The high prevalence of
obesity and
obesity-related comorbidities has reached pandemic proportions, particularly in Western countries.
Obesity increases the risk to develop several chronic
noncommunicable disease, ultimately contributing to reduced survival. Recently,
obesity has been recognized as major risk factor for
coronavirus disease-19 (COVID-19)-related prognosis, contributing to worse outcomes in those with established
COVID-19. Particularly,
obesity has been associated with higher hospitalization rates in acute or
intensive care and greater risk for invasive
mechanical ventilation than lean people.
Obesity is characterized by metabolic impairments and chronic low-grade systemic
inflammation that causes a pro-inflammatory microenvironment, further aggravating the
cytokine production and risk of
cytokine storm response during Sars-Cov2
sepsis or other
secondary infections. Moreover, the metabolic dysregulations are closely related to an impaired immune system and altered response to
viral infection that can ultimately lead to a greater susceptibility to
infections, longer viral shedding and greater duration of illness and severity of the disease. In individuals with
obesity, maintaining a healthy diet, remaining physically active and reducing sedentary behaviors are particularly important during COVID-19-related quarantine to reduce metabolic and immune impairments. Moreover, such stategies are of utmost importance to reduce the risk for
sarcopenia and sarcopenic
obesity, and to prevent a reduction and potentially even increase cardiorespiratory fitness, a well-known independent risk factor for cardiovascular and
metabolic diseases and recently found to be a risk factor also for hospitalizations secondary to
COVID-19. Such lifestyle strategies may ultimately reduce morbility and mortality in patients with
infectious disease, especially in those with concomitant
obesity. The aim of this review is to discuss how
obesity might increase the risk of
COVID-19 and potentially affect its prognosis once
COVID-19 is diagnosed. We therefore advocate for implementation of strategies aimed at preventing
obesity in the first place, but also to minimize the metabolic anomalies that may lead to a compromized immune response and chronic low-grade systemic
inflammation, especially in patients with
COVID-19.