Why Abdominal Obesity Raises Risk of Death, New Study Unravels the Mechanisms

by Mike Mutzel

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Scientists in Italy discover how abdominal obesity and poor metabolic health raises risk of death from COVID-19 via a novel mechanism mirroring Fat embolism syndrome (FES).




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Articles Mentioned


CINTI, S., Graciotti, L., Giordano, A., Valerio, A., & Nisoli, E. (2020). COVID-19 and fat embolism: a hypothesis to explain the severe clinical outcome in people with obesity. International Journal of Obesity, 1–3.

Alexa, A. L., Care, A. O. C. R. I. C.,. (2021). Fat Embolism Syndrome Mimicking a COVID-19 Infection.

CINTI, S. (2021). Visceral Fat Inflammation and Fat Embolism are associated with Lung’s Lipidic Hyaline Membranes in COVID-19 patients , 1–28.

Maurya, R., Sebastian, P., Namdeo, M., Devender, M., & Gertler, A. (2021). COVID-19 Severity in Obesity: Leptin and Inflammatory Cytokine Interplay in the Link Between High Morbidity and Mortality, 1–11.


Time Stamps

01:10 Debris from overfilled fat cells circulate throughout your body, causing liver and respiratory distress that ultimately manifest in COVID 19 complications.

01:20 Similarly, FES (Fat Embolism Syndrome), from the crushing of large bones in trauma, releases bone marrow and fat. With FES, it is common to have a reduction of blood oxygen saturation, respiratory distress, systemic inflammation, mental challenges. This mirrors what is commonly found in severe COVID 19.

02:50 Insulin resistance creates overfilled fat cells. Overfilled fat cells become infiltrated by macrophages, part of your innate immune system. This causes necrosis within the fat cell, causing the lipid spill-over of inflammatory debris. This debris goes to the liver, damaging it, and then to the lungs, where it causes a narrowing of the blood vessels, compromising their function. There is increased risk of clotting, coagulation, and embolisms.

05:56 Some obese or overweight people are physically fit. Being physically fit is protective, even if you are overweight or obese.

06:15 Skinny people are not automatically protected. About 30% of skinny looking people are fat on the inside, metabolic obesity.

06:38 Men outnumber women by 60% in COVID 19 severity and deaths. Children are generally not severely affected by COVID 19. The children who are severely impacted may have had high levels of intra-abdominal visceral fat and may be at risk for this fat embolism syndrome.

11:00 High levels of lipid overload from enlarged fat cells, caused the recruitment of innate immune system cells, called macrophages. These start to release cytokines, causing local insulin resistance and local inflammation. This also causes local increases in pro-thrombotic mechanisms.

12:20 Visceral adipose tissue inflammation is associated with stagnant blood flow and lipid spillover from dead fat cells, adipocytes.

12:40 FES was more prevalent in COVID 19 patients compared to controls.  Lipids within the liver, lungs and fat tissue were infiltrated with macrophages.

13:00 Signs of fat embolism were more prevalent among the obese, independently of COVID 19 diagnosis.

13:20 Lipids infiltrate your vessels, compromising your cell’s ability to get nutrition and oxygen and remove waste.

14:15 Infected subject’s lungs presented with lipid-rich staining in highline membranes, associated with COVID 19 related pneumonia and death.

14:55 There is a large concentration of ACE2 receptor on fat tissue. By way of the ACE2 receptor, where the spike protein latches on and allows the virus to hijack your cellular machinery.

16:03 Signs of fat embolism syndrome was more prevalent in obese subjects, compared to non-obese subjects. This is independent of COVID 19 diagnosis.

16:18 Reduce your belly fat. Focus on your diet, reducing carbohydrate intake to match your expenditure, sleep, stress reduction, circadian rhythms, breath work, and exercise at least 150 minutes per week.

17:15 Liver samples from autopsies of COVID 19 patients found microvasculature steatosis, lipid build up. There were functional changes within the fat cell and the liver.

18:50 Overweight individuals with visceral adipose tissue accumulation (belly fat), also have a buildup of fat within the liver. The pancreas and heart also accumulate fat buildup.

20:00 As you accumulate belly fat, cells begin to die. They become overfilled and infiltrated with immune cells. The spillover goes to your liver, lungs, heart, and blood vessels. This causes a host of problems.


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