Following the acute phase of a COVID-19 infection, many individuals experience a constellation of persistent symptoms, collectively known as Long COVID, long-haul COVID, or post-COVID conditions (PCC). These conditions can significantly impact various aspects of health, including metabolism and body weight. While some individuals gain weight during the initial periods of lockdown, which reduced physical activity, others deal with unintended and significant weight loss after being infected with COVID-19.
Understanding Long COVID
Long COVID is a complex, multisystem condition characterized by the persistence of symptoms beyond 12 weeks after the initial COVID-19 infection. It can affect approximately 10% of people post-infection, although estimates vary widely. Risk factors include female sex, socioeconomic disadvantage, and elevated body mass index (BMI). Common symptoms encompass fatigue, breathlessness, and pain, profoundly affecting quality of life, daily function, employment, and relationships.
Potential Causes of Long COVID
Experts propose several leading theories to explain the development of Long COVID:
- Reactivation of the SARS-CoV-2 virus.
- Overactive immune cells releasing high levels of inflammatory substances.
- The immune system producing autoantibodies that injure organs and tissues.
Risk factors for long COVID
You're more likely to get long COVID-19 if you:
- Had severe COVID-19, particularly if you had to stay in a hospital
- Have other health conditions like diabetes, asthma, or an autoimmune disease
- Have obesity
- Didn't get the COVID-19 vaccine
- Had multisystem inflammatory syndrome (MIS) during or after COVID-19. This is a rare disease where different body parts, including the heart, lungs, and brain, get inflamed.
- Have female anatomy.
- Are over 40.
- Are of Hispanic or Latino heritage, according to some studies
Common Symptoms of Long COVID
Long COVID manifests differently in each person, with a wide range of health problems that can linger for an extended period. Common symptoms include:
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- General symptoms: Tiredness or fatigue, exhaustion after physical or mental tasks, fever.
- Lung and heart symptoms: Shortness of breath, cough, chest pain, inflammation of the heart muscle, lung-related issues, rapid heartbeat.
- Neurological symptoms: Brain fog, numbness and tingling, dizziness, blurred vision, tinnitus, headache, fatigue, sleep issues, loss of smell and taste, difficulty with concentration and memory, seizures, anxiety, depression, PTSD, suicidal thoughts.
- Stomach symptoms: Stomach pain, diarrhea, constipation, changes in stool color, heartburn.
- Reproductive symptoms: Erectile dysfunction, changes in menstruation or worsening PMS.
- Other symptoms: Joint pain, jaundice, muscle pain, kidney problems, hair loss, skin rashes.
Diagnosis of Long COVID
There's no specific test for Long COVID. Diagnosis relies on a history of COVID-19, reported symptoms, and the exclusion of other potential causes through various tests, including:
- Blood tests
- Heart rate and blood pressure checks
- Chest X-ray
- EKG
- Exercise tolerance test
Weight Changes and Long COVID
Weight changes, whether weight gain or weight loss, have emerged as a notable concern for individuals experiencing Long COVID. A study published in Nutrients revealed that COVID-19 could affect body composition, even in uninfected individuals. The study compared body composition using two whole-body DXA scans, one obtained before the pandemic and the other afterward. Interestingly, body fat increased more in uninfected individuals than in those diagnosed with COVID-19.
Weight Loss in Long COVID
Weight loss is a complex issue associated with COVID-19, with multiple factors contributing to its occurrence. The primary reasons for COVID-19 related weight loss include:
- Loss of taste and smell: A common symptom of COVID-19 that can significantly reduce the desire to eat.
- Gastrointestinal symptoms: Nausea, vomiting, and diarrhea can lead to dehydration and nutrient loss.
- Metabolic changes: The viral infection triggers an immune response, leading to a higher metabolic rate.
- Stress and anxiety: These can affect eating habits and lead to unintentional weight loss.
The amount of weight loss experienced by COVID-19 patients varies widely. Milder cases may not involve weight loss, while more severe cases can lead to substantial weight loss. Research suggests that even moderate cases can result in a loss of greater than 5% of baseline body weight.
