Group, Department of Endocrinology, University of São Paulo, São Paulo, Brazil
Weight Control Center, Hospital 9 de Julho, São Paulo, Brazil
Correspondence
Bruno Halpern, Obesity Group, Department of Endocrinology, University of São Paulo, Rua Alves Guimarães 462 CJ 72/73, São Paulo, Brazil.
Email: [email protected]
Search for more papers by this authorMaria Laura da Costa Louzada
School of Public Health, University of São Paulo, São Paulo, Brazil
Center of Epidemiology Research on Nutrition and Health, University of São Paulo, São Paulo, Brazil
Search for more papers by this authorPablo Aschner
Javeriana University School of Medicine, San Ignacio University Hospital, Bogotá, Colombia
Search for more papers by this authorFernando Gerchman
Internal Medicine Department, Post-graduate Program in Medical Sciences: Endocrinology, Universidade Federal do Rio Grande do Sul. Endocrine and Metabolism Division, Hospital de Clínicas, Porto Alegre, Brazil
Search for more papers by this authorImperia Brajkovich
Department of Internal Medicine B—School of Medicine “Luis Razetti”, University Hospital of Caracas—Universidad Central de Venezuela, Caracas, Venezuela
Search for more papers by this authorJosé Rocha Faria-Neto
Center for Clinical and Epidemiological Research (EpiCenter), School of Medicine, Pontifícia Universidade Católica do Paraná, Curitiba, Brazil
Search for more papers by this authorFelix Escaño Polanco
Executive Committee, Latin American Federation of Obesity Societies (FLASO), Executive Committee, Santo Domingo, Dominican Republic
Search for more papers by this authorJulio Montero
Executive Committee, Latin American Federation of Obesity Societies (FLASO), Executive Committee, Santo Domingo, Dominican Republic
Executive Committee, Argentinian Society of Obesity and Alimentary Disorders, Buenos Aires, Argentina
Search for more papers by this authorSilvia María Marín Juliá
Executive Committee, Latin American Federation of Obesity Societies (FLASO), Executive Committee, Santo Domingo, Dominican Republic
Obesity Group, Universidad de Ciencias Médicas de La Habana, Havana, Cuba
Search for more papers by this authorPaulo Andrade Lotufo
Department of Internal Medicine, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil
Search for more papers by this authorOscar H. Franco
Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
Search for more papers by this authorCorresponding Author
Bruno Halpern
Executive Committee, Latin American Federation of Obesity Societies (FLASO), Executive Committee, Santo Domingo, Dominican Republic
Obesity Group, Department of Endocrinology, University of São Paulo, São Paulo, Brazil
Weight Control Center, Hospital 9 de Julho, São Paulo, Brazil
Correspondence
Bruno Halpern, Obesity Group, Department of Endocrinology, University of São Paulo, Rua Alves Guimarães 462 CJ 72/73, São Paulo, Brazil.
Email: [email protected]
Search for more papers by this authorMaria Laura da Costa Louzada
School of Public Health, University of São Paulo, São Paulo, Brazil
Center of Epidemiology Research on Nutrition and Health, University of São Paulo, São Paulo, Brazil
Search for more papers by this authorPablo Aschner
Javeriana University School of Medicine, San Ignacio University Hospital, Bogotá, Colombia
Search for more papers by this authorFernando Gerchman
Internal Medicine Department, Post-graduate Program in Medical Sciences: Endocrinology, Universidade Federal do Rio Grande do Sul. Endocrine and Metabolism Division, Hospital de Clínicas, Porto Alegre, Brazil
Search for more papers by this authorImperia Brajkovich
Department of Internal Medicine B—School of Medicine “Luis Razetti”, University Hospital of Caracas—Universidad Central de Venezuela, Caracas, Venezuela
Search for more papers by this authorJosé Rocha Faria-Neto
Center for Clinical and Epidemiological Research (EpiCenter), School of Medicine, Pontifícia Universidade Católica do Paraná, Curitiba, Brazil
Search for more papers by this authorFelix Escaño Polanco
Executive Committee, Latin American Federation of Obesity Societies (FLASO), Executive Committee, Santo Domingo, Dominican Republic
