Extra Pounds Increase Your Risk of a Bad Case of COVID-19

By Temma Ehrenfeld @temmaehrenfeld
April 28, 2021

If you’re overweight, you’re at risk for a number of illnesses. You include the coronavirus on that list; it is more dangerous the heavier you are. Learn more

When you’re too heavy, at a certain point your weight increases your risk of illnesses. Those extra pounds make COVID-19 (coronavirus) more dangerous even if you’re otherwise healthy.

This was one reason for worry about President Trump when he caught the coronavirus: men his age are at more risk, and he was slightly obese. During his annual physical exam in June, he stood at 6-foot-3 and 244 pounds, giving him a body mass index (BMI) of 30.5. A BMI of 30 or greater is considered obese.

Carrying that much extra weight isn’t unusual for Americans. More than 42 percent of the U.S. adult population is obese, and more than 9 percent are severely so. The problem is more common at lower incomes, among African Americans, and in certain states in the South and Midwest. When you’re surrounded by other heavy people, it’s easy to feel normal and dismiss the idea that your weight is threatening your health. The coronavirus is a sad reminder.


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Why obesity increases the risks of COVID-19

Early in the pandemic, doctors were alarmed when they saw young people in emergency rooms with COVID-19 infections who seemed healthy — except for their weight.

The Centers for Disease Control and Prevention reports that obesity triples your risk of being hospitalized if you get COVID-19.

It may also triple your risk of dying, according to a study of nearly 7,000 COVID-19 patients in southern California. In that research, if you were morbidly obese, your risk was more than four times higher.

In general, the heavier you are above normal the greater your risks.

One reason is mechanics: Obesity makes it harder to breathe. A big beer belly pushes up on the diaphragm, which then pushes on the lungs, restricting airflow. Airways in the lower lobes of the lungs collapse. Many people with obesity develop sleep apnea — when your windpipe is blocked as you breathe while sleeping. Breathing problems in turn increase the risk of pneumonia and heart stress.

Since you’re already breathing with some effort, any impact the new coronavirus has on your breathing is more dangerous.

People with obesity are also more likely to have other diagnoses like high blood pressure, type 2 diabetes, and chronic kidney and liver disease. These are risk factors for a tougher case of COVID-19.

But even if you don’t have those other illnesses — or perhaps not yet — obesity on its own involves impaired immunity, chronic inflammation, and blood with a tendency to clot. Each of these can worsen COVID-19.

Impaired immunity

Fat cells can take up space in organs that produce memory T cells, leaving us with both fewer and less effective ones. These are the immune cells that remember a past infection to defend you in the future. They’re triggered by vaccines. And it turns out that vaccines are less effective in people with obesity. The effect wears off: adults with obesity are twice as likely to get flu symptoms despite a good early response to a vaccine. On the positive side, memory T cells seem to be at work in people who contract COVID-19 but don’t get symptoms. In some people, the cells remember similar coronaviruses, though never exposed to this one.

Chronic inflammation

Another part of the immune system may be overactive in people with obesity. Fat cells pump out cytokines, which trigger inflammation throughout your body, as if you had a low-grade infection. The immune system also has cells with the job of cleaning out dead fat cells. In the process, they trigger cytokines.

The downturn that kills some people with COVID-19 is an overreaction of those same cytokines — called a cytokine storm. The fact that obese people have more of them active doesn’t help.

Clotting blood

People with obesity have blood that tends to clot. In severe cases of COVID-19, their lungs fill up with blood clots. Adding the two together increases the danger.

COVID-19 may continue to be a danger for people with obesity even after we have vaccines — because of their impaired immunity. So now is the perfect time to do your best to lose extra weight.

How have people who lost weight and kept it off done it?

If you like success stories, read the many recorded by the National Weight Control Registry (NWCR), established in 1994. The NWCR is tracking over 10,000 individuals who have lost significant amounts of weight and kept it off for long periods of time. Registry members have lost an average of 66 lbs. and kept it off for 5.5 years.

Here’s what we know about them: Nearly all of them changed their diets and increased their physical activity to lose weight. Most stick to a low calorie, low fat diet and stay very active:

  • Seventy eight percent eat breakfast every day.
  • Seventy five percent weigh themselves at least once a week.
  • Sixty two percent watch less than 10 hours of TV per week.
  • Ninety percent exercise, on average, about 1 hour a day.


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April 28, 2021

Reviewed By:  

Janet O’Dell, RN