What to Know About Obesity and COVID-19

Obesity has been deemed a risk factor for a more severe case of coronavirus disease 2019 (COVID-19). Defined as weight that is higher than what is considered a healthy weight for a given height and a body mass index (BMI) of over 30 for adults, obesity affects more than 650 million people worldwide.

Obesity is linked to impaired immune function, and has been shown to worsen outcomes from COVID-19. For example, people with obesity have a greater risk for hospitalization, ICU admission, ventilation difficulties due to decreased lung capacity, and even death.

Obesity and COVID-19


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Obesity and COVID-19 Risk

Over the course of the pandemic, the Centers for Disease Control and Prevention (CDC) included obesity as well as severe obesity (a BMI of 40 or above) among 12 conditions that it deemed had enough evidence to put people at an increased risk for a more severe case of COVID-19. The CDC also states that people who are overweight (a BMI of 25 to 30) are also more likely to get severely ill from COVID-19. While it's too soon to know exactly why people with obesity fare worse with COVID-19 than those at a healthy weight, it is believed that chronic inflammation may play a role. 

A recent study by the American Heart Association (AHA) examined data from 88 hospitals in the United States that were part of the AHA's COVID-19 Cardiovascular Disease Registry. They found that people with obesity were more likely to be hospitalized, more likely to be put on a ventilator, and had a higher risk of death compared with people with a BMI under 30.

The data revealed that these negative COVID-19 outcomes increased in tandem with higher BMIs. For instance, people with severe obesity were at a little more than double the risk of being put on a ventilator and faced a 26% higher risk of death compared with people who did not have obesity.

A report from the CDC found that overweight is also a risk factor for invasive mechanical ventilation.

Obesity, COVID-19, and Racial Disparities

COVID-19 has shone a spotlight on racial health disparities. People of color are impacted by obesity at high rates in this country. Non-Hispanic Black adults in the U.S. have the highest prevalence of self-reported obesity at 39.8%, followed by Hispanic adults at 33.8% and non-Hispanic white adults at 29.9%. At the same time that high rates of obesity exist for these populations, they are also found to experience higher rates of worse COVID-19 outcomes.

Complications of Obesity and COVID-19

Both COVID-19 and obesity pathophysiology are associated with coagulation disturbances, so individuals with obesity are at higher risk of developing blood clots in the eventuality of a COVID-19 infection. This can lead to pulmonary embolism, stroke, or heart disease.

It is well known that people with obesity often also have other comorbidities such as type 2 diabetes and heart disease. An impaired cell-mediated immune response forms part of the type 2 diabetes pathophysiology, putting these individuals at higher risk of acquiring infections.

An obesity state also promotes vitamin D deficiency. This vitamin has an effect on the modulation of both the innate and the adaptive immune responses.

In a paper published in Nature Reviews Endocrinology, the authors wrote that "the COVID-19 pandemic could have serious consequences for the obesity epidemic." They suggested that as obesity leads to potentially worse COVID-19 outcomes, the new coronavirus pandemic might be contributing to higher obesity rates.

This is due to a number of factors like mandated lockdowns and shelter-in-place orders that have led people to be more sedentary in general. Additionally, economic problems and the fear of getting infected may drive people to eat emotionally, be less inclined to pursue exercise, and embrace other unhealthy lifestyle behaviors to cope with the stress of the pandemic.

Some individuals who have COVID-19 end up experiencing symptoms months after they've had the virus. These so-called "long-haulers" are still being studied. A 2020 study indicated that people who have obesity or who are overweight, along with women, the elderly, individuals with asthma, and those who had a wider range of symptoms than others in the first week of being sick were more likely to become long-haulers.

Obesity Treatments and COVID-19

While there are several FDA-approved drugs for treating obesity, there isn't any clear information on whether these medications impact COVID-19 treatment, recovery, or symptom exacerbation or reduction.

