Monika Safford podcast severe covid

The New New Normal: Severe COVID-19 and Obesity

Intellihealth’s Dr. Louis Aronne and Dr. Katherine Saunders talk with Dr. Monika Safford about the relationship between severe COVID-19 and obesity, as well as the issues the pandemic revealed around public health and healthcare inequity. 

From the earliest days of the pandemic, physicians noticed that a disproportionate amount of patients in the hospital had obesity. Was there a link between severe COVID-19 and obesity?

When Dr. Monika Safford heard about this phenomenon, she became one of the first people to conduct research on the topic and identify a connection. Safford is a John J. Kuiper Professor of Medicine and chief of the Division of General Internal Medicine at Weill Cornell Medical College, and she is an expert clinician-investigator. 

In this episode of Weight Matters, Dr. Louis Aronne and Dr. Katherine Saunders talk with Safford about the links between obesity and severe COVID-19. She also discusses new findings about long COVID, and she explains what the pandemic taught her about public health communication and healthcare inequity.

COVID-19 and Obesity

In Safford’s early research on COVID-19, she and her team found that people with obesity were at higher risk for more severe cases of the disease.

Safford also noted that obesity plays a different role with COVID-19 than it does with cardiovascular disease, which she has spent years studying. 

“We’re still learning a lot about the molecular mechanisms and the damage that is created by this infection,” she shared. “People with obesity, that was the causal pathway. It was not just a bystander phenomenon.”

But while obesity does correlate with higher rates of severe infection, it does not seem to impact mortality rates.

“We saw obesity definitely as a risk factor, but we did not see it as a risk factor for mortality. So obesity landed you in the intensive care unit on a ventilator more often, but once you got to the intensive care unit, we did not observe a difference in mortality,” Safford explained. 

The Impacts of Long COVID

Researchers are still learning more about the way the COVID-19 virus is retained in some people’s tissues long after the initial infection, but it’s possible that long COVID could lead to more people developing diabetes.

“It’s probably people who are sort of on their way to insulin resistance, pre-diabetes, not yet recognized, and they’re sort of pushed over the edge by contracting COVID,” Safford explained.

Though COVID-19 is a unique phenomenon in many ways, coronaviruses in general are more likely than other viruses to cause a post-viral autoimmune phenomenon, Safford explained. 

And while it’s not yet clear whether or not obesity increases someone’s risk for long COVID, Safford theorizes that a connection may be likely. 

“The jury is definitely still out on whether obesity is a risk factor for long COVID. But if you sort of think about the heterogeneity of obesity and the heterogeneity of long COVID, I would suspect that once we really begin to describe carefully what happens with, for example, the development of diabetes in the post-COVID time period, I would not be surprised if that time of longer-term consequence is associated with pre-existing obesity,” she explained. 

Lessons on Health Inequity and Public Health Communication

From the start of the pandemic, poor communities and communities of color faced unique challenges that the shelter-in-place orders did not account for.

“The rate of transmission and infection was much higher in poor communities with a lot of crowding and a lot of minorities, not because they’re minorities, but just because of the way our social structure has created living circumstances for them,” Safford explained. 

A variety of factors in lower-income neighborhoods — including lower quality hospitals, crowding, and higher numbers of essential workers — made it harder for people to socially distance and to receive the care they needed in the event that they did contract COVID-19.

Plus, conditions like heart disease, obesity, and diabetes are closely tied to social determinants of health and therefore impact low income people and people of color at higher rates. 

“It was all of these factors converging in the pandemic. And the result was African Americans, for example, had two to four times the mortality from COVID compared to white people,” Safford shared. “It was really a tragedy.”

Along with shining a spotlight on issues of healthcare inequity, the pandemic also revealed the medical profession’s shortcomings around communicating with and educating patients. 

For example, most people prefer to hear medical information from doctors they have relationships with, but doctors feel that they aren’t given enough time to talk to and build relationships with patients. This is especially concerning when it comes to things like COVID-19 vaccine hesitancy, Safford explained. 

“It’s pretty clear that we’re in our infancy in terms of understanding how best to communicate with patients in a way that actually influences their decision-making. It’s clear that just providing facts is not enough, but we also have seen that the information that comes out is very confusing to a lot of people.”

Follow Weight Matters wherever you get your podcasts to never miss an episode. To learn more about Dr. Saunders and Dr. Aronne’s work to transform specialized treatments for chronic conditions through the best in medical science and advanced digital technologies, visit

Find this episode on your favorite podcast platform

Related Episodes