Search for more papers by this authorJulio Montero
Executive Committee, Latin American Federation of Obesity Societies (FLASO), Executive Committee, Santo Domingo, Dominican Republic
Executive Committee, Argentinian Society of Obesity and Alimentary Disorders, Buenos Aires, Argentina
Search for more papers by this authorSilvia María Marín Juliá
Executive Committee, Latin American Federation of Obesity Societies (FLASO), Executive Committee, Santo Domingo, Dominican Republic
Obesity Group, Universidad de Ciencias Médicas de La Habana, Havana, Cuba
Search for more papers by this authorPaulo Andrade Lotufo
Department of Internal Medicine, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil
Search for more papers by this authorOscar H. Franco
Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
Search for more papers by this authorSummary
In May 2020, Latin America became the epicenter of the COVID-19 pandemic, a region already afflicted by social disparities, poor healthcare access, inadequate nutrition and a large prevalence of noncommunicable chronic diseases. Obesity and its comorbidities are increasingly prevalent in Latin America, with a more rapid growth in individuals with lower income, and currently a disease associated with COVID-19 severity, complications and death. In this document, the Latin American Association of Obesity Societies and collaborators present a review of the burden of two pandemics in Latin America, discuss possible mechanisms that explain their relationship with each other and provide public health and individual recommendations, as well as questions for future studies.
REFERENCES
- 1Morens DM, Daszak P, Taubenberger JK. Escaping Pandora's box—another novel coronavirus. N Engl J Med. 2020; 382(14): 1293-1295.
- 2Dawood FS, Ricks P, Njie GJ, et al. Observations of the global epidemiology of COVID-19 from the prepandemic period using web-based surveillance: a cross-sectional analysis. Lancet Infect Dis. 2020; 1255–1262, S1473–3099(20)30581–8.
- 3Pablos-Mendéz A, Veja J, Aranguren FP, Tabish H, Raviglione MC. Covid-19 in Latin America. BMJ. 2020; 370:m2939.
- 4Burki T. COVID-19 in Latin America. Lancet Infect Dis. 2020; 20(5): 547-548.
- 5Williamson EJ, Walker AJ, Bhaskaran K, et al. OpenSAFELY: factors associated with COVID-19 death in 17 million patients. Nature. 2020, eahead of print; 584(7821): 430-436.
- 6Yang J, Hu J, Zhu C. Obesity aggravates COVID-19: a systematic review and meta-analysis. J Med Virol 2020 PMID: 32603481. https://doi.org/10.1002/jmv.2623
- 7Lockhart SM, O'Rahilly SM. When two pandemics meet: why is obesity associated with increased COVID-19 mortality? Medicine. 2020; S2666-6340(20): 30010-30016.
- 8Sattar N, McInnes IB, McMurray JJV. Obesity a risk factor for severe COVID-19 infection: multiple potential mechanisms. Circulation. 2020; 142(1): 4-6.
- 9Ryan DH, Ravussin E, Heymsfield S. COVID 19 and the patient with obesity—the editors speak out. Obesity (Silver Spring). 28(5): 847.
- 10Simonnet A, Chetboun M, Poissy J, et al. High prevalence of obesity in severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) requiring invasive mechanical ventilation. Obesity (Silver Spring). 2020; 28(7): 1195-1199.
- 11 NCD Risk Factor Collaboration. Worldwide trends in body-mass index, underweight, overweight, and obesity from 1975 to 2016: a pooled analysis of 2416 population-based measurement studies in 128•9 million children, adolescents, and adults. Lancet. 2017; 390(10113): 2627-2642.
- 12 The GBD Obesity Collaborators. Health effects of overweight and obesity in 195 countries over 25 years. N Engl J Med. 2017; 377(1): 13-27.
- 13Gomez-Cuevas R. II Consenso Latino-Americano de Obesidad. 2016; available at http://www.administracion.usmp.edu.pe/institutoconsumo/wp-content/uploads/LIBRO-II-CONSENSO-LATINOAMERICANO-DE-OBESIDAD-2017.pdf Acessed August 4th 2020
- 14Pérez-Galarza J, Baldeón L, Franco OH, et al. Prevalence of overweight and metabolic syndrome, and associated sociodemographic factors among adult Ecuadorian populations: the ENSANUT-ECU study. J Endocrinol Investigation. 2020. Epub ahead of print. PMID: 32430865.
