The parallel lives of pandemics: COVID‑19 and obesity

Georgakopoulou,Vasiliki Epameinondas; Lempesis,Ioannis G.; Spandidos,Demetrios A.

doi:10.3892/etm.2024.12472

The parallel lives of pandemics: COVID‑19 and obesity

Authors:
- Vasiliki Epameinondas Georgakopoulou
- Ioannis G. Lempesis
- Demetrios A. Spandidos
View Affiliations

Affiliations: Department of Pathophysiology, Laiko General Hospital, Medical School of National and Kapodistrian University of Athens, 11527 Athens, Greece, Laboratory of Clinical Virology, School of Medicine, University of Crete, 71003 Heraklion, Greece
Published online on: March 6, 2024 https://doi.org/10.3892/etm.2024.12472
Article Number: 184
Copyright: © Georgakopoulou et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

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Abstract

The present article discusses the interconnectedness of coronavirus disease 2019 (COVID‑19) and obesity as global health crises. The similarities between the two conditions are highlighted; these include shared risk factors and comorbidities, and the impact of obesity on the immune system. The present article also mentions the challenges faced in combating both pandemics, including misinformation and prejudice against obesity. It discusses the development of therapeutic medications and vaccines for COVID‑19 and the potential of injectable incretin analogues for weight loss. Socioeconomic issues are also addressed, with obesity being more prevalent in lower socioeconomic groups and the cost of obesity treatments being a barrier for those in need. The present article emphasizes the need for comprehensive and sustainable solutions, including public health interventions, education, policy changes and equitable distribution of resources, to address both COVID‑19 and obesity.

The interconnectedness of COVID-19 and obesity

In recent years, the field of medical research has been confronted with immense challenges and has achieved significant advancements with regards to coronavirus disease 2019 (COVID-19) and obesity, both of which are conditions that are forming global health crises with varying degrees of coverage, attitudes and actions (1-4). The interconnectedness of COVID-19 and obesity is addressed in the present article, which also highlights the complex nature of the interaction between these two prevalent problems in global health (1,2,5-10).

Although at first glance these pandemics appear to be distinct, further investigations reveal that they have some striking parallels. Both COVID-19 and obesity are influenced by the same pre-existing health conditions and risk factors, such as an advanced age, a deteriorated socio-economic status and co-existing health conditions (2,11-15). Comorbidities, such as type 2 diabetes mellitus and cardiovascular disorders, as well as cancer, are typically the result of obesity, which contribute to unfavorable COVID-19 outcomes (2,16-20). Additionally, obesity influences the immune system, which has implications in the body's ability to defend against infections and, perhaps, the COVID-19 outcomes (20-22). COVID-19 also appears to influence the immune system and its responses (21-24). By developing an understanding of these parallels, it may be possible to increase resilience to both pandemics. Strategies for managing post-pandemic health should consider the long-term health consequences of COVID-19 and obesity, since lingering issues and chronic conditions may continue to exist after a pandemic has passed (12,13,25-27).

The battle against COVID-19 and the development of an arsenal of therapeutic medications and preventive vaccines became an example of a vigorous biomedical scientific community, as well as socio-political zeal to overcome a common threat (27). These attempts, however, did not remain unaffected by another emergence of the current era, misinformation, and the avoidance of evidence-based medicine from members of the public but also, unfortunately, from the biomedical scientific community. The COVID-19 vaccine was not unanimously popular as one would expect (28).

Notably, the world witnessed the miracles of other ‘jabs’ for obesity, the arising family of injectable incretin analogues, with a secondary, yet highly favorable outcome, resulting in outstanding weight loss comparable to bariatric and metabolic surgical procedures (29-32). Anti-obesity medications were the result of decades of research, proceeding at a much slower pace than those of COVID-19, demonstrating that wherever there is a will, there is a way (30). There is a possibility of prejudice against individuals who are obese both inside and outside of the scientific community. To combat this type of prejudice, as well as any other type of misinformation, it is necessary to first recognize obesity as a chronic and complex disease, rather than a lifestyle choice (33-35).

