**15. Impact of obesity on COVID 19**

People with obesity are at high risk for the contraction of COVID – 19 infection. Adipose tissue is increased in ACE2 receptors, which facilitates the SARS-CoV-2 to enter the human cells quickly [35]. The viral load is significantly increased along with the prolonged viremia due to the massive number of adipocytes in obese people. Visceral adiposity causes cytokine proliferation, which causes the low-grade inflammation to advance the cytokines storm in COVID- 19 [36]. Obesity is responsible for reducing individuals' immunity and susceptibility to infection due to various pathogenic organisms. Because increased cytokines in the circulatory system reduce adiponectin levels, thus the immune response to infection is reduced. This mechanism causes damage to the lymphoid tissue and decreasing the B and T cells in the immune system, susceptible to viral infection [37]. Obesity and procoagulant factors are interlinked together that play a vital role in causing thromboembolic complications in patients with COVID-19. Obesity also reduces pulmonary function, reducing reserve volume and respiratory system compliance, at high risk for COVID 19 complications. Obesity with dysfunctional adipose tissue is associated with type 2 diabetes, hypertension, and CVD, which impair individuals' health during COVID 19 infection [38].