- 15Watanabe M, Caruso D, Tuccinardi D, et al. Visceral fat shows the strongest association with the need of intensive Care in Patients with COVID-19. Metabolism. 2020; 111:154319, Epub 2020 32712222.
- 16Petersen A, Bressem K, Albrecht J, et al. The role of visceral adiposity in the severity of COVID-19: highlights from a unicenter cross-sectional pilot study in Germany. Metabolism. 2020; 110: 154317. https://doi.org/10.1016/j.metabol.2020.154317
- 17Ross R, Neeland IJ, Yamashita S, et al. Waist circumference as a vital sign in clinical practice: a consensus statement from the IAS and ICCR working group on visceral obesity. Nat Rev Endocrinol. 2020; 16(3): 177-189.
- 18Aschner P, Buendía R, Brajkovich I, et al. Determination of the cutoff point for waist circumference that establishes the presence of abdominal obesity in Latin American men and women. Diabetes Res Clin Pract. 2011; 93(2): 243-247.
- 19Jiwani S, Carrillo-Larco RM, Hernández-Vásquez A, et al. The shift of obesity burden by socioeconomic status between 1998 and 2017 in Latin America and the Caribbean: a cross-sectional series study. Lancet Glob Health. 2019; 7(12): e1644-e1654.
- 20Monteiro CA, Cannon G, Lawrence M, Louzada MLC, Machado PP. Ultra-processed foods, diet quality, and health using the NOVA classification system. Rome: Food and Agriculture Organization of the United Nations; 2019.
- 21Hall KD, Ayuketah A, Brychta R, et al. Ultra-processed diets cause excess calorie intake and weight gain: an inpatient randomized controlled trial of ad libitum food intake. Cell Metab. 2019; 30(1): 67-77.e3.
- 22Bray GA, Heisel WE, Afshin A, et al. The science of obesity management: an endocrine society scientific statement. Endocr Rev. 2018; 39(2): 79-132.
- 23Wharton S, Lau DCW, Vallis M, et al. Obesity in adults: a clinical practice guideline. CMAJ. 2020; 192(31): E875-E9124.
- 24van Crevel R, van de Vijver S, Moore DAJ. The global diabetes epidemic: what does it mean for infectious diseases in tropical countries? Lancet Diabetes Endocrinol. 2017; 5: 457-468.
- 25Cruz FO. Convid Pesquisa de Comportamentos. Available at: <https://convid.fiocruz.br/>. Assessed August 4th, 2020
- 26Steele EM, Rauber F, Costa CS, Leite MA, Gabe KT, da Costa Louzada ML, Levy RB, Monteiro CA. Changes in the diet in the NutriNet Brasil cohort under COVID-19. Scielo preprints 2020. https://doi.org/10.1590/SciELOPreprints.1015
- 27Ruíz-Roso MB, Padilha PC, Matilla-Escalante DC, et al. Changes of physical activity and ultra-processed food consumption in adolescents from different countries during Covid-19 pandemic: an observational study. Nutrients. 2020; 12(8):E2289.
- 28Reyes-Olavarría D, Latorre-Román PÁ, Guzmán-Guzmán IP, Jerez-Mayorga D, Caamaño-Navarrete F, Delgado-Floody P. Positive and negative changes in food habits, physical activity patterns, and weight status during COVID-19 confinement: associated factors in the Chilean population. Int J Environ Res Public Health. 2020; 17(15): 5431.
- 29Miller MJ, Loaiza JR, Takyar A, Gilman RH. COVID-19 in Latin America: novel transmission dynamics for a global pandemic? PLoS Negl Trop Dis. 2020; 14(5):e0008265.
- 30Andrus JK, Evans-Gilbert T, Santos JI, et al. Perspectives on battling COVID-19 in countries of Latin America and the Caribbean. Am J Trop Med Hyg. 2020; 103(2): 593-596.
