Sheffield's Women of Steel

Making Sense of Obesity and Bad COVID Outcomes

Why? It’s that simple question that toddlers employ against their parents. But it’s pure genius. Maybe we’re past the shock, denial, and anger of coming to terms with COVID-19 and obesity. Clearly, if someone gets COVID-19, having obesity adds to the problem. The risk of severe symptoms is higher, as is the risk of landing in an ICU, and even for dying. But why?

Increasingly, it looks like visceral fat and inflammation tell the story.

Is It the Mechanics of Breathing?

Early on, people focused on the mechanics of breathing. Maybe this could explain the link between COVID-19 outcomes and obesity. Way back in March, we noted here that hypoventilation syndrome was a factor in obesity that might explain why people with obesity were having worse outcomes.

After all, this new coronavirus is a respiratory infection. People with severe symptoms developed pneumonia. They often died from acute respiratory distress. So if obesity brings problems with respiratory function, isn’t that explanation good enough?

Inflammation, Obesity, and COVID-19

People pedling misinformation about obesity depict it as being all about size. But in fact, it’s all about adiposity – the abnormal accumulation and storage of fat. Visceral and ectopic fat accumulates around and in vital organs. It promotes chronic, systemic inflammation. That’s why untreated obesity leads to so many other chronic diseases.

As it turns out, when COVID-19 threatens a person’s life, it’s often because of inflammation. The virus triggers a cascade of inflammation that brings a host of problems. Lungs become inflamed. So do other vital organs. Abnormal blood clotting can become a problem, leading to strokes and other tissue damage.

It’s also true that certain receptors, plentiful in fat tissue, seem to help the coronavirus infect that tissue. By doing so, it may be that the virus can trigger more inflammation through adipose tissue. Those receptors are called ACE2 receptors. Many people take ACE inhibitors for blood pressure, but these drugs don’t pose any issue for COVID-19.

This may be why researchers are finding that visceral fat and ectopic fat in the liver put patients at risk for bad COVID outcomes.

Physiology, Not Size

After age, it’s clear that obesity is a key risk factor for bad COVID outcomes. But it’s not about size. It’s likely to be all about inflammation and they way that adipose tissue promotes it. Research is suggesting that the new coronavirus amplifies this process. And when it does, it leads to bad outcomes.

We have much to learn.

Click here for more from WebMD, here for new research on visceral fat and COVID-19 risks, and here for research on fatty liver disease and COVID.

Sheffield’s Women of Steel, photograph © Tim Dennell / flickr

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July 25, 2020