Unlock the Surprising Link Between COVID-19 and Weight Loss + Proven Recovery Tips!

It's not uncommon to experience weight loss after contracting COVID-19, mirroring the effects of many viral infections. While weight loss might seem desirable to some, unintentional weight loss, especially following COVID-19, can lead to malnutrition and muscle loss, potentially hindering recovery. This article explores the multifaceted relationship between COVID-19 and weight loss, examining the underlying causes, potential complications, and strategies for regaining weight safely and effectively.

The Link Between COVID-19 and Weight Loss

There are several ways in which COVID-19 can affect your appetite and your body’s ability to use calories from food as energy. A combination of factors probably causes some people to lose weight related to COVID-19. One notable pattern observed in many individuals infected with COVID-19 is weight loss. Specifically, people have reported muscle loss, which healthcare professionals call “cachexia.”

Factors Contributing to COVID-19 Related Weight Loss:

Affected Taste and Smell: One of the hallmark symptoms of COVID-19 is the distortion or loss of taste and smell, significantly diminishing the desire to eat and reducing caloric intake.
Appetite Loss: This can lead to a reduced desire to eat or finding oneself not consuming their usual portion sizes.
Gastrointestinal Symptoms: COVID-19 can manifest with gastrointestinal issues like nausea, vomiting, and diarrhea, leading to dehydration and further weight loss due to fluid and nutrient depletion.
Dysfunction of Body Systems: Including the endocrine and renal (kidney) systems.
Fever and Generally Feeling Unwell: These symptoms can suppress appetite and make it difficult to consume adequate calories.
Changes in Metabolism: The viral infection triggers an immune response, elevating the metabolic rate. If the individual cannot consume sufficient calories, this can lead to weight loss.
Stress and Anxiety: The psychological impact of COVID-19 can disrupt eating habits, contributing to unintentional weight loss.
Being Constipated: Constipation can impact one's appetite due to factors such as distension and discomfort in the abdomen, slowed digestive transit leading to prolonged feelings of fullness, altered gut hormones, nutrient absorption issues, and potential disruptions to the gut microbiota, all of which can contribute to appetite fluctuations.

A 2020 study indicated a correlation between the duration of COVID-19 symptoms and the likelihood of experiencing weight loss. One month post-hospital discharge, a study of COVID-19 patients revealed that 30% had lost more than 5% of their baseline body weight, with over half facing the risk of malnutrition.

Recognizing the Signs of COVID-19 Weight Loss

Weight loss during COVID-19 can sometimes be gradual and go unnoticed initially. Therefore, being aware of the subtle signs is crucial:

Loss of Appetite: A reduced desire to eat or a feeling of fullness after consuming small portions.
Loose-Fitting Clothes and Accessories: Clothes and rings may feel looser due to decreased body mass.
Poorly Fitting Dentures: Weight loss can alter facial structure, affecting the fit of dentures.
Fatigue and Lack of Energy: General tiredness and decreased energy levels.
Difficulty Concentrating: Experiencing mental fogginess or trouble focusing.

Potential Complications of COVID-19 Weight Loss

While some weight loss might be expected during a COVID-19 infection or any type of prolonged illness, significant COVID weight loss can lead to a variety of complications, including:

Malnutrition
Muscle loss
Weakness or fatigue
Anemia
Elevated C-reactive protein levels, indicating inflammation
Prolonged disease duration
Impaired kidney function

COVID-19 weight loss has been connected with health effects, including higher C-reactive protein levels, which can indicate inflammation, longer disease duration, and reduced kidney function. Additionally, COVID-19 can induce fibrosis (scarring) in your body’s tissues, including important organs like your heart and lungs. This fibrosis can also worsen muscle wasting.

The Role of Obesity in COVID-19

Obesity is defined medically as having a body mass index (weight in kilograms divided by the square of height in meters) of 30 or greater. Someone with a BMI of 25 or greater is defined as being overweight. Obesity is an established, independent risk factor for SARS-CoV-2 infection as well as for the patients' progression, once infected, to severe disease and death. But the new study provides a more direct reason: SARS-CoV-2, the virus that causes COVID-19, can directly infect adipose tissue (which most of us refer to as just plain "fat"). That, in turn, cooks up a cycle of viral replication within resident fat cells, or adipocytes, and causes pronounced inflammation in immune cells that hang out in fat tissue. The findings are described in a study published online Sept. 22 in Science Translation Medicine.

