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Obesity and COVID-19: Key Insights and Mitigation Strategies

Written by Andrew Le, MD

UpdatedFebruary 29, 2024

As the world combats the pandemic, a silent epidemic looms large. Obesity, a well-established risk factor for respiratory infections, is now acknowledged as contributing to the ongoing COVID-19 pandemic.

A comprehensive study conducted by the World Obesity Federation has revealed that in nations where over 50% of the adult population is categorized as obese, the mortality rates due to COVID-19 are tenfold higher.

This article explores the underlying mechanisms connecting obesity and COVID-19, the challenges faced by individuals with obesity during the pandemic, and the steps that can be taken to mitigate these risks.

🔑 Key Takeaways

  • Obesity and COVID-19 significantly increase the risk of experiencing severe COVID-19 complications such as hospitalization and death.
  • The global increase in obesity presents a significant health challenge for individuals and healthcare systems.
  • Obesity places a considerable economic burden on healthcare systems and leads to social stigmatization and psychological distress.
  • Managing obesity begins with sustainable lifestyle changes, including dietary modifications and regular exercise.
  • Seeking professional help, such as medical evaluations, guidance from registered dietitians, behavioral therapy, or bariatric surgery, is essential for effective weight management.
  • Combining efforts to manage obesity with following COVID-19 safety measures, such as vaccination, mask-wearing, and hand hygiene, is crucial to overall health.
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What Is The Global Obesity Epidemic?

Experts estimated that by 2030, 38% of the world’s adult population will be overweight and another 20% obese. It's a multifaceted health issue with far-reaching consequences for those struggling daily.

Identifying Obesity

The National Institute of Health (NIH) and the World Health Organization (WHO) have adopted specific BMI values and categories for overweight and obese. However, for Asian and South Asian populations, slight adjustments have been made, as they tend to underestimate the risk of obesity.

The values and categories are detailed below.

1. For White, Hispanic, and Black individuals:

  • Overweight – BMI greater than or equal to 25 to 29.9 kg/m^2
  • Obesity – BMI greater than or equal to 30 kg/m^2
    • Obesity class I – BMI 30 to 34.9 kg/m^2
    • Obesity class II – BMI 35 to 39.9 kg/m^2
    • Obesity class III – BMI greater than or equal to 40 kg/m^2 (also referred to as severe, extreme, or massive obesity)

2. For Asian and South Asian individuals:

  • Overweight - BMI between 23 and 24.9 kg/m^2
  • Obesity - BMI greater than 25 kg/m^2

Overweight and obesity are the fifth primary cause of global mortality, leading to an annual fatality of at least 2.8 million adults. This is primarily because it has a firmly established connection to various health disturbances, including insulin resistance, diabetes, atherosclerosis, hypertension, and certain forms of cancer, among other conditions.

The Alarming Growth of Childhood Obesity

Childhood obesity has also been on the rise, posing a grave concern for the future. In a 2017-2020 study, obesity prevalence for children and adolescents aged 2-19 years are as follows:

  • 12.7% among 2 to 5-year-olds
  • 20.7% among 6 to 11-year-olds
  • 22.2% among 12 to 19-year-olds

In many cases, childhood obesity continues into adulthood, significantly increasing the risk of chronic diseases, including cardiovascular diseases and diabetes, amplifying the risk of severe COVID-19 outcomes.

💡 Did You Know?

Chronic conditions like heart problems, cancer, and diabetes are the main reasons behind mortality and disability in the United States. Furthermore, they are the leading drivers of the nation's annual healthcare expenditure of $4.1 trillion.

What Is The Connection Between Obesity And Covid-19?

Obesity is linked to a higher risk of severe COVID-19 outcomes, as individuals with obesity are more likely to experience severe respiratory issues, need intensive care, and have impaired immune responses.

There is increasing evidence that people who are obese are at higher risk of experiencing severe complications when they get infected with the coronavirus.

As an example, the findings of an international group of researchers indicated that individuals with obesity who contracted SARS-CoV-2 faced a 113% higher likelihood of hospitalization compared to individuals with a healthy weight, a 74% increased probability of ICU admission, and a 48% elevated risk of mortality.

Here’s a breakdown explaining the relationship between obesity and COVID-19:

Mechanical Challenges

Obesity leads to excess fat in the abdomen, which pushes up on the diaphragm (a large muscle involved in breathing). This pressure on the diaphragm restricts the ability of the lungs to expand fully, reducing lung volume.

As a result, the airways in the lower part of the lungs, where oxygenation occurs, tend to collapse more easily. This mechanical issue worsens the effects of COVID-19, making it harder for these patients to breathe properly.

Increased Blood Clotting

The endothelial cells help prevent clot formation. It counteracts coagulation by supplying tissue factors, thrombin inhibitors, and receptors for protein C activation. However, COVID-19 disrupts this signaling.

When you add obesity to the equation, the risk of clotting increases significantly as people with obesity have blood that tends to clot more easily.

