• The association between obesity and severe COVID-19: A systematic review
  • zahra ghorbani,1,*
    1. Member of Student Research Committee, Abhar School of Nursing, Zanjan University of Medical Sciences, BSc in Nursing


  • Introduction: Coronavirus disease 2019 (COVID-19) is a novel threat that seems to result from the collusion between a new pandemic of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and an existing pandemic of metabolic disease driven by obesity. Obesity, a silent killer which is increasingly prevalent globally and patients with obesity are at increased risk of exacerbations from viral respiratory infections. This study is to determine the association between obesity and severe COVID-19.
  • Methods: In this study all papers from 2016-2020 were identified in a search of Elsevier, PubMed and SID, Google Scholar databases. Finally 70 studies that the association between obesity and severe COVID-19.
  • Results: The findings of this systematic review suggested that Obesity (BMI≥35 kg/m2) was recently identified as a major risk factor for worse COVID-19 severity and the need of intensive care, especially among the young (patients aged <60 years). Patients with obesity with COVID-19 are 7 times more likely to need invasive mechanical ventilation than are patients without obesity. Obesity is closely linked to DM, hypertension and cardiovascular disease, aforementioned risk factors for severe COVID-19. Physical inactivity, common in obesity, may lead to impaired immune response. The altered dynamics of pulmonary ventilation with reduced diaphragmatic excursion and a relative increase in anatomical dead space may account for the increased incidence of severe COVID-19 in patients with obesity. Adipose tissue is also a source of many pro-inflammatory mediators and adipokines such as C-Reactive protein, interleukin 6, hyperleptinemia with Leptin resistance, hypoadiponectinemia and high serum concentrations of TNF-α and IL-17A associated with obesity explains the preexisting inflammatory state in obese individuals which predisposes them to worse outcomes and fatality. Increased adipose tissue and lowe Vitamin D serum levels in obesity could lead to increased ACE-2expression (which is the putative co-receptor for cellular SARSCoV-2 entry) and risk of infection.
  • Conclusion: The study finding shows obese patients especially in younger patients aged had increased odds of progressing to severe COVID-19. As the severe acute respiratory syndrome coronavirus 2 may continue to spread worldwide, clinicians should pay close attention to obese patients, who should be carefully managed with prompt and aggressive treatment
  • Keywords: obesity, COVID-19, respiratory physiology, immunity