Tale of the double pandemics, COVID-19 and obesity: a never ending story

Abstract

It has been almost two years since we have been shocked by the COVID-19 pandemic, which initially started in Wuhan, China, on December 31, 2019. It was not long before the World Health Organization (WHO) finally declared it as a global pandemic on March 11, 2020, after announcing it as a public health emergency of international concern (PHEIC) on January 30, 2020. Since then, we can see the pandemic accelerated in most countries all over the world. Globally, as of 4 December 2021, there have been 270,031,622 confirmed cases of COVID-19, including 5,310,502 deaths. Due to the COVID-19 pandemic, a number of non-pharmaceutical interventions colloquially known as lockdowns have been implemented in numerous countries and territories around the world. The results of the pandemic lockdown have instigated another major concern, i.e. obesity. Overweight and obesity are defined as excessive or abnormal fat accumulation that may impair health. Based on the WHO classification for adults of both genders and all ages, overweight is defined as a body mass index (BMI) over 25 kg/ m2 and obese as a BMI over 30 kg/m2. COVID-19 has ubiquitously proven to be a major challenge for people struggling with obesity as the unfavorable effects of excess body weight in the course of SARS-CoV-2 infections have been mainly attributed to the metabolic perturbations and chronic inflammation of the adipose tissue leading to impaired immunity (blunted macrophage activation, impaired B and T lymphocyte responses) and more severe clinical outcomes. To make the matters worse, the COVID-19 pandemic has taken place at a time when there are around 2 billion overweight adults, of whom 650 million are considered to be affected by obesity (BMI ?30 kg/m2). That equates to respectively 39% and 40% of adult men and women aged 18 or over who are overweight, with 13% obese. To top it up, the lockdowns do force us to stay at home to avoid crowds by practising social distancing and locking ourselves at home with limited outdoor activities, which ultimately leads to another undeniable pandemic, obesity. The COVID-19 pandemic with its lockdowns has caused many to put on pounds. At the same time, obesity has emerged as a major risk for severe disease and death from the virus. In many countries, the interventions required to combat COVID-19 have resulted in severe socioeconomic crises. Given the well-described relationship between socio-economic status and risk of obesity, a widening societal inequality propelled by the political interventions against COVID-19 might translate into an increase in obesity and metabolic diseases in groups with a lower socio-economic status. People of lower socio-economic status with limited income and resources prefer cheap and readily available and palatable foods, which are highly processed and promote high caloric intake beyond energy needs.