Socioeconomical issues appear to exist and affect the course of both pandemics, i.e., obesity being more prevalent in lower socioeconomic groups of societies and the wealthy individuals being able to purchase the costly ‘obesity jabs’, leaving these out of reach for individuals who are truly in need of either treating their diabetes or obesity with these drugs (36). The extraordinary results also led to a marked rise in the GDP of the country of origin, which is not to scrutinize, but appropriate to consider in a broader view of how health can shape economies and countries (37). Comparable was the situation for the growth of the pharmaceutical companies related to the COVID-19 pandemic (38).

What needs to be considered and learnt from these situations is that they both reflect the current era and societal situations, as well as biased opinions. Obesity, even though it has tremendous health and socioeconomic impacts, is not treated as such (39,40). However, as attributed to the writer of Parallel Lives, Plutarch, ‘To find fault is easy; to do better may be difficult’ (41). Both pandemics may teach humanity how to combat the next (non)-communicable one, from which there is still much to be learnt. After all, as C. Jung proclaimed, ‘Man needs difficulties; they are necessary for health’; these challenges may lead the views of intertwined aspects of the complex landscape of human health to new horizons and responses (42). Based on the aforementioned observations and considerations, it can be concluded that two crucial aspects of global public health and related policies need to be reconsidered: Interventions and equity. Public health interventions, including education, policy changes and community engagement, are crucial in addressing obesity and COVID-19, promoting a healthier global population through comprehensive and sustainable solutions. Finally, sustainable global health requires equity necessitating a holistic approach, integrating efforts to address COVID-19 and obesity simultaneously, to ensure equitable distribution of resources and interventions across vulnerable communities (8).

Acknowledgements

Not applicable.

Funding

Funding: No funding was received.

Availability of data and materials

Not applicable.

Authors' contributions

VEG, IGL and DAS substantially contributed to the conception and design of the study and to manuscript preparation. All authors have read and approved the final manuscript. Data authentication is not applicable.

Ethics approval and consent to participate

Not applicable.

Patient consent for publication

Not applicable.

Competing interests

DAS is the Editor-in-Chief for the journal, but had no personal involvement in the reviewing process, or any influence in terms of adjudicating on the final decision, for this article. The other authors declare that they have no competing interests.

