Body Fat and Covid-19

Why is it that the majority of folks hospitalized and frequently dying after COVID-19 infection have lots of excess body fat? What is going on here?

Let’s start at the beginning. The virus that causes COVID-19 enters cells by attaching the virus corona (crown) to a receptor on cells. Once inside the cell the virus multiplies,, escapes, and begins infecting other cells. The receptor is the ACE2 receptor.

Everything in your body has good purpose – until something goes wrong.

ACE-2 receptor

The ACE2 receptor has an important role in your body; it is primarily associated with protection against high blood pressure, lung cell death, inhibit acute lung injury and prevent lung fibrosis after chronic injury to the lungs. In other words, under good circumstances that receptor adds a lot of value to your body. However, there are bad circumstances and COVID-19 is one.

Just about every cell in your body has ACE2 receptors including adipose (fat) cells. The only organ in your body that can vary significantly in size is adipose tissue. That’s the reason that some people are slender and others may be obese Everything else, like your liver for example, pretty much stays the same size.

It is important to have enough fat tissue on your body to stay healthy. Even the slimmest person you know has body fat for good purpose. But too much fat—or adipose tissue—is a signal that something is awry, initiating an immune response. That immune response becomes chronic inflammation.

The more adipose tissue, the more your body up-regulates (increases) the receptors. The more receptors the more opportunities for the COVID virus to attach. And it does.

Adipose (fat) tissue is inflammatory

That’s the first problem. The second problem, as I said, is that adipose tissue is inflammatory, the first action in the immune system. Actually inflammation is a good thing as part of healing – like when you cut your finger or break a bone. But inflammation is supposed to go away as you heal. All is good.

However, the inflammation associated with excess body fat (remember adipose) is chronic. It may go on and on forever, getting worse as you add more fat. Perpetual activation of the immune system results in a lot of stuff including insulin resistance, diabetes, cardiovascular trouble, etc. It starts to get complicated here so we will leave that for another time.

So just imagine this!

So I want you to imagine this. You have too much body fat with the resulting inflammation and overactive immune system. And then you have perhaps hypertension, heart trouble, and diabetes. Your ACE2 receptors are upgraded due to the fat, predisposing you to a higher level of viral infection. Package all that together (maybe along with just getting old) and a lot can go wrong.

The hospital is going to try to keep you alive. There are more and better treatments all the time. But, based on a review of the people who have died due to infection with Covid-19, it looks very clear that avoiding excess body fat and the associated conditions may be the best protection you have.

And a final reminder as I have suggested before.. We have just been talking about COVID-19. Chronic inflammation is dangerous under all circumstances. Don’t plan on a COVID-19 vaccine protecting you from all the other possibilities.

Pat Smith is the author of “It’s All about the Food,” a book that guides nutritious food choices as the way to avoid illness and maintain a healthy weight. Proceeds from her book benefit the Montgomery County Food Pantry. Her website is She can be contacted at, 870-490-1836. Her Facebook page is