Coronavirus Chronicles — Multiple and Overlapping Risk Factors

So, the problem with being obese in the current health climate: Fat cells contain macrophages, which try to defend the body by releasing cytokines, which cause inflammation. Bad things happen, like insulin resistance, and a vulnerability to COVID-19. Many researchers have things to say about this unhelpful behavior, looking at it from their own particular angles.

The previously quoted Camilla Cavendish, who advises the United Kingdom’s health services, puts it like this:

Surprisingly for a virus that hits the lungs, the researchers say that excess body fat seems to matter more than heart or lung disease, or smoking — perhaps because obesity triggers chronic inflammation, leaving sufferers more susceptible.

The title of the next article we look at is worrisome, beginning as it does with the words “Being fat triggers a ‘troublesome’ immune response to Covid-19…” Just a moment, please — isn’t the immune response desirable? Sure, but as we have seen, there can be too much of a good thing.

Immunity and cytokine storm

In the intensive care units of hospitals in the United Kingdom, almost three-fourth of the COVID-19 patients are overweight or obese. There obesity raises, by almost 40%, the chance that the patient will die. One current theory is that fat cells somehow trap immune cells, keeping them from doing their good work elsewhere.

Or maybe it’s just that the immune response gets all hyped up — which is a cytokine storm, and leads to fatality. Health reporter Vanessa Chalmers describes how the immune systems of obese people…

[…] are constantly ramped up as they try to protect and repair the damage inflammation causes to cells. Using all its energy fending off inflammation means the body’s defense system has few resources left to defend against a new infection like COVID-19.

Cytokines are chemical-signaling molecules which guide a healthy immune response. They tell immune cells to attack viral molecules in the body. But in some people, this response goes into overdrive and immune cells start attacking healthy tissue as well, known as a cytokine storm.

Biggest risk factor

Risk factors seem to vary from one country to another, but in most places, the most significant risk factor seems to be excessive body weight. Cavendish describes a huge COVID-19 study collaborated on by researchers from the Universities of Edinburgh, Liverpool, and Imperial College London. Working with information from almost 17,000 British subjects in 166 hospitals, they concluded that the other main risk factor is poverty.

The economically disadvantaged tend to be overweight or obese, and to suffer from Type 2 diabetes, hypertension, kidney disease, and other conditions that make them more likely to wind up in the ICU even under normal, non-pandemic conditions. The poor also tend to belong to minority groups. Cavendish says,

They have weakened immune systems which often relate to chronic stress from low-income jobs, poor diet and physical inactivity.

Everything is worse for them, and any advantage that youth may confer is negated by minority status and poverty. And despite all its victim-blaming and societal unrest, Britain is a relatively benign and caring country. Imagine places like Saudi Arabia and Singapore, where foreign migrant workers endure miserable, and miserably crowded, living conditions. Where undocumented immigrants make up the workforce, a room might be slept in by one group of inhabitants at night, and a different group by day.

Completely in their employers’ power, they can’t quit. But if their jobs disappear because of mandated isolation or economic failure, these folks have literally nowhere else to go. Imagine a couple of dozen young men compelled to shelter in place, in a single room, for an indeterminate period. It seems as if even a medical miracle will not be enough. Saving the world from this pandemic might require an entire reshaping of the social order.

Your responses and feedback are welcome!

Source: “Obesity dangers make Covid-19 a rebuke to unequal societies,”, 05/01/20
Source: “Being fat triggers a ‘troublesome’ immune response to Covid-19,”, 05/03/20
Image by Hsing Wei/(CC BY 2.0)

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About Dr. Robert A. Pretlow

Dr. Robert A. Pretlow is a pediatrician and childhood obesity specialist. He has been researching and spreading awareness on the childhood obesity epidemic in the US for more than a decade.
You can contact Dr. Pretlow at:


Dr. Pretlow’s invited presentation at the American Society of Animal Science 2020 Conference
What’s Causing Obesity in Companion Animals and What Can We Do About It

Dr. Pretlow’s invited presentation at the World Obesity Federation 2019 Conference:
Food/Eating Addiction and the Displacement Mechanism

Dr. Pretlow’s Multi-Center Clinical Trial Kick-off Speech 2018:
Obesity: Tackling the Root Cause

Dr. Pretlow’s 2017 Workshop on
Treatment of Obesity Using the Addiction Model

Dr. Pretlow’s invited presentation for
TEC and UNC 2016

Dr. Pretlow’s invited presentation at the 2015 Obesity Summit in London, UK.

Dr. Pretlow’s invited keynote at the 2014 European Childhood Obesity Group Congress in Salzburg, Austria.

Dr. Pretlow’s presentation at the 2013 European Congress on Obesity in Liverpool, UK.

Dr. Pretlow’s presentation at the 2011 International Conference on Childhood Obesity in Lisbon, Portugal.

Dr. Pretlow’s presentation at the 2010 Uniting Against Childhood Obesity Conference in Houston, TX.

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