Are individuals with overweight more vulnerable to a severe course of infection caused by the SARS-CoV-2 virus

Obese individuals are more susceptible to severe complications in many diseases, including the flu and COVID-19. Why is that? Obesity is closely linked with high blood pressure, diabetes, heart disease, kidney disease, or heart failure. These patients also have a number of metabolic disorders. Individuals with diabetes have an increased blood sugar level and a decreased function of B-lymphocytes, leading to a reduced ability to induce an adequate metabolic response in the case of immunological stimulation. As a result, the normal functioning of the immune system is disrupted, leading to an increased risk of infection, including coronavirus infection. Obesity is also a risk factor for the development of thrombosis and vascular damage. In people who have been infected with the SARS-CoV-2 virus, deep vein thrombosis and arterial calcification occur more frequently than in those with other diseases. The risk of thrombosis in COVID-19 patients increases due to vascular damage, inflammation, and prolonged bed rest. An uncontrolled excessive immune response, known as a cytokine storm, can also contribute to the development of a coronavirus infection and affect the course of the disease. Excessive release of pro- and anti-inflammatory mediators by macrophages and lymphocytes leads to a systemic inflammatory reaction. As a result, massive production of chemokines and cytokines occurs, leading to obstruction of the airways and severe lung damage. The enzyme ACE2 (angiotensin-converting enzyme) can also play a significant role in the development of a more severe coronavirus infection in obese individuals. It is present in subcutaneous and visceral fat tissue, as well as in lung cells. The main function of this enzyme is to lower blood pressure. The SARS-CoV-2 virus binds to the ACE2 enzyme, allowing it to enter the cell. As a result, a larger amount of virus can enter the body in individuals with excessive fat tissue, affecting the course of the disease. It is also worth mentioning the typical mechanical stresses in obese individuals. A large accumulation of fat tissue in the abdominal cavity leads to an increase in diaphragmatic tension and intra-abdominal pressure. As a result, there is a significant reduction in respiratory capacity in people infected with the SARS-CoV-2 virus. Obese individuals often delay seeking medical attention because they sometimes feel stigmatized by society, leading to poorer control over their condition and more frequent problems with providing adequate medical care due to their body mass. In 2020, a study was conducted to determine whether there is a link between obesity and a more severe course of coronavirus infection. The study included 150 individuals with confirmed COVID-19 who were hospitalized in China from January 17, 2020, to February 11, 2021. Of these, 75 patients were diagnosed with obesity. Each obese individual was randomly assigned to a person of normal weight. The patients received standard treatment according to Chinese guidelines for COVID-19. It was found that obesity increases the risk of a severe course of COVID-19 by about three times and that obese individuals stay in the hospital longer than those in the control group.

From an epidemiological perspective, imposing a lockdown in many countries was a reasonable measure to prevent the spread of the COVID-19 pandemic. However, these restrictions have had negative effects on the mental and physical health of many people. In particular, individuals with lower socio-economic status are more vulnerable to developing obesity and metabolic diseases due to the implemented restrictions and deepening social inequalities. Furthermore, people with lower incomes and resources are more likely to choose highly processed, energy-rich foods that are easily accessible (Schwartz et al., 2017). The pandemic causes great psychological stress and anxiety in many individuals. Additionally, social distancing can lead to an increase in feelings of loneliness. A deterioration in mental and social health can negatively impact eating behavior and lead to an increase in calorie intake (Björntorp, 2017). The need to stay at home means that people are more exposed to food cues, which can be a challenge for those who are not aware of the calorie content of their food. There may also be episodes of 'emotional eating'. Closed gyms and limited access to recreation centers make it difficult to maintain an active lifestyle, and as is widely known, physical activity is key in preventing obesity and fighting this condition. If there is a further increase in obesity in the Polish and global population, appropriate preventive measures must be taken. Only by understanding how the restrictions introduced to contain the pandemic affect the deterioration of people's metabolic health can a strategy be developed to counteract the increase in obesity.

Research has shown that obesity can result in severe complications associated with coronavirus infection. It is crucial to disseminate information about this risk, especially via media channels, as it can aid in preventing the disease in numerous individuals. Individuals should be motivated to adopt a healthy lifestyle in order to lower the risk of contracting COVID-19. Apart from introducing regular physical activity, advocating for public awareness regarding a balanced diet rich in micronutrients and providing sufficient caloric intake is essential. Thus, it is beneficial to make use of one's imagination and ensure a proper amount of movement throughout the day.