🩺 A Doctor’s Note:

Smoking heightens the likelihood of developing blood clots. Moreover, individuals with inherited conditions often experience the onset of blood clots before age 45.

Weakened Immunity

Obesity affects the immune system in multiple ways. Fat cells infiltrate organs where immune cells are produced and stored, making the immune system less effective. This means it struggles to protect the body from infections like COVID-19 and responds less effectively to vaccines.

Immune cells, called T-cells, function less efficiently in obese individuals. They produce fewer molecules to combat virus-infected cells, and the "memory" T-cells, crucial for future protection, are also reduced.

Chronic Inflammation

Obesity is associated with chronic, low-grade inflammation. Fat cells release inflammatory substances called cytokines, and immune cells called macrophages contribute to this inflammation while cleaning up dying fat cells.

This inflammation can worsen the excessive immune response seen in severe COVID-19 cases. It leads to tissue damage, an overabundance of immune cells, and the destruction of healthy cells.

Much of the added risk for COVID-19 complications in obese individuals is related to these immune-related issues.

What Are The Broader Consequences Of Obesity?

Beyond its direct health effects, obesity burdens healthcare systems, economies, and society. Here’s a closer look at its impact in different aspects.

Economic Impact

Obesity contributes significantly to healthcare costs. Treating obesity-related illnesses places an enormous financial burden on healthcare systems, affecting individuals and governments.

In 2014, the Milken Institute calculated that the direct and indirect overall expenses associated with obesity in the US amounted to a staggering $1.4 trillion.

Indirect costs, which encompass "resources lost due to a health condition," cover various areas:

  • Value of Lost Work: Obese employees tend to miss more workdays due to short-term absences, long-term disability, and premature death than non-obese employees. Additionally, they may work at less than full capacity, a phenomenon often referred to as presenteeism.
  • Insurance: Employers bear higher costs for life insurance premiums and payouts for workers' compensation when they have obese employees than those who are not obese.
  • Wages: Some studies indicate that obesity is linked to lower wages and reduced household income.

The indirect costs further exacerbate the economic toll of obesity.

Social and Psychological Impact

Obesity can lead to stigmatization and discrimination, causing individuals to face social isolation and reduced opportunities in education and employment. The psychological toll of obesity includes increased rates of depression and low self-esteem, which can have a ripple effect on mental health.

💡 Did You Know?

In 2022, all 50 states of the US reported an obesity rate exceeding 20%. Moreover, 17 states have an obesity rate surpassing 35%.

What Are Effective Strategies For Managing Obesity?

Managing obesity is not just about losing weight. It's about improving your overall health, enjoying a better quality of life, and reducing the risks of this serious condition.

Here are some successful approaches to address obesity.

Lifestyle Changes, Diet, and Exercise

Addressing obesity begins with sustainable lifestyle changes. Diet and exercise play pivotal roles in weight management, and adopting healthier habits can significantly reduce the risk of obesity-related health problems.

1. Dietary Modifications

Eating a balanced diet comprising various foods from all the nutrient categories is essential. As well as reducing the consumption of high-calorie, low-nutrient foods like sugary beverages and fast food, incorporating healthier options into your diet is essential.

For example, replacing a daily soda habit with water or herbal tea can significantly reduce sugar intake and improve overall health.

It’s also important to pay attention to portion sizes. Mindful eating can help control calorie intake. Incorporate more fruits, vegetables, lean proteins, and whole grains into daily meals to support weight loss and maintenance.

2. Regular Exercise

Physical activity is key to maintaining a healthy weight. You can also incorporate strength training exercises to build muscle mass, boosting metabolism.

For instance, adding weightlifting or bodyweight exercises like push-ups and squats to your weekly workouts can help increase muscle mass and improve your body's ability to burn calories.

Most importantly, find activities you enjoy to make exercise a sustainable part of your routine.

👍Health Recommendations:

Strive for 150 minutes of moderate-intensity aerobic exercise or 75 minutes of vigorous-intensity activity each week, as advised by health professionals.

3. Behavioral Changes

Identifying triggers for overeating or sedentary behavior is essential for lasting change. Seek support from friends, family, or support groups to stay motivated.

Consider working with a registered dietitian or behavioral therapist to develop healthy eating patterns and strategies for long-term success.

Seeking Professional Help and Support

While diet and exercise are critical components of obesity management, seeking professional help and support can be a game-changer for individuals facing obesity.

1. Medical Evaluation

Consult a healthcare provider to evaluate your weight-related health risks comprehensively. Identify underlying medical conditions that may contribute to weight gain and address them as needed.

2. Registered Dietitian

A registered dietitian can provide personalized nutrition guidance, help create a balanced meal plan, and offer ongoing support to achieve and maintain a healthy weight.

3. Behavioral Therapy

Behavioral therapy can help individuals address the emotional and psychological aspects of overeating and develop strategies to change unhealthy habits.