- 31 FT Visual & Data Journalism team. Coronavirus tracked: the latest figures as countries fight Covid-19 resurgence. Finantial Times. Available at: https://www.ft.com/content/a2901ce8-5eb7-4633-b89c-cbdf5b386938. Assessed August 19th
- 32Belanger MJ, Hill MA, Angelidi AM, Dalamaga M, Sowers JR, Mantzoros CS Covid-19 and disparities in nutrition and obesity. New Engl J Med 2020; PMID: 32668105, 383, 11, e69
- 33Cuevas A, Barquera S. COVID-19, obesity and undernutrition: a major challenge for Latin American countries. Obesity (Silver Spring). 2020; 28(10): 1791-1792. https://doi.org/10.1002/oby.22961
- 34Baqui P, Bica I, Marra V, Ercole A, van Der Schaar M. Ethnic and regional variations in hospital mortality from COVID-19 in Brazil: a cross-sectional observational study. Lancet Glob Health. 2020; 8(8): e1018-e1026.
- 35Tartof SY, Qian L, Hong V, et al. Obesity and mortality among patients diagnosed with COVID-19: results from an integrated health care organization. Ann Intern Med. 2020; M20: 3742. https://doi.org/10.7326/M20-3742
- 36Meneses-Navarro S, Freyermurth-Enciso MG, Pelcastre-Villafuerte BE, Campos-Navarro R, Meléndez-Navarro DM, Gómez-Flores-Ramos L. The challenges facing indigenous communities in Latin America as they confront the COVID-19 pandemic. Int J Equity Health. 2020; 19(1): 63.
- 37Docherty AB, Harrison EM, Green CA, et al. Features of 20 133 UK patients in hospital with covid-19 using the ISARIC WHO clinical characterisation protocol: prospective observational cohort study. BMJ. 2020; 369: m1985.
- 38Cai Q, Chen F, Wang T, et al. Obesity and COVID-19 severity in a designated Hospital in Shenzhen, China. Diabetes Care. 2020; 43(7): 1392-1398.
- 39Mauvais-Jarvis F. Aging, male sex, obesity, and metabolic inflammation create the perfect storm for COVID-19. Diabetes. 2020; 69(9): 1857-1863. https://doi.org/10.2337/dbi19-0023. Online ahead of print
- 40Petrilli CM, Jones SA, Yang J, et al. Factors associated with hospital admission and critical illness among 5279 people with coronavirus disease 2019 in New York City: prospective cohort study. BMJ. 2020; 369:m1966.
- 41Popkin BM, Du S, Green WD, et al. Individuals with obesity and COVID-19: a global perspective on the epidemiology and biological relationships. Obes Rev. 2020 Aug 26; 21(11):e13128. https://doi.org/10.1111/obr.13128
- 42Soares RCM, Mattos LR, Raposo LM. Risk factors for hospitalization and mortality due to COVID-19 in Espırito Santo State, Brazil. Am J Trop Med Hyg. 2020; 1-7.
- 43Denova-Gutiérrez E, Lopez-Gatell H, Alomia-Zegarra JL, et al. The association between obesity, type 2 diabetes, and hypertension with severe COVID-19 on admission among Mexicans [published online ahead of print, 2020 Jul 1]. Obesity (Silver Spring). 2020; 28(10): 1826–1832.
- 44Hernández-Garduño E. Obesity is the comorbidity more strongly associated for Covid-19 in Mexico. A case-control study. Obes Res Clin Pract. 2020; 14(4): 375–379, S1871-403X(20)30421-X.
- 45Kass DA, Duggal P, Cingolani O. Obesity could shift severe COVID-19 disease to younger ages. Lancet. 2020;10236. Epub ahead of print: 1544–1545.
- 46Lighter J, Phillips M, Hochman S, et al. Obesity in patients younger than 60 years is a risk factor for COVID-19 hospital admission. Clin Infect Dis. 2020; 71(15): 896-897.
- 47Klang E, Kassim G, Soffer S, Freeman R, Levin MA, Reich DL. Severe obesity as an independent risk factor for COVID-19 mortality in hospitalized patients younger than 50. Obesity (Silver Spring). 2020; 28(9): 1595-1599. https://doi.org/10.1002/oby.22913
- 48Idele P, Anthony D, You D, Luo C, Mofenson L. The evolving picture of SARS-CoV-2 and COVID-19 in children: critical knowledge gaps. BMJ Glob Health. 2020; 5(9):e003454.
