This commentary addresses three fundamental questions, 1) How solid is the evidence regarding obesity as a risk factor to Covid-19, in particular to the most serious form of the disease requiring hospitalization and mechanical ventilation? 2) What cellular and/or molecular mechanisms could explain a possible enhancement of the disease by obesity? 3) Given a probable and causal relationship of overweight and obesity with severe Covid-19, the question then arises on whether it may be possible to use as therapy well know drugs that work on fat metabolism?
In summary, overweight and obesity seem to be important risk factors to severe Covid-19, as supported by abundant data from tens of meta-analyses involving hundreds of studies and thousands of patients. The mechanisms involved comprise both mechanical hindrances by abdominal fat to pulmonary ventilation, as well as diverse routes of immune disturbances triggered by a storm of adipocytokines, and a host of other pro-inflammatory agents. Noteworthy is also the notion of the adipose cell as a reservoir of SARS-CoV-2 particles, with such tissues functioning as a dissemination hub of SARS- CoV-2, to many organs and systems. And, last but not least, the answer to the question of using conventional drugs of known efficacy and safety, to prevent and treat severe cases of Covid-19, with antilipemics such as fibrates, and proper nutrition, with the aid of measures to balance the microbiota to combat associated dysbiosis, are still unproven but promising possibilities.