Obesity is not a risk factor for becoming infected with COVID-19 that we are aware of today. However, new data suggests that patients who have obesity are more likely to require intensive care for COVID-19.

“Once you have the virus, we’re seeing patients with obesity need more ICU care,” says Angela Fitch, MD, FACP, FOMA, associate director of the Massachusetts General Hospital Weight Center.

“While obesity has not always been considered a disease in the U.S., it is, and we are seeing it as a common comorbidity among COVID-19 patients with the severe form,” says Matthew Hutter, MD, director of the Weight Center and president of the American Society for Metabolic and Bariatric Surgery (ASMBS).

Dr. Fitch and Dr. Hutter share four specific risk factors that link obesity with severe COVID-19 and how to mitigate risks.

Risk Factors for Severe COVID-19 Symptoms

1. Inflammation
When your body is inflamed, the immune system does not respond well to an infectious agent—in this case, a virus. “Excess body fat can lead to an overall inflammatory state of the body,” says Dr. Fitch. In other words, the baseline state of inflammation that exists already from the obesity is augmented by COVID-19 and can lead to more severe symptoms of this virus, or those of unrelated conditions.

2. Blood Clotting
Inflammation, onset either by obesity or the virus, can also lead to coagulation of the blood in the lungs, or clotting. “If you are already at increased risk of clotting due to obesity and then you are in this disease state where one of the pathologies of the virus includes blood clotting,” says Dr. Fitch, “that can lead to worsening problems.”

3. ACE Receptors
Research has shown that the coronavirus enters the cells through the ACE receptor (angiotensin converting enzyme 2) and with a more widespread amount of ACE receptors on the lung tissue comes an increase in the severity of COVID-19 symptoms. Fat cells typically have more ACE receptors; therefore, one theory is the virus can more likely cause severe illness. “Then the immune response can lead to ARDS (acute respiratory distress syndrome), which overwhelms the person’s ability to get enough oxygen and causes them to require the ventilator,” Dr. Fitch says.

4. Obesity-related Diseases
Metabolic syndrome is associated with other diseases, such as diabetes, hypertension and hypercholesterolemia. “One complication specifically related to obesity is hypoventilation syndrome, where excess tissue of the chest wall makes it harder for patients with obesity to take full and deep breaths,” says Dr. Hutter. “The combination increases the severity of symptoms in those who develop COVID-19.”

Mitigating Risks

The public is advised to do everything possible to avoid spreading the coronavirus until a vaccine or treatment for COVID-19 has been released. This includes physical distancing, hand-washing and wearing masks in public. Patients with obesity, or any other risk factors that fall within the higher-risk bracket, should be even more mindful of avoiding exposure to the coronavirus.

“Obesity is a lifelong, chronic disease that needs to be treated as such,” says Dr. Fitch. “We want people to know that now is a good time to start taking steps toward losing 5-10% of your weight if you have obesity. This can be accomplished with the help of an obesity medicine team in six-12 months which still is in the window of possibly improving your risk of severe disease if you contract this virus.”

There are those for whom surgery is the necessary and effective option for achieving long-term weight-loss goals. “A definitive treatment could be metabolic and bariatric surgery, which could improve quality of life and help prevent obesity-related diseases and future illnesses, including the severe form of COVID-19, should they develop,” says Dr. Hutter.

There are few risks associated with weight loss pursued in a healthy way and one of the best ways to do so is through proper nutrition. Right now, the world is facing supply chain issues that make it difficult to access fresh ingredients. Dr. Fitch suggests that those who can try to make the best choices possible within these restraints such as filling the refrigerator with whole, plant-based foods like berries, nuts and leafy vegetables—all of which contain vital nutrients that boost the immune system.

Other advice that Dr. Fitch shares for cultivating healthy weight-loss habits include:

• Practice good sleep habits
• Avoid alcohol intake, as alcohol also impairs your immune system
• Reduce stress by practicing mindfulness
• Stay active at home in whatever way you can

Looking to the Future

One potential bright side that Dr. Fitch offers: the current health crisis may result in more people recognizing obesity as a disease, not a lifestyle choice.

As Dr. Hutter commented in his monthly President’s Letter to ASMBS members, “Obesity is showing itself as the ferocious disease that it is.” In light of COVID-19 patients with obesity and obesity-related diseases showing significantly higher risk of requiring ventilation, obesity is now being taken seriously, as are the options to treat the disease.

Another potential positive is that this public health crisis could be a turning point that motivates people to develop healthy habits as, throughout it, many people have started walking daily, planning meals ahead of time and cooking at home.

“Even in the midst of COVID-19, the Mass General Weight Center is still open and taking new patients,” says Dr. Fitch. “We are seeing patients virtually and encourage patients to meet with us.”

If you start the process now, then we can start treatments now and can safely have surgery in the future, adds Dr. Hutter.