- 49Zachariah P, Johnson CL, Halabi KC, et al. Epidemiology, clinical features, and disease severity in patients with coronavirus disease 2019 (COVID-19) in a Children's Hospital in New York City, New York. JAMA Pediatr. 2020; 174(10):e202430. https://doi.org/10.1001/jamapediatrics.2020.2430
- 50Chao JY, Derespina KR, Herold BC, et al. Clinical characteristics and outcomes of hospitalized and critically ill children and adolescents with coronavirus disease 2019 at a tertiary care medical Center in New York City. J Pediatr. 2020; 223: 14-19.e2.
- 51 Prospective Studies Collaboration, Whitlock G, Lewington S, et al. Body-mass index and cause-specific mortality in 900 000 adults: collaborative analyses of 57 prospective studies. Lancet. 2009; 373(9669): 1083-1096.
- 52Pantalone KM, Hobbs TM, Chagin KM, et al. Prevalence and recognition of obesity and its associated comorbidities: cross-sectional analysis of electronic health record data from a large US integrated health system. BMJ Open. 2017; 7(11):e017583.
- 53Stefan N, Birkenfeld AL, Schulze MB, Ludwig DS. Obesity and impaired metabolic health in patients with COVID-19. Nat Rev Endocrinol. 2020; 16(7): 341-342.
- 54Bansal R, Gubbi S, Muniyappa R. Metabolic syndrome and COVID 19: endocrine-immune-vascular interactions shapes clinical course. Endocrinology. 2020; 161(10):bqaa112.
- 55Ren H, Yang Y, Wang F, et al. Association of the insulin resistance marker TyG index with the severity and mortality of COVID-19. Cardiovasc Diabetol. 2020; 19(1): 58.
- 56Deng M, Qi Y, Deng L, et al. Obesity as a potential predictor of disease severity in young COVID-19 patients: a retrospective study. Obesity (Silver Spring). 2020; 28(10): 1815-1825.
- 57Canhada SL, Luft VC, Giatti L, et al. Ultra-processed foods, incident overweight and obesity, and longitudinal changes in weight and waist circumference: the Brazilian longitudinal study of adult health (ELSA-Brasil). Public Health Nutr. 2020; 23(6): 1076-1086.
- 58Popkin BM, Slining MM. New dynamics in global obesity facing low- and middle-income countries. Obes Rev. 2013; 14(Suppl 2(0 2)): 11-20.
- 59Painter SD, Ovsyannikova IG, Polang GA. The weight of obesity on the human immune response to vaccination. Vaccine. 2015; 33(36): 4422-4429.
- 60Honce R, Schultz-Cherry S. Impact of obesity on influenza a virus pathogenesis, immune response, and evolution. Front Immunol. 2019; 10: 1071.
- 61Beumer MC, Koch RM, van Beuningen D, et al. Influenza virus and factors that are associated with ICU admission, pulmonary co-infections and ICU mortality. J Crit Care. 2019; 50: 59-65.
- 62Cariou B, Hadjadj S, Wargny M, et al. Phenotypic characteristics and prognosis of inpatients with COVID-19 and diabetes: the CORONADO study. Diabetologia. 2020; 63(8): 1500-1515.
- 63Krause M, Gerchman F, Friedman R. Coronavirus infection (SARS-CoV-2) in obesity and diabetes comorbidities: is heat shock response determinant for the disease complications? Diabetol Metab Syndr. 2020; 12: 63.
- 64Butler MJ, Barrientos RM. The impact of nutrition on COVID-19 susceptibility and long term consequences. Brain Behav Immun. 2020; 87: 53-54.
- 65Barazzoni R, Bischoff SC, Breda J, et al. ESPEN expert statements and practical guidance for nutritional management of individuals with SARSCoV-2 infection. Clin Nutr. 2020; 39(6): 1631-1638.
- 66Swinburn BA, Kraak VI, Allender S, et al. The global syndemic of obesity, undernutrition, and climate change: the lancet commission report. Lancet. 2019; 393(10173): 791-846.
