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From debilitating headaches to persistent vertigo and memory loss, people living with long COVID are grappling with a wide range of symptoms that researchers say are more likely to affect individuals with obesity — even long after the virus has cleared.
A study published in the journal PLOS ONE found that obesity was strongly associated with persistent post-COVID-19 symptoms such as headaches, memory impairment, vertigo, numbness, smell and taste disorders, depression, fatigue and sleep disturbances. The paper demonstrated that obesity raises the risk of neurological and mental health symptoms in people who have recovered from COVID-19.
Researchers conducted a meta-analysis of studies involving approximately 140,000 participants. They found growing evidence that a subset of COVID-19 survivors experienced long-term, debilitating symptoms — referred to as post-COVID-19 condition (PCC) — which led to extended recovery periods and impaired daily functioning.
The study noted that the global prevalence of overweight and obesity coincided with the COVID-19 pandemic in 2020. This dual burden, the authors argued, exacerbated the risk of related diseases and posed serious clinical and social consequences.
“Obesity was found to be associated with poor COVID-19 outcomes, such as hospital admissions, intensive care admissions, and lethality rates. Although the COVID-19 pandemic has come under control, the multisystemic nature of this disease and its long-term impacts have yet to be elucidated,” the researchers wrote in the paper.
Excess weight may contribute to the development of PCC symptoms persisting for more than 12 weeks after the initial infection, the authors wrote. Many patients reported that headaches worsened with physical exertion, while a sedentary lifestyle and reduced physical activity during recovery contributed to further weight gain.
Disruptions in taste and smell, the study suggested, might lead to unhealthy eating behaviours, including increased consumption of highly palatable, ultra-processed foods rich in salt, sugar and additives. These dietary changes could worsen taste dysfunction and aggravate other symptoms.
Vertigo, which often affected balance and mobility, was strongly linked to depressive symptoms. The study warned that a cycle of physical and psychological distress may reinforce one another in those with PCC, increasing the risk of chronic depression.
“A significant positive association between obesity and depressed mood has been observed across multiple COVID-19 periods, similar to findings in other coronavirus outbreaks,” it observed.
The study emphasised that long-term neurological symptoms significantly reduced quality of life and may be more severe in people with pre-existing conditions. Because symptoms often overlapped with those of chronic illnesses such as diabetes or hypertension, many individuals attributed them to their underlying conditions rather than recognising them as part of PCC.
However, the study emphasised that it remained unclear whether these neurological and neuropsychiatric symptoms could be directly attributed to the SARS-CoV-2 virus or whether they emerged indirectly as a result of immune responses or medical interventions. The symptoms appeared to involve both the central and peripheral nervous systems.
Additionally, the role of excess weight in the progression of COVID-19 is not yet fully understood, though it may be linked to an exaggerated inflammatory response or shared genetic factors, the authors noted.
The scientists also discussed the possible role of adipose tissue — which stores fat — in enabling viral persistence. Adipocytes (fat cells), they argued, might serve as reservoirs for the virus, due to their expression of ACE2 receptors that facilitate viral entry. Elevated fatty acid levels may further promote viral replication and delay clearance, contributing to ongoing symptoms.
The researchers underpinned widely agreed treatment on post COVID-19 conditions are yet to be established. “This highlights gaps in scientific knowledge and the urgent need for government agencies, especially of low and middle-income countries, to develop evidence-based clinical practice guidelines and training programs for health-care workers, especially in primary care services to improve diagnosis and enable more comprehensive patients care,” the paper said.
The authors called for the development of multidisciplinary rehabilitation strategies tailored to individual needs in order to improve care and support recovery for those affected by long COVID.