Fat tissue surrounds our hearts, guts, kidneys and pancreases, which can be adversely affected by tissue inflammation. Genetic material encoding SARS-CoV-2 was almost invariably present in fat tissue from various bodily regions of eight patients who'd died of COVID-19. "This was of great concern to us, as epicardial fat lies right next to the heart muscle, with no physical barrier separating them," McLaughlin said.

Obesity is a common, serious, and costly chronic disease. Having obesity puts people at risk for many other serious chronic diseases and increases the risk of severe illness from COVID-19. More than 900,000 adult COVID-19 hospitalizations occurred in the United States between the beginning of the pandemic and November 18, 2020. Racial and ethnic minority groups have historically not had broad opportunities for economic, physical, and emotional health, and these inequities have increased the risk of getting sick and dying from COVID-19 for some groups. Hispanic and non-Hispanic Black adults have a higher prevalence of obesity and are more likely to suffer worse outcomes from COVID-19. Hispanic and non-Hispanic Black children also have a higher prevalence of obesity. In 2017-2018, obesity affected 19.3% of children ages 2 to 19 years. Obesity is a complex disease with many contributing factors. Policy makers and community leaders can work to ensure that their communities, environments, and systems support a healthy, active lifestyle for all.

Strategies for Regaining Weight After COVID-19

For individuals who have experienced weight loss due to COVID-19, regaining weight healthily and sustainably is vital for a full recovery. Here are some tips to facilitate weight gain:

Balanced Diet: Prioritize a balanced diet rich in essential nutrients. Include lean proteins (chicken, turkey, eggs, or lean cuts of beef), whole grains, fruits, vegetables, and healthy fats to support weight gain. Consume about 1 gram of protein per kilogram (or 0.45 grams per pound) of body weight.
Calorie Intake: Consume about 27 to 30 calories per day for every kilogram of body weight (or 12.3 to 13.6 calories per day for every pound).
Frequent, Smaller Meals: Opt for smaller, more frequent meals to ease digestion and increase caloric intake.
Stay Hydrated: Adequate hydration is essential for nutrient absorption and overall health.
Exercise Gradually: As you recover, gradually incorporate light exercises to rebuild strength and muscle mass. Engage in resistance training 3 days a week with hand weights, resistance bands, or your own body weight. It’s best to speak with a healthcare professional before starting an exercise program to ensure you can do so safely.
Seek Professional Guidance: Consulting a healthcare professional or registered dietitian is highly recommended to create a personalized plan for healthy weight gain. You may consider the following: See a nutritionist or registered dietitian for counseling and evaluation.

Talk with a healthcare professional about medications that may stimulate your appetite, like ghrelin agonists, megestrol acetate, or corticosteroids.

Study on Body Composition and Metabolic Alterations

In a recent study published in the journal Cureus, researchers explored the relationship between severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and levels of serum insulin, body fat distribution, and insulin resistance (IR) estimated by homeostasis model assessment (HOMA).

The researchers randomly selected individuals referred to a university-affiliated nutrition counseling clinic in Tehran, Iran, between July and September 2021. They arranged a balanced (or weight control) diet for all the recruited participants for a month. The researchers first collected data on the frequency and the portion size of specific foods consumed by the participants the previous day, month, and year. Next, using a home scale manual, they converted the consumed food quantities into grams for each day. Finally, they computed, for each participant, the total calorie, protein, fat, and carbohydrate consumption for each day. Furthermore, the researchers evaluated their metabolic and biochemical parameters following 12-hour fasting, e.g., insulin concentration. The team evaluated the participants on all these parameters in a follow-up session scheduled one month after their first visit. All the participants with mild to moderate COVID-19, as assessed by a positive reverse transcription-polymerase chain reaction (RT-PCR) test, constituted the case group of the study.

Of the 441 patients, 224 were men, and 217 were women, with an average age of 38.82±4.63 years. Expectedly, the total fat (TF) percentage decreased in participants with no COVID-19 (control group) due to the weight-control diet and drop-in energy consumption; this decrease was apparent in 2.5% of females and 1.8% of males. On the contrary, despite losing weight and consuming fewer calories, SARS-CoV-2-infected participants showed over a 2% increase in TF post-infection. The average difference in these TF changes between the two groups was significant. The researchers also noted that changes in TF% correlated with differences in metabolic parameters, such as insulin, IR, and glucose.