- 67Louzada ML, Martins AP, Canella DS, et al. Impact of ultra-processed foods on micronutrient content in the Brazilian diet. Rev Saude Publica. 2015; 49: 45.
- 68Ruiz-Nunez B, Dijck-Brouwer DA, Muskiet FA. The relation of saturated fatty acids with low-grade inflammation and cardiovascular disease. J Nutr Biochem. 2016; 36: 1-20.
- 69Giugliano D, Ceriello A, Esposito K. The effects of diet on inflammation: emphasis on the metabolic syndrome. J am Coll Cardiol. 2006; 48(4): 677-685.
- 70Binks M, Chin SH. What are the challenges in developing effective health policies for obesity? Int J Obes (Lond). 2017; 41: 849-852.
- 71Richardson MB, Williams MS, Fontaine KR, Allison DB. The development of scientific evidence for health policies for obesity: why and how. Int J Obes (Lond). 2017; 41: 840-848.
- 72Rubino F, Puhl RM, Cummings DE, et al. Joint international consensus statement for ending stigma of obesity. Nat Med. 2020; 26(4): 485-497.
- 73Halpern B, Halpern A. Why are anti-obesity drugs stigmatized? Expert Opin Drug Saf. 2015; 14: 185-188.
- 74 The Lancet Diabetes Endocrinology. Obesity and COVID-19: blame isn't a strategy. Lancet Diabetes Endocrinol. 2020; 8(9): 731, S2213–8587(20)30274–6.
- 75Clément K, Coupaye M, Laville M, Oppert JM, Ziegler O. COVID-19: a lever for the recognition of obesity as a disease? The French experience. Obesity (Silver Spring). 2020; 28(9): 1584–1585. https://doi.org/10.1002/oby.22924
- 76Le Brocq S, Clare K, Bryant M, Roberts K, Tahrani AA. Obesity and COVID-19: a call for action from people living with obesity. Lancet Diabetes Endocrinol. 2020; 8(8): 652-654.
- 77Zachary Z, Brianna F, Brianna L, et al. Self-quarantine and weight gain related risk factors during the COVID-19 pandemic. Obes Res Clin Pract. 2020; 14(3): 210-216.
- 78Cominato L, Di Biagio GF, Lellis D, Franco RR, Mancini MC, de Melo ME. Obesity prevention: strategies and challenges in Latin America. Curr Obes Rep. 2018; 7(2): 97-104.
- 79 FAO, Unicef, WFP, WHO. Joint statement on nutrition in the context of the COVID-19 pandemic in Asia and the Pacific. In http://www.fao.org/3/ca8820en/ca8820en.pdf. Acessed Sept 22th.
- 80 World Health Organization. Fiscal policies for diet and prevention of noncommunicable diseases: technical meeting report; 5–6 May 2015, Geneva, Switzerland. Geneva: World Health Organization, 2016. Available from: http://apps.who.int/iris/bitstream/10665/250131/1/9789241511247-eng.pdf?ua=1. Assessed August 4th, 2020
- 81Colchero MA, Rivera-Dommarco J, Popkin BM, Ng SW. In Mexico, evidence of sustained consumer response two years after implementing a sugar-sweetened beverage tax. Health Aff (Millwood). 2017; 36(3): 564-571.
- 82Mozaffarian D, Rogoff KS, Ludwig DS. The real cost of food: can taxes and subsidies improve public health? JAMA. 2014; 312(9): 889-890.
- 83 World Health Organization. Marketing of foods and non-alcoholic beverages to children. https://www.who.int/dietphysicalactivity/marketing-food-to-children/en/. Accessed August 4th 2020
- 84Tan M, He FJ, MacGregor GA. Obesity and covid-19: the role of the food industry. BMJ. 2020; 369: m2237.
- 85White M, Nieto C, Barquera S. Good deeds and cheap marketing: the food industry in the time of COVID-19. Obesity (Silver Spring). 2020; 28(9): 1578-1579. https://doi.org/10.1002/oby.22910
- 86Barquera S, Rivera JA. Obesity in Mexico: rapid epidemiological transition and food industry interference in health policies. Lancet Diabetes Endocrinol. 2020; 8(9): 746-747.
