A major international study published in The Lancet has found that obesity is strongly associated with a significantly higher risk of severe outcomes from a wide range of infectious diseases — and may underlie roughly one in ten infection‑related deaths worldwide. The findings, drawn from data on more than half a million people and complemented by global mortality modeling, underscore obesity’s far‑reaching impacts beyond chronic diseases and add urgency to global prevention efforts.
A Landmark Study on Obesity and Infection
Led by researchers from University College London (UCL), the study brought together data from two large cohort studies — one in Finland and the UK Biobank dataset in the United Kingdom — covering more than 540,000 adults followed for an average of 13–14 years. Participants were initially categorized by Body Mass Index (BMI) into healthy weight (BMI 18.5–24.9), overweight, and obesity (BMI ≥30). These classifications were then linked to records of hospitalisations and deaths caused by infectious diseases over the follow‑up period.
The results were striking: people living with obesity had a 70% higher risk of being hospitalised or dying from an infectious disease compared with those of healthy weight. Moreover, the risk increased progressively with rising BMI — with individuals in the highest BMI category (BMI ≥40) facing about three times the risk of severe infection compared to healthy‑weight counterparts.
Wide‑Ranging Effects Across Infection Types
The link between obesity and severe infection was consistent across a broad range of infectious diseases. These included common illnesses such as influenza (flu), COVID‑19, pneumonia, gastroenteritis, urinary tract infections, and lower respiratory infections. For most of these conditions, obese individuals were more likely to be hospitalised or to die from infection than those of healthy weight.
Interestingly, not all infections showed the same association. For diseases such as HIV and tuberculosis, the study did not find a higher risk related to obesity, suggesting that the relationship varies by pathogen and disease mechanism.
From Individual Risk to Global Burden
To estimate the broader implications, researchers linked the observed risk patterns with global mortality data from the Global Burden of Diseases (GBD) Study. By applying the higher relative risks observed in the cohort studies to worldwide death statistics, they estimated that approximately 0.6 million out of 5.4 million infection‑related deaths in 2023 — about 10.8% — could be associated with obesity. In other words, roughly one in every ten deaths from infectious diseases globally may be linked to excess body weight.
These findings represent a dramatic expansion of what is known about the health burden of obesity. While obesity has long been recognised as a major risk factor for diabetes, cardiovascular disease, certain cancers, and other non‑communicable conditions, its role in infectious disease outcomes has been less thoroughly quantified at a global scale until now.
Geographic Variation in Obesity’s Impact
The study also highlighted the considerable variation across countries and regions in the proportion of infection deaths linked to obesity. In high‑income countries with high obesity prevalence, such as the United States, obesity was associated with about one in four infection‑related deaths. In the United Kingdom, the figure was around one in six. By contrast, in countries with lower obesity prevalence — such as Vietnam — obesity accounted for only around 1% of infection deaths.
This geographic pattern reflects both differences in obesity prevalence and in background infection risks. Countries facing high burdens of infectious diseases have traditionally focused public health efforts on pathogen control, sanitation, and vaccination, but rising obesity may increasingly shape infection outcomes in those settings too.
Biological Mechanisms: Why Obesity Increases Infection Risk
Although the study did not directly investigate the biological underpinnings of the observed associations, researchers and experts offer several plausible explanations. One key pathway is immune system impairment. Excess body fat is known to contribute to chronic low‑grade inflammation and alterations in immune function, which can weaken the body’s ability to mount effective responses to pathogens.
Moreover, obesity is often accompanied by metabolic dysfunction — including insulin resistance, type 2 diabetes, and cardiovascular stress — which can further compromise immune responses and the body’s resilience to infections. These conditions may make individuals more susceptible to severe disease once infected and less able to recover.
Another important factor is that adipose (fat) tissue itself produces chemical signals — such as cytokines — that can interfere with the normal regulation of inflammation and immunity. Over time, this sustained inflammatory milieu can blunt the effectiveness of immune cells and disrupt normal defence mechanisms.
Public Health Implications and Policy Response
The findings carry profound implications for global public health strategies. Traditionally, infectious disease prevention has focused on vaccination, sanitation, antibiotics, and outbreak control. While these remain essential, the study suggests that tackling obesity must also become part of comprehensive strategies to reduce infection severity and mortality.
Weight management and prevention programmes, including access to affordable healthy foods, opportunities for physical activity, and support for behavioural change, may help reduce individual risk and the broader societal burden. Moreover, some evidence suggests that weight loss can lower the risk of severe infection outcomes, pointing to the value of early intervention.
Additionally, clinicians may need to consider obesity as a risk factor when prioritising vaccination and other preventive measures. For example, ensuring that people with obesity receive timely immunisations for influenza, pneumococcal disease, and COVID‑19 could help mitigate their higher risk of severe outcomes.
Limitations and Interpretive Caution
While influential, the study has limitations that warrant careful interpretation. It is observational, meaning that it identifies associations rather than definitive cause‑and‑effect relationships. Researchers adjusted for a range of potential confounders, but residual confounding by unmeasured factors — such as lifestyle differences or socioeconomic status — cannot be fully excluded.
Another limitation is that the global estimates rely on input data from the GBD Study, which may have variable accuracy across countries, especially in low‑resource settings where death registration and obesity surveillance systems are less robust. As a result, some regional estimates may be less precise.
Finally, the cohort populations (primarily from Europe) may not fully represent the genetic, environmental, and cultural diversity of the world, further underscoring the need for broader research across varied populations.
Overall, the study’s findings send a clear message: obesity is more than a lifestyle concern — it is a significant driver of infectious disease mortality worldwide. With global obesity rates continuing to rise, especially in urbanising and developing regions, the intersection of excess weight and infection outcomes demands urgent attention from policymakers, health professionals, and communities alike.
By reframing obesity as a risk factor not only for chronic diseases but also for severe infection outcomes, this research may influence future global health strategies aimed at reducing mortality and improving resilience against both old and emerging infectious threats.
Leave a comment