References

1	Tsamakis K, Gavriatopoulou M, Schizas D, Stravodimou A, Mougkou A, Tsiptsios D, Sioulas V, Spartalis E, Sioulas AD, Tsamakis C, et al: Oncology during the COVID-19 pandemic: challenges, dilemmas and the psychosocial impact on cancer patients. Oncol Lett. 20:441–447. 2020.PubMed/NCBI View Article : Google Scholar
2	Petrakis D, Margină D, Tsarouhas K, Tekos F, Stan M, Nikitovic D, Kouretas D, Spandidos DA and Tsatsakis A: Obesity - a risk factor for increased COVID-19 prevalence, severity and lethality (Review). Mol Med Rep. 22:9–19. 2020.PubMed/NCBI View Article : Google Scholar
3	Skalny AV, Rink L, Ajsuvakova OP, Aschner M, Gritsenko VA, Alekseenko SI, Svistunov AA, Petrakis D, Spandidos DA, Aaseth J, et al: Zinc and respiratory tract infections: Perspectives for COVID-19 (Review). Int J Mol Med. 46:17–26. 2020.PubMed/NCBI View Article : Google Scholar
4	Mammas IN, Drysdale SB, Theodoridou M and Spandidos DA: Exploring medical terminology inexpediencies: Tripledemic vs. triple epidemic. Exp Ther Med. 26(334)2023.PubMed/NCBI View Article : Google Scholar
5	Papadakis AA, Tsirigotakis I, Katranitsa S, Donousis C, Papalexis P, Keramydas D, Chaidoutis E, Georgakopoulou VE, Spandidos DA and Constantinidis TC: Assessing the impact of the COVID-19 pandemic health protocols on the hygiene status of swimming pools of hotel units. Med Int (Lond). 3(32)2023.PubMed/NCBI View Article : Google Scholar
6	Mathioudakis N, Zachiotis M, Papadakos S, Triantafyllou M, Karapanou A, Samara S, Karamanakos G, Spandidos DA, Papalexis P, Damaskos C, et al: Onodera's prognostic nutritional index: Comparison of its role in the severity and outcomes of patients with COVID-19 during the periods of alpha, delta and omicron variant predominance. Exp Ther Med. 24(675)2022.PubMed/NCBI View Article : Google Scholar
7	Efstathiou V, Stefanou MI, Demetriou M, Siafakas N, Makris M, Tsivgoulis G, Zoumpourlis V, Kympouropoulos SP, Tsoporis JN, Spandidos DA, et al: Long COVID and neuropsychiatric manifestations (Review). Exp Ther Med. 23:1–12. 2022.PubMed/NCBI View Article : Google Scholar
8	Anyfantakis D, Mantadaki AE, Mastronikolis S, Spandidos DA and Symvoulakis EK: COVID-19 pandemic and reasons to prioritize the needs of the health care system to ensure its sustainability: A scoping review from January to October 2020 (Review). Exp Ther Med. 22(1039)2021.PubMed/NCBI View Article : Google Scholar
9	Tsamakis K, Tsiptsios D, Ouranidis A, Mueller C, Schizas D, Terniotis C, Nikolakakis N, Tyros G, Kympouropoulos S, Lazaris A, et al: COVID-19 and its consequences on mental health (Review). Exp Ther Med. 21(244)2021.PubMed/NCBI View Article : Google Scholar
10	Giannopoulou I, Galinaki S, Kollintza E, Adamaki M, Kympouropoulos S, Alevyzakis E, Tsamakis K, Tsangaris I, Spandidos DA, Nikolaos Siafakas, et al: COVID-19 and post-traumatic stress disorder: The perfect ‘storm’ for mental health (Review). Exp Ther Med. 22(1162)2021.PubMed/NCBI View Article : Google Scholar
11	Lempesis IG, Karlafti E, Papalexis P, Fotakopoulos G, Tarantinos K, Lekakis V, Papadakos SP, Cholongitas E and Georgakopoulou VE: COVID-19 and liver injury in individuals with obesity. World J Gastroenterol. 29:908–916. 2023.PubMed/NCBI View Article : Google Scholar
12	Lempesis IG and Georgakopoulou VE: Implications of obesity and adiposopathy on respiratory infections; focus on emerging challenges. World J Clin Cases. 11(2925)2023.PubMed/NCBI View Article : Google Scholar