Significant weight loss can lead to complications such as:
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- Malnutrition
- Muscle loss
- Weakness or fatigue
- Anemia
- Elevated C-reactive protein levels, indicating inflammation
- Prolonged disease duration
- Impaired kidney function
Weight Gain and Long COVID
While weight loss is a concern for some, others experience weight gain during and after a COVID-19 infection. A study of nonsevere COVID-19 cases revealed significant weight gain in most participants, particularly among healthy individuals. This weight gain was associated with increased mean values for body weight, BMI, and HbA1c.
One potential explanation for weight gain is that metabolic disturbances could be potential sequelae in individuals who have recovered from or survived a SARS-CoV-2 infection20,21,22.
The Impact of Excess Weight on Long COVID Neurological Symptoms
Excess body weight has been linked to experiencing long-COVID neurologic symptoms, including headaches, vertigo, sleep problems, and depression. A meta-analysis published in PLOS One involving almost 140,000 participants found that excess weight was associated with a higher rate of depression, memory issues, and sleep disturbance in Long COVID. Obesity was significantly associated with persistent headache and numbness. The authors suggested that excess weight might contribute to the development of these symptoms that persist for more than 12 weeks after COVID-19 onset. They also noted that the adipose tissue plays a role in SARS-CoV-2 entry and deposition, and it may serve as a reservoir for virus spread.
Managing Weight and Long COVID Symptoms
Given the potential impact of weight on Long COVID symptoms, managing weight through lifestyle interventions may be beneficial. A study assessed whether remotely delivered evidence-based and professionally supported weight management could improve symptoms for people living with both LC and overweight. The study found that a remotely delivered weight management intervention in people with LC and excess body weight effectively reduced LC symptoms that matter most to participants, alongside substantial weight loss. All individually self-reported LC symptoms (except pain) improved at 6 months in the intervention group compared with the control group, with a parallel improvement in quality of life. The mean weight loss of 10 kg in the intervention group corresponded to meaningful reductions in blood pressure.
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:
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- Balanced diet: Consume a balanced diet that includes lean proteins, whole grains, fruits, vegetables, and healthy fats.
- Frequent, smaller meals: Eating smaller, more frequent meals can be easier on the digestive system and help increase caloric intake.
- Stay hydrated: Ensure adequate hydration to support nutrient absorption.
- Exercise gradually: Incorporate light exercises to rebuild strength and muscle mass as recovery progresses.
- Seek professional guidance: Consult a healthcare professional or a registered dietitian to develop a personalized plan for healthy weight gain.
Lifestyle Changes and Medications
Changes like these might help ease long COVID symptoms:
- Take lots of small breaks throughout the day. Understand when you have the most energy and plan how you want to use it. Donât overdo it. Break up tasks into small chunks.
- Exercise when you can.
- To ease muscle or joint pain, try low-intensity flexibility exercises like yoga or tai chi, light stretches, and strength exercises. Stair-climbing and resistance bands can help improve strength.
- Try to stick to a daily routine. This will help with memory and mood issues.
- If youâre having trouble remembering things, write them down or put them in your phone, in a diary, or on a calendar.
- Try to curb distractions when you work, or keep a to-do list. This can help improve your focus.
- Reach out to friends and family when you need support and help. Long COVID symptoms may last a long time and vary in intensity. Be kind to yourself through the recovery process. Know that some days may be worse than others.
The Importance of Vaccination and Prevention
The best way to avoid long COVID is to limit the spread of COVID-19 infection and get vaccinated as soon as you can. The CDC recommends that everyone 6 months and older get the COVID-19 vaccine and everyone get boosters when they are eligible. The vaccines are safe and work well to prevent and limit the spread of the virus. If you have COVID-19, wait until the illness clears before getting the shot. If youâre not sure, ask your doctor.
Also, wear a mask and try to stay at least 6 feet away from other people when you're out in public if you are in an area with a high COVID-19 level or if you or a loved one is at increased risk from COVID-19. Avoid very crowded places. Wash your hands often with soap and water, or use alcohol-based hand sanitizer.