Several previous studies have documented muscle atrophy in SARS-CoV-2-infected individuals, which occurs swiftly, likely within two days of inactivity. Accordingly, both groups experienced a marked reduction in FFM (in the legs, trunk, and arms) on their second visit compared to their first visit. Within almost 30 days, the decrease in lean mass of the legs, trunk, and arms of male participants was 11.4%, 9.6%, and 19.4%, respectively. These reductions were slightly higher for females, with lean mass reductions of arms, legs, and trunks of 21%, 7.9%, and 12.6%, respectively. Reduced muscle protein synthesis likely caused muscle loss post-COVID.

Read also: Weight Loss Meds & BCBS

The study uncovered that despite following a weight-control diet and consuming fewer calories, the TF% of COVID-19 patients surged over 2% after infection. Future studies should investigate the possible mechanism governing changes in TF% and FFM in COVID-19 subjects.

Weight Changes Post-Hospitalization: A Detailed Study

A study assessed weight changes from hospital admission to three months after discharge in COVID-19 survivors across body mass index (BMI) categories, and to assess changes in abdominal adiposity, as estimated by waist circumference, in this cohort.

Study Design

This was a sub-study of the COVID-BioB study, a large prospective observational investigation performed at San Raffaele University Hospital, a tertiary health-care hospital in Milan, Italy. The study included adult (age ≥ 18 years) patients with a confirmed diagnosis of COVID-19 who had been admitted to and subsequently discharged home from a COVID-19 medical ward of San Raffaele University Hospital, and were re-evaluated one and three months after remission at the Outpatient COVID-19 Follow-Up Clinic of the same Institution from April 7, 2020, to October 6, 2020.

Results

A total of 185 patients were included in the analysis. Most patients were males (71%), median age was 62.1 [54.3; 72.1] years. Median BMI upon admission was 27.1 [25.5; 31.4] kg/m2. The majority (80%) of patients had overweight or obesity; the remainder had a BMI within the normal range.

Overall, median percent weight change from hospital admission to V1 (the first follow-up outpatient visit) was −3.0 [−7.2; 0.9]%. Most patients (57.8%) experienced a weight loss >2%, and 25.4% remained weight stable. The proportion of patients with a weight loss >5% was 35.1%. Median BMI did not change significantly from baseline to V1 in normal weight subjects, whereas it significantly decreased in subjects with overweight or obesity. The magnitude of absolute BMI reduction from baseline to V1 was significantly greater in subjects with obesity as compared with normal weight or overweight subjects.

Median percent weight change from V1 to V2 (the second follow-up outpatient visit) was +1.5 [0.0; 4.4]%. Overall, nearly half (47.6%) of patients gained more than 2% of V1 weight, and 43.8% remained weight stable. Median BMI did not change significantly from V1 to V2 in normal weight individuals, whereas it significantly increased in subjects with overweight or obesity. The absolute BMI gain between the first and second follow-up visit was significantly greater in subjects with obesity as compared with normal weight subjects.

Hunger levels significantly decreased from one to three months in COVID-19 survivors with normal weight or overweight, whereas no significant change was observed in those with obesity.

Waist circumference was higher in the obesity group as compared to the overweight and normal weight groups. Waist circumference significantly increased from V1 to V2 in the whole group. This observation was mainly driven by changes in the overweight and obesity groups.

At univariable logistic regression analysis including the whole cohort, male sex, baseline BMI, hunger at 1 month, abdominal obesity and percent weight loss from baseline to 1 month significantly predicted a weight gain >2% from V1 to V2.

Discussion

Weight loss was highly prevalent in COVID-19 survivors one month after hospital discharge. At three months after discharge, nearly half of patients had gained more than 2% of weight since the previous visit. Weight change patterns differed across BMI categories.

Common Questions About COVID-19 and Weight Loss

Why Am I Losing Weight During My COVID-19 Infection? Weight loss can stem from reduced appetite, gastrointestinal issues, increased metabolism, and the stress associated with the illness.
When Should I Be Worried About COVID-19 Weight Loss? Seek medical attention for rapid or significant weight loss, persistent weight loss post-recovery, or weight loss accompanied by severe symptoms like fatigue or fever.
What Gastrointestinal Symptoms May Lead to Weight Loss? Stomach aches, nausea, vomiting, and diarrhea can cause dehydration and nutrient loss, contributing to weight loss.
How Do Stress and Anxiety Impact Eating Habits and Weight? Stress can disrupt eating patterns, leading to either overeating or reduced appetite and subsequent weight loss.

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