13	Georgakopoulou VE, Gkoufa A, Bougea A, Basoulis D, Tsakanikas A, Makrodimitri S, Karamanakos G, Spandidos DA, Angelopoulou E and Sipsa NV: Characteristics and outcomes of elderly patients with Parkinson's disease hospitalized due to COVID-19-associated pneumonia. Med Int (Lond). 3(34)2023.PubMed/NCBI View Article : Google Scholar
14	Georgakopoulou VE, Gkoufa A, Tsakanikas A, Makrodimitri S, Karamanakos G, Basoulis D, Voutsinas PM, Eliadi I, Bougea A, Spandidos DA, et al: Predictors of COVID-19-associated mortality among hospitalized elderly patients with dementia. Exp Ther Med. 26(395)2023.PubMed/NCBI View Article : Google Scholar
15	Georgakopoulou VE, Basoulis D, Voutsinas PM, Makrodimitri S, Samara S, Triantafyllou M, Eliadi I, Karamanakos G, Papageorgiou CV, Anastasopoulou A, et al: Factors predicting poor outcomes of patients treated with tocilizumab for COVID-19-associated pneumonia: A retrospective study. Exp Ther Med. 24(724)2022.PubMed/NCBI View Article : Google Scholar
16	Lempesis IG, Varrias D, Sagris M, Attaran RR, Altin SA, Bakoyiannis C, Palaiodimos L, Dalamaga M and Kokkinidis DG: Obesity and Peripheral Artery Disease: Current Evidence and Controversies. Curr Obes Rep. 12:264–279. 2023.PubMed/NCBI View Article : Google Scholar
17	Lempesis IG, Georgakopoulou VE, Papalexis P, Chrousos GP and Spandidos DA: Role of stress in the pathogenesis of cancer (Review). Int J Oncol. 63(124)2023.PubMed/NCBI View Article : Google Scholar
18	Arvanitakis K, Papadakos SP, Lekakis V, Koufakis T, Lempesis IG, Papantoniou E, Kalopitas G, Georgakopoulou VE, Stergiou IE, Theocharis S, et al: Meeting at the Crossroad between Obesity and Hepatic Carcinogenesis: Unique Pathophysiological Pathways Raise Expectations for Innovative Therapeutic Approaches. Int J Mol Sci. 24(14704)2023.PubMed/NCBI View Article : Google Scholar
19	Lempesis IG, Hoebers N, Essers Y, Jocken JWE, Dineen R, Blaak EE, Manolopoulos KN and Goossens GH: Distinct inflammatory signatures of upper and lower body adipose tissue and adipocytes in women with normal weight or obesity. Front Endocrinol (Lausanne). 14(1205799)2023.PubMed/NCBI View Article : Google Scholar
20	Lempesis IG, van Meijel RLJ, Manolopoulos KN and Goossens GH: Oxygenation of adipose tissue: A human perspective. Acta Physiol (Oxf). 228(e13298)2020.PubMed/NCBI View Article : Google Scholar
21	Lempesis IG and Georgakopoulou VE: Physiopathological mechanisms related to inflammation in obesity and type 2 diabetes mellitus. World J Exp Med. 13:7–16. 2023.PubMed/NCBI View Article : Google Scholar
22	Georgakopoulou VE, Makrodimitri S, Triantafyllou M, Samara S, Voutsinas PM, Anastasopoulou A, Papageorgiou CV, Spandidos DA, Gkoufa A, Papalexis P, et al: Immature granulocytes: Innovative biomarker for SARS-CoV-2 infection. Mol Med Rep. 26(217)2022.PubMed/NCBI View Article : Google Scholar
23	Kadiyska T, Tourtourikov I, Dabchev K, Cherneva R, Stoynev N, Hadjiolova R, Mitev V, Spandidos DA, Adamaki M and Zoumpourlis V: Role of endothelial dysfunction in the severity of COVID-19 infection (Review). Mol Med Rep. 26(351)2022.PubMed/NCBI View Article : Google Scholar
24	Neagu M, Calina D, Docea AO, Constantin C, Filippini T, Vinceti M, Drakoulis N, Poulas K, Nikolouzakis TK, Spandidos DA and Tsatsakis A: Back to basics in COVID-19: Antigens and antibodies-Completing the puzzle. J Cell Mol Med. 25:4523–4533. 2021.PubMed/NCBI View Article : Google Scholar
25	Bougea A, Georgakopoulou VE, Palkopoulou M, Efthymiopoulou E, Angelopoulou E, Spandidos DA and Zikos P: New-onset non-motor symptoms in patients with Parkinson's disease and post-COVID-19 syndrome: A prospective cross-sectional study. Med Int (Lond). 3(23)2023.PubMed/NCBI View Article : Google Scholar