- 87Rodríguez Osiac L, Pizarro Quevedo T. Ley de Etiquetado y Publicidad de Alimentos: Chile innovando en nutrición pública una vez más [law of food labelling and advertising: Chile innovating in public nutrition once again]. Rev Chil Pediatr. 2018; 89(5): 579-581.
- 88Gabe KT, Jaime PC. Development and testing of a scale to evaluate diet according to the recommendations of the dietary guidelines for the Brazilian population. Public Health Nutr. 2019; 22(5): 785-796.
- 89 WHO/Europe. Food and nutrition tips during self-quarantine. https://www.euro.who.int/en/health-topics/health-emergencies/coronavirus-covid-19/technical-guidance/food-and-nutrition-tips-during-self-quarantine. Acessed at August 4th, 2020
- 90Dietz WH, Solomon LS, Pronk N, et al. An integrated framework for the prevention and treatment of obesity and its related chronic diseases. Health Aff (Millwood). 2015; 34(9): 1456-1463.
- 91Hollander JE, Carr BG. Virtually perfect? Telemedicine for Covid-19. New Engl J Med. 2020; 382(18): 1679-1681.
- 92O'Hara VM, Johnston SV, Browne NT. The paediatric weight management office visit via telemedicine: pre- to post-COVID-19 pandemic. Pediatr Obes. 2020; 15:e12694.
- 93Krukowski RA, Ross KM. Measuring weight with electronic scales in clinical and research settings during the coronavirus disease 2019 pandemic. Obesity (Silver Spring). 2020 Jul; 28(7): 1182-1183.
- 94 Latin American Federation of Endocrinology, Latin American Federation of Obesity. Recife Declaration 2015; available at https://s3.eu-central-1.amazonaws.com/ps-wof-web-dev/site_media/uploads/Declaracion_Recife_ingles__2015_con_WOD_-_FINAL.pdf. Acessed August 04th 2020
- 95Rubino F, Cohen RV, Mingrone G, et al. Bariatric and metabolic surgery during and after the COVID-19 pandemic: DSS recommendations for management of surgical candidates and postoperative patients and prioritisation of access to surgery. Lancet Diabetes Endocrinol. 2020; 8(7): 640-648.
- 96Magkos F, Fraterrigo G, Yoshino J, et al. Effects of moderate and subsequent progressive weight loss on metabolic function and adipose tissue biology in humans with obesity. Cell Metab. 2016; 23(4):5 91-560.
- 97Halpern B, Mancini MC. Controlled obesity status: a rarely used concept, but with particular importance in the COVID-19 pandemic and beyond. J Endocr Invest. 2020; 1–4. Epub ahead of print.
- 98Zbinden-Foncea H, Francaux M, Deldicque L, Hawley JA. Does high cardiorespiratory fitness confer some protection against proinflammatory responses after infection by SARS-CoV-2? Obesity (Silver Spring). 2020; 28(8): 1378-1381. https://doi.org/10.1002/oby.22849
- 99Kunutsor SK, Laukkanen T, Laukkanen JA. Cardiorespiratory fitness and future risk of pneumonia: a long-term prospective cohort study. Ann Epidemiol. 2017; 27(9): 603-605.
- 100Ross R, Blair SN, Arena R, et al. Importance of assessing cardiorespiratory fitness in clinical practice: a case for fitness as a clinical vital sign: a scientific statement from the American Heart Association. Circulation. 2016; 134(24): e653-e699.
- 101Stamatakis E, Gale J, Bauman A, Ekelund U, Hamer M, Ding D. Sitting time, physical activity, and risk of mortality in adults. J am Coll Cardiol. 2019; 73(16): 2062-2072.
- 102Gasmi A, Noor S, Tippairote T, Dadar M, Menzel A, Bjorklund G. Individual risk management strategy and potential therapeutic options for the COVID-19 pandemic. Clin Immunol. 2020; 215: 108409.
- 103Zhang J, Lu H, Zeng H, et al. The differential psychological distress of populations affected by the COVID-19 pandemic. Brain Behav Immun. 2020; 87: 49-50.
- 104St-Onge MP. The role of sleep duration in the regulation of energy balance: effects on energy intakes and expenditure. J Clin Sleep Med. 2013; 9(1): 73-80.