COVID-19 and Obesity: Dangerous Liaisons

COVID-19 and Obesity: Dangerous Liaisons

In this article, we are going to talk about the relation between COVID-19 and Obesity. In fact, this is a very important risk factor from a medical point of view.

Why does the mortality rate change from one country to another?

Lately, the media is desperately trying to find answers hidden in a bunch of information that is hard to interpret.

Most of us are currently wondering:

  • Why does Germany have a much lower mortality rate than Spain?
  • Why does Italy have a similar morality rate to that of New York, but much higher than China?

To answer these questions, everyone is pointing to socioeconomic factors: cultural different, better or worse political management of the crisis, stronger healthcare systems or solid preventive measures.

All of these are crucial elements that we have to analyze thoroughly.

But let’s not forget about a tremendously important factor: physiopathology.

We mainly need two elements for an infection: an infectious agent and the subject that is infected.

Lately, everyone has been pointing to the source of the infection. However, not many are talking about the infected subject, about the different susceptibilities and how two human beings can deal with the virus in very different ways.

COVID-19 in China

Culture or management are not the only explanation.

What makes us different from eastern countries?

Our body mass index. Yes, we are more obese.

The mortality rate of patients with obesity who are infected with COVID-19 is much higher when compared to thin individuals.

This is not new, we have a lot of experience with other viral infections like H1N1.

It is a key difference that we are not emphasizing enough. In fact, it will condition the morality in countries like Spain, Italy, France and the United States when compared to South Korea, Japan or China.

For example, in New Mexico, from all the patients who were hospitalized due to the flu in 2009: a 46% were obese and 56% of those who needed respiratory support had type 2 obesity or higher (Thompson et al., 2011).

The same thing happens with the flu: hospitalization and mortality rates increase in Afro-american and Hispanics than non-Hispanic white people.

Obese man

Why? Because they are more obese.

Why is Obesity an important Risk Factor?

People with Obesity do not only suffer from Obesity

Lung diseases like COPD or asthmacardiovascular (HTA) and metabolic problems (like type 2 diabetes) have a much higher prevalence in obese patients.

Risk factor

The comorbidities add up and the risks increase.

Why do patients with Diabetes and Hypertension are more vulnerable to Coronavirus? Click here to find out.

Difficulty in breathing

Obesity is related to:

  • Lower respiratory volume reserve.
  • Lung functional capacity and compliance of the respiratory system.

Moreover, the so called restrictive pattern of these patients makes breathing even harder.

That is why they need respiratory support more frequently.

More pro-inflammatory cytokines

When the virus joins the Toll Like Receptor, it activates the inflammasome and the production of IL-1beta. Consequently, this causes inflammation and fibrosis in the lung, which are symptoms of respiratory distress syndrome who is killing the patients (Conti et al., 2020).

Covid and obesity

COVID-19 and obesity.

This general response goes together with the basal context of more systemic inflammation in obese patients.

Lower muscle quality

To counter the increase in pro-inflammatory adipokines, the muscle releases anti-inflammatory myokines.

Moreover, let’s not forget that the mechanics of breathing occur thanks to the muscles. Therefore, the muscle quality of an individual is going to determine most of their ventilatory quality.

The term sarcopenic obesity refers to a sad but incredibly common fact: most patients with obesity also suffer sarcopenia. In other words, their muscle quantity and quality is much lower than what is actually recommended.

Visceral lipotoxicity

Lipotoxicity is one of the metabolic alterations that occur to patients with obesity.

When we cannot accumulate more fat in the sub-cutaneous tissue, our body accumulates it in the heart, kidneys, pancreas or liver.

However, the internal organs are not ready or designed to store energy (unlike the sub-cutaneous adipose tissue).

Consequently, this results in a loss of functionality of these organs, the liver is probably the one that suffers the most with lipotoxicity.


In fact, non-alcoholic steatohepatitis is about to become the first cause of liver transplant in the entire world.

Worse peripheral tissue perfusion

Imagine a war where the fleet, aircraft and land vehicles cannot reach the hot spot of the battle.

This is what happens when the blood tissue perfusion is not good. Precisely, that is the case of patients with obesity.

That is another reason why physical exercise improves the immune response: by improving the tissue perfusion.

Medical equipment

That way, the soldiers can reach the battle easily and they know what to do: their job.

Poor immune response

As we mentioned before, obesity goes together with metabolic deterioration. For example, it alters the carbohydrate metabolism.

Patients with diabetes have a certain degree of immunosuppression that is directly proportional to a “bad control” of diabetes.

A patient with a 10% glycated hemoglobin should be regarded as an immunodeficient patient.

When it comes to viral infections or preventive measures, they should be treated like patients who are taking immunosuppressants or a patient with cancer.


We can conclude that the relation between COVID-19 and obesity is harmful…

If we take obesity and overweight into account, many countries have something to worry about, since more than two thirds of the populations suffers one of these conditions.

Consequently, the virus will easily attack their systems, causing problems that can threaten their lives.

Obesity and COVID-19 do not get along

Obesity (like being a man) is an important risk factor when it comes to SARS-CoV-2.

If you are obese, the risk of being hospitalized, needing respiratory support and dying are higher.

Woman with face mask

Different morality rates in different countries

There are several physiopathological elements in obese patients that explain why this group is more vulnerable.

Reducing the Metabolic Disease

When moving forward, if we want to become more resilient to this and other pandemics, we need to come up with programs to reduce the metabolic disease as much as possible.

After all this is over, I hope we will not only rely on masks, vaccines and respiratory support machines. This is extremely necessary but it will only be effective in the short-term.

If we really want to succeed in the long-term, we need to create a more resilient population. Healthier and less fragile.

See you in the next post. Cheers!


  1. Conti, P., Ronconi, G., Caraffa, A., Gallenga, C. E., Ross, R., Frydas, I., & Kritas, S. K. (2020). Induction of pro-inflammatory cytokines (IL-1 and IL-6) and lung inflammation by Coronavirus-19 (COVI-19 or SARS-CoV-2): anti-inflammatory strategies. J Biol Regul Homeost Agents, 34(2).
  2. Thompson, D. L., Jungk, J., Hancock, E., Smelser, C., Landen, M., Nichols, M., Selvage, D., Baumbach, J., & Sewell, M. (2011). Risk factors for 2009 pandemic influenza A (H1N1)-related hospitalization and death among racial/ethnic groups in New Mexico. American Journal of Public Health, 101(9), 1776–1784.

Related Entries

  • The COVID-19 crisis will change medicine… keep reading.
  • Did you know that there is a relation between Epigenetics and Exercise? Find out more on this link.
COVID-19 and Obesity Review

Differences between countries - 100%

Risk Factor - 100%

View from a physician - 100%

Conclusions - 100%


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About Carlos Sánchez
Carlos Sánchez
Carlos Sánchez has a degree in Human Nutrition and Dietetics, and therefore all his actions are rigorously backed by science.
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