26	Georgakopoulou VE, Gkoufa A, Makrodimitri S, Basoulis D, Tsakanikas A, Karamanakos G, Mastrogianni E, Voutsinas PM, Spandidos DA, Papageorgiou CV, et al: Early 3-day course of remdesivir for the prevention of the progression to severe COVID-19 in the elderly: A single-centre, real-life cohort study. Exp Ther Med. 26(462)2023.PubMed/NCBI View Article : Google Scholar
27	Gkoufa A, Saridaki M, Georgakopoulou VE, Spandidos DA and Cholongitas E: COVID-19 vaccination in liver transplant recipients (Review). Exp Ther Med. 25(291)2023.PubMed/NCBI View Article : Google Scholar
28	Mao W, Zimmerman A, Urli Hodges E, Ortiz E, Dods G, Taylor A and Udayakumar K: Comparing research and development, launch, and scale up timelines of 18 vaccines: lessons learnt from COVID-19 and implications for other infectious diseases. BMJ Glob Health. 8(e012855)2023.PubMed/NCBI View Article : Google Scholar
29	Chavda VP, Ajabiya J, Teli D, Bojarska J and Apostolopoulos V: Tirzepatide, a New Era of Dual-Targeted Treatment for Diabetes and Obesity: A Mini-Review. Molecules. 27(4315)2022.PubMed/NCBI View Article : Google Scholar
30	Lempesis IG, Liu J and Dalamaga M: The catcher in the gut: Tirzepatide, a dual incretin analog for the treatment of type 2 diabetes mellitus and obesity. Metabol Open. 16(100220)2022.PubMed/NCBI View Article : Google Scholar
31	Mayendraraj A, Rosenkilde MM and Gasbjerg LS: GLP-1 and GIP receptor signaling in beta cells - A review of receptor interactions and co-stimulation. Peptides. 151(170749)2022.PubMed/NCBI View Article : Google Scholar
32	Rosenstock J, Wysham C, Frías JP, Kaneko S, Lee CJ, Landó LF, Mao H, Cui X, Karanikas CA and Thieu VT: Efficacy and safety of a novel dual GIP and GLP-1 receptor agonist tirzepatide in patients with type 2 diabetes (SURPASS-1): a double-blind, randomised, phase 3 trial. The Lancet. 398:143–155. 2021.PubMed/NCBI View Article : Google Scholar
33	Rubino F, Puhl RM, Cummings DE, Eckel RH, Ryan DH, Mechanick JI, Nadglowski J, Salas XR, Schauer PR, Twenefour D, et al: Joint international consensus statement for ending stigma of obesity. Nat Med. 26:485–497. 2020.PubMed/NCBI View Article : Google Scholar
34	Bray GA, Kim KK and Wilding JPH: World Obesity Federation. Obesity: a chronic relapsing progressive disease process. A position statement of the World Obesity Federation. Obes Rev. 18:715–723. 2017.PubMed/NCBI View Article : Google Scholar
35	Lempesis IG, Tsilingiris D, Liu J and Dalamaga M: Of mice and men: Considerations on adipose tissue physiology in animal models of obesity and human studies. Metabol Open. 15(100208)2022.PubMed/NCBI View Article : Google Scholar
36	Sumithran P, Finucane FM and Cohen RV: Obesity drug shortages are symptomatic of wider malaise. The Lancet: Sep 29, 2023 (Epub ahead of print).
37	Wilson C: Why is the Wegovy weight-loss treatment so hard to get hold of? Elsevier, 2023.
38	Ba S and Bai H: Covid-19 pandemic as an accelerator of economic transition and financial innovation in China. J Chin Econ Business Stud. 18:341–348. 2020.
39	Gilmore AB, Fabbri A, Baum F, Bertscher A, Bondy K, Chang HJ, Demaio S, Erzse A, Freudenberg N, Friel S, et al: Defining and conceptualising the commercial determinants of health. Lancet. 401:1194–1213. 2023.PubMed/NCBI View Article : Google Scholar
40	Anekwe CV, Jarrell AR, Townsend MJ, Gaudier GI, Hiserodt JM and Stanford FC: . Socioeconomics of Obesity. Curr Obes Rep. 9:272–279. 2020.PubMed/NCBI View Article : Google Scholar
41	Plutarch: Parallel lives. Endymion Press, 2018.
42	Jung CG: The structure and dynamics of the psyche. Adler G, Jung CG, Fordham M and Read H (eds). 1st Edition. Routledge, London, 2014.