COVID-19: Necessitating the Need for Health Behavior Modification

Underlying conditions and age have shown to increase the hospitalization and mortality rates for those who have contracted COVID-19. However, certain lifestyle factors are now proving to be just as significant in determining the severity of the virus. Obesity and smoking are two factors that are causing severe COVID-19 symptoms, underscoring the need for behavior modification by those at the highest risk.


Obesity is now the most important predictor of severe COVID-19 complications, second only to age. And, young adults are at particular risk. Providers have seen a large number of seriously ill adults, who outside of being obese, have no underlying conditions. This is a major concern given that 42% of individuals in the U.S. are considered obese.

Obesity, especially abdominal obesity, compresses the diaphragm, lungs and chest cavity, aggravating COVID-19 symptoms to severe levels. Obesity also causes inflammation and increased circulation of pre-inflammatory cytokines which have been shown to result in the worst COVID-19 outcomes.

A NYU Langone study of more than 4,000 COVID-19 patients identified obesity as one of the most prominent risk factors for hospitalization and mortality. The largest study of COVID-19 patients to date, it was shown that obesity was a higher risk factor for hospitalization than hypertension, diabetes and cardiovascular disease. A second NYU Langone study found that those under the age of 60 who were identified as obese were twice as likely to be hospitalized and had higher rates of ICU admission.


Another lifestyle factor that has shown to have significant impact on COVID-19 symptoms is smoking. Smoking and vaping tobacco products inflames the lungs, weakens the immune system and compromises lung function, creating the ideal environment for COVID-19 to flourish. Smoking also increases the risk of spreading the virus as smokers continually touch their face and circulate particles through coughing.

The New England Journal of Medicine found that Chinese patients who were smokers were twice as likely to suffer severe symptoms of COVID-19, including problematic lung infections. Based on this study, it can be predicted that of the 34 million smokers in the U.S., many are at a higher risk of having severe COVID-19 issues.

The Importance of Risk Stratification and Behavior Modification

The significant impact of these lifestyle factors indicates the importance of identifying high-risk individuals and providing wellbeing programs that address behavior modification. By employing a risk stratification engine such a the bIQ Population Health Management platform, employers can identify employees with the highest health risks and provide tools and resources to assist with behavior modification.

Applied Health Analytics has identified two programs that have proven successful in assisting employees with health behavior modification:

  1. Incentive Programs: Incentive programs can be a useful tool to motivate individuals to participate in company-sponsored health initiatives. A HealthMine survey of employees with company-sponsored health plans showed that 71% wanted health management programs from their employers and more than 75% responded that an incentive would motivate them to take action to improve their health. Solid communication to employees about incentive programs is crucial as nearly two-thirds of employees underestimate employer-provided incentives as highlighted in a UnitedHealthcare survey.

    An employee incentive strategy that is tailored to a specific population is the key to garnering employee participation. Applied Health Analytics offers metrics-based incentive design that is customized for each employer. Tools available through bIQ include trended data and connectivity with coaching, wearable devices and payroll. With a properly designed incentive program, employers can provide the tools to help motivate behavior modification in high-risk employees.

  2. Health Coaching: One-on-one coaching provided by a health professional can provide essential support to employees who are looking to improve their health. A health coach can help manage goals, report progress and direct employees to the proper professional resources. With bIQ, all interactions with a health coach can be documented and tracked in the employee’s health record. bIQ also supports phone and virtual coaching sessions for when in-person meetings aren’t an option. A health coach can provide the accountability needed by those who are looking to modify their behaviors, especially those who have issues with obesity and smoking.

COVID-19 has shown certain lifestyle factors are indicative of severe illness and poor outcomes, necessitating the assessment of high-risk individuals in determining the need for behavior modification. Identifying high-risk individuals and providing the appropriate tools and resources to modify behavior will improve overall health and lessen the impact of viruses such as COVID-19. Addressing issues such as obesity and smoking can help significantly reduce hospitalization and mortality rates.

Applied Health Analytics offers technology that can help identify high-risk individuals and provide customized wellbeing programs that motivate employees to engage in the management of their health. If you are interested in learning more about how your hospital or health system can develop and manage wellbeing programs that are customized to the employers in your market, contact Applied Health Analytics to help you create a successful employer health management strategy.