TO THE EDITOR: A recent Journal of the American Medical Association viewpoint regarding fatalities in Italy associated with the new coronavirus (COVID-19) pandemic failed to mention obesity as one of the preexisting diseases associated with death (1). It seems likely that the increased prevalence of obesity in older adults in Italy compared with China may account for the differences in mortality between the two countries. Furthermore, the rising prevalence of obesity in the United States and prior experience of the impact of obesity on mortality from H1N1 influenza should increase the sensitivity of clinicians caring for patients with obesity and COVID-19 to the need for aggressive treatment of such patients.

Between April 2009 and January 2010, the Centers for Disease Control and Prevention estimated that 41 to 84 million people were infected with the H1N1 influenza virus and that between 180,000 and 370,000 infected patients were hospitalized, with 8,000 to 17,000 deaths (2). Several reports from around the world identified obesity and severe obesity as risk factors for hospitalization and mechanical ventilation. For example, in California between April and August 2009, 1,088 patients with H1N1 influenza either were hospitalized or died (2). Of 268 patients≥ 20 years old in whom BMI was