4. Bariatric Surgery

In some cases, when other methods have not been effective, bariatric surgery may be an option. This should be discussed with a medical professional.

5. Support Groups

Joining a support group can provide a sense of community, motivation, and shared experiences, which can be instrumental in the journey towards a healthier weight.

With the right strategies and support, individuals can embark on a path toward a healthier, happier, and more fulfilling life.

What Measures Help Prevent Covid-19 Infection?

To protect ourselves and our communities, it's crucial to understand how to mitigate the risk of COVID-19 infection. Here are some practical strategies to help you and your loved ones safe.

Get Vaccinated

Vaccination is the most effective way to reduce the risk of severe illness and death from COVID-19. Vaccines have proven their effectiveness in preventing infection and transmission. Keep up to date with booster shots as health authorities recommend maintaining your immunity.

🎉Fun Fact:


A total of 13,499,983,736 vaccine doses have been administered as of August 202.3

Practice Good Hand Hygiene

Frequent handwashing with soap and water for at least 20 seconds remains a cornerstone of infection prevention. If soap and water aren't available, use hand sanitizer with at least 60% alcohol. Make it a habit to clean your hands after touching high-contact surfaces in public places.

Wear Masks

Wearing masks, especially in indoor and crowded settings, can significantly reduce the transmission of the virus. High-quality, well-fitting masks offer better protection. Follow local guidelines regarding mask mandates, and be considerate of others by wearing masks when required.

Maintain Physical Distancing

While physical distancing is not always possible, maintain a safe distance of at least 6 feet from people outside your household, especially in crowded or poorly ventilated spaces. Avoid close contact with individuals who are sick, and limit social gatherings to reduce the risk of transmission.

Practice Respiratory Etiquette

Cover your mouth and nose with a tissue or elbow when coughing or sneezing. Dispose of tissues in a lined trash bin and wash your hands immediately. Encourage others to do the same to prevent the spread of respiratory droplets.

Improve Indoor Ventilation

Proper ventilation is crucial in reducing the concentration of airborne virus particles indoors. Open windows and doors when possible to increase fresh air circulation. Consider using air purifiers equipped with HEPA filters to improve indoor air quality further.

📕Definition:

The acronym "HEPA" stands for "high-efficiency particulate air" (filter). These filters are highly efficient in trapping particles of nearly all sizes, including viruses, bacteria, pollen, PM2.5, allergens, and various other contaminants. HEPA air filters are the crucial core element of any air purification system.

Stay Informed

Stay updated on the latest information and guidelines from trusted sources such as the World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC). Knowledge about the virus and its variants will help you make informed decisions.

Practice Safe Travel

If you must travel, check your destination's COVID-19 guidelines and requirements. Wear masks, maintain physical distance, and follow all safety protocols at airports, train stations, and public transportation hubs.

Limit Non-Essential Activities

Reducing unnecessary outings and non-essential activities can lower your exposure risk. Opt for outdoor activities, and consider virtual alternatives for social gatherings.

Monitor Your Health

Stay vigilant for symptoms of COVID-19, such as fever, cough, and loss of taste or smell. If you experience symptoms or have been in close contact with a confirmed case, get tested and self-isolate until you receive results. Follow local health guidelines for quarantine and isolation.

Final Words

The connection between obesity and severe COVID-19 is clear. Obesity increases the risk of severe complications when infected. It also burdens healthcare systems and individuals economically and socially.

While addressing obesity is important, don't ignore the immediate threat of the virus. Follow public health guidelines to control COVID-19. Balancing obesity management with virus precautions ensures holistic health protection.

Everyone must prioritize their health to reduce obesity-related risks in these challenging times. Health is a collective responsibility in the global fight against health challenges.

FAQs on Obesity and COVID-19

Can obesity directly cause COVID-19?

No, obesity itself does not cause COVID-19. However, it can increase vulnerability to the virus and worsen its outcomes.

Are all individuals with obesity at the same risk level?

No, the risk varies depending on overall health, age, and other underlying medical conditions.

Does losing weight reduce the risk of severe COVID-19 outcomes?

Yes, maintaining a healthy weight can lower the risk and severity of COVID-19.

Is vaccination still necessary for individuals with obesity?

Yes. Vaccination remains crucial in preventing COVID-19, even for those with obesity.

How can I support a loved one with obesity during the pandemic?

Encourage them to prioritize a healthy lifestyle, offer emotional support, and help them access medical care when needed.

Are there medications that can reduce COVID-19 risk for people with obesity?

Research is ongoing, but no specific medication is recommended solely for reducing COVID-19 risk in individuals with obesity.

Illustration of a healthcare provider asking questions on a smart phone.
Virtual weight loss solution
A personalized GLP-1 medication program delivered to you via our partner Korb Health
Illustration of a healthcare provider asking questions on a smart phone.
  • Free consultation; program starts at $269/mo
  • Checkmark Inside Circle.Customized online program and wellness coaching
  • Prescription medications and supplies shipped to your door