Explained: Why is Obesity a Risk Factor for COVID-19?

4 min read
Hindi Female

There is emerging observational evidence that obesity might be linked to the risk of getting COVID-19 in India.

Recently, a study done at Apollo hospitals in Delhi found that around 70 per cent of around 1,000 COVID-19 patients were overweight or obese. However, the study results have not been published or peer-reviewed as yet.

Dr Sumit Ray, a senior consultant of Critical Care Medicine at Holy Family Hospital in Delhi explained that along with diabetes, obesity was emerging as a serious risk factor.

“90 per cent of the deaths in my ICU were patients with diabetes. A large percentage were obese as well, around 60 per cent but we are still collecting the data.”
Dr Sumit Ray, a senior consultant of Critical Care Medicine at Holy Family Hospital

Dr Arun Prasad, senior gastrointestinal and bariatric surgeon at Apollo hospital quoted a slightly higher figure, “Among those who succumbed, 82% were overweight/obese,” he told the Times of India.

What Makes Obesity a Risk Factor?

There are a combination of three factors in obese patients and a combination of these three that puts them at risk of infecting the virus and of getting better. These are mechanical factors relating to their weight:

  • Obese people are usually already compromised in breathing

“Their abdominal girth pushes up the diaphragm, the breathing muscles and the chest. So they have difficulties in breathing anyway and their lungs are usually smaller relative to the size of their body, plus the metabolic breathing ratio is already a little compromised.”

COVID-19 is primarily a respiratory illness that damages the lungs. “So those who are already somewhat on the edge get tipped over and they find it difficult to recover,” says Dr Ray.


Dr Rajesh Chawla, pulmonologist and critical care specialist at Apollo Hospitals told TOI, “ Due to high fat in their upper airway, it is difficult to intubate and to turn and mobilise them.”

Healthy lungs are essential to fighting COVID-19. And Dr Prasad adds that obese people often have weaker respiratory muscles, compromised lung volumes and increased resistance in their airways. All of this makes it much harder to defend against the virus.

  • Difficulty using Ventilators

The mechanical problem with breathing often creates a difficulty when they are on ventilators. “Obesity is always a problem with acute respiratory distress syndrome (ARDS) and to wean people off the ventilator, even without COVID-19. This is well-known,” says Dr Ray. Therefore obese patients are more likely to get infected and more seriously so meaning they would be placed in the ICU and on ventilators - but this is again risky and so there is almost a triple whammy.

  • Diabetes and obesity is a risk factor for COVID-19

The co-relation between diabetes and obesity is fairly strong and diabetes is one of the most at-risk co-morbidities for COVID-19. “In India we have Type 2 diabetes which is related to body weight, mass and an enlarged abdomen,” says Dr Ray.

He adds, “Obese patients also often have related health issues like hypothyroidism or obstructive sleep apnea (they retain CO2 at night) and these things all add together.”

There is not clarity on what makes a difference at a cellular level. “In COVID-19 yes, a person with diabetes has compromised immunity and that makes them prone to get the illness but many of the deaths from COVID-19 is not related only to immunity being compromised it is usually the cytokine storm.”

“In obesity, there is a chronic inflammatory state, sometimes there is a slight increase in the surge of cytokines constantly - that's the natural state of obesity, your immune response is slightly on the edge. So perhaps this could worsen with the COVID-19 infection, this is a hypothesis. But the mechanical dysfunction of obesity is very obvious, and this is true not only of COVID-19 but when any obese patient is on the ventilator.”

Dr Anoop Misra, chairman, Fortis C-Doc also added that the inflammation in obese people leads to increased morbidity and mortality.


Understanding Obesity

Obesity For the Apollo study, they looked at the BMI of 812 patients who were infected over the past few months and found that around 70 per cent were overweight or obese. But BMI by itself is notorious for being an inaccurate representation of health as it may identify obesity by weight but cannot always be used to extrapolate health problems. WebMD recommends the waist size or a waist-to-height ratio.

Dr Ray also mentioned that it was difficult to collate the data on obesity as it is not a factor that is usually written as part of the initial diagnosis. “When a patient is admitted, residents take down their essential information and note co-morbidities like diabetes and their history but obesity is usually not written.”

FIT had earlier reported that the stigma associated with obesity is what leads to poorer health outcomes and not the actual obesity itself. I asked Dr Ray and he told me that obesity was being seen as a risk factor for COVID-19 all over the world and that India’s relationship with obesity was not as stigmatised. “Here, it is considered a good thing to be slightly overweight. And it does not carry the same marginalisation as it does in the west and in the US.” Besides, here obesity and diabetes are closely linked and that is a medical issue.

Dr Ray says that the link between obesity and COVID-19 has been seen across the globe. “Initial studies from Wuhan also stated that obesity was a risk factor but it is not that big of a problem in China yet. Studies from Europe also suggest a strong link between obesity and the risk of getting COVID-19.”

Healthcare experts suggest breathing exercises to increase lung capacity, and healthier eating habits to improve overall health.

(At The Quint, we are answerable only to our audience. Play an active role in shaping our journalism by becoming a member. Because the truth is worth it.)

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Topics:  COVID-19 

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