That being said, there are natural remedies and lifestyle modifications that can play a role in one's experience with COVID-19. Research has shown that COVID-19 is associated on clinically significant weight loss and a risk of malnutrition. It's recommended that doctors monitor a person's nutrition and ability to sustain a healthy weight while being treated for COVID-19.

A lot of the techniques one uses to achieve a healthy weight can be beneficial while dealing with the coronavirus. A review published in 2020 showed that consistent exercise and physical activity might actually reduce the risk of acute respiratory disease syndrome (ARDS), which is a top cause of death in people with COVID-19. The study found that exercise can prevent or reduce the severity of ARDS, which affects between 3% and 17% of all people who have COVID-19.

Beyond fitness, healthy nutrition can be key to combating the virus and boosting a person's immune response. Anti-inflammatory diets can be key to fending off some of the inflammation caused by obesity and the virus.

Additionally, getting enough sleep and instituting regular, healthy behavioral patterns— all important in helping to achieving a healthy weight—can improve one's immune system, which is key to COVID-19 prevention and treatment.

Frequently Asked Questions

Should I Get a COVID-19 Vaccine If I Have Obesity?

Yes. While there were earlier questions about the efficacy of COVID-19 vaccines for people who have obesity, the current consensus among medical professionals is that the vaccines are as effective for people with obesity as they are for people who have other underlying conditions.

Obesity seems to affect vaccination efficacy. Flu vaccinations have been found to be less effective at preventing illness among people who have obesity, for example. However, data released by the U.S. Food and Drug Administration (FDA) and Pfizer showed that the vaccines were about equally effective across age groups, sexes, racial and ethnic groups, as well as people with underlying conditions like high blood pressure, diabetes, and obesity.

States across the country have opened up vaccine access to people who have a BMI of 30 and up. Consult your doctor or other healthcare providers about what the best course of treatment for you is and whether you qualify right now for the COVID-19 vaccine.

Are Certain Vaccines Safer Than Others for People with Obesity?

At the moment, there is no research to indicate any of the vaccines on the market are less safe than others for people with obesity. Again, make sure to address any concerns about your health or COVID-19 prevention with your medical provider or doctor.

How High Is My Risk of Being Exposed to COVID-19 If I Seek Care for Obesity?

We live in a time when it can be nerve-wracking to enter any public space. There has been a lot of attention paid to people skipping out on routine medical treatment out of COVID-19 fears over the past year. If you regularly seek treatment or consultation for obesity from a medical provider, discuss with your doctor about ways you can safely meet for these appointments. This could involve telehealth or physically distanced in-person meetings. Keep in mind that most medical facilities adhere to the most stringent public health safety practices.

Exercise is a slightly different story. While many gyms have started to reopen across the country, you may not feel comfortable visiting an indoor gym at this time. If you are looking to incorporate fitness into your life to lose weight or just incorporate more physical activity into your daily life, consider adopting simple at-home workouts in the safety of your home.

How to Stay Safe

The same COVID-19 preventive rules and recommendations that apply for the population at large apply for people with obesity. You should always wear masks when in public spaces, wash your hands thoroughly and regularly, and maintain social distancing when you are around others. That means maintaining a distance of at least 6 feet away from those who are not part of your immediate household.

Other tips for staying safe from COVID-19 include:

  • Avoid touching your eyes, nose, and mouth
  • Cough or sneeze into your elbow, or a tissue that you immediately discard
  • Clean and disinfect frequently touched surfaces daily
  • Stay home as much as possible, especially if you are sick

A Word From Verywell

It can be alarming to read headlines about how conditions like obesity can potentially lead to more serious COVID-19 outcomes. The best thing you can do to prevent COVID-19 is continuing your obesity treatment plan, including weight loss and prescription medications, and follow the CDC guidelines on how to avoid getting infected by the coronavirus. If you're really worried or unsure about how to manage obesity or protect yourself and others from COVID-19 at this time, make sure to always raise concerns about your health and well-being with your doctor.

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