Earlier this year, doctors observed a troubling trend as the COVID-19 pandemic swept across the United States and the world: Obesity significantly increased the threat of severe and sometimes deadly coronavirus-related complications. At two New York City hospitals in March, 35.8 percent of the first 393 COVID-19 patients were obese and 43.4 percent of those who ended up on ventilators were obese, according to a letter in the New England Journal of Medicine. A study published in May in the BMJ found that in the United Kingdom, obesity increased the risk of dying from COVID-19 by 33 percent.

"Obesity is emerging as a major risk factor for doing poorly with COVID-19, especially in those under 60," says Brian Callaghan, MD, MS, FAAN, associate professor of neurology at the University of Michigan, Ann Arbor.

In a letter to the editor in Clinical Infectious Diseases, researchers at NYU Langone Health noted that of 3,615 people who tested positive for COVID-19 in the emergency department of one New York City hospital, about 37 percent had a body mass index (BMI) of at least 30, the threshold for obesity. People younger than 60 who were mildly obese were about twice as likely to be admitted to acute or critical care than those with a BMI under 30.

"This has important and practical implications in the United States, where nearly 40 percent of adults are obese with a BMI [equal to or greater than] 30," the researchers wrote.

For patients with COVID-19, excess weight can interfere with healthy lung function and increase the risk of blood clots. Excess body fat, particularly abdominal fat, contributes to systemic inflammation, which can hinder a healthy immune-system reaction to infection. "In people with obesity and type 2 diabetes who have COVID-19, we've seen cytokine storm syndrome [a dangerous immune response to infection that damages cells, including in the lungs] in response to huge surges in blood glucose levels," says Eva Feldman, MD, PhD, FAAN, director of the NeuroNetwork for Emerging Therapies and the ALS Center of Excellence at the University of Michigan. "We are also seeing kidney and cardiac complications in these patients." Dr. Feldman and her colleagues plan to track more than 400 COVID-19 survivors with diabetes and obesity to see if the virus has effects on thinking, memory, peripheral neuropathy, and more.

In addition to its exacerbation of COVID-19, extra body weight increases the risk of many neurologic conditions, including mild cognitive impairment, dementia, and Alzheimer's disease, Dr. Feldman says. It also can fuel relapses and progression of multiple sclerosis (MS), increase risk for chronic migraines or a stroke, and boost the likelihood of developing obstructive sleep apnea, which can have neurologic consequences that affect thinking, mood, and alertness.

For people with neurologic conditions who were overweight before the pandemic or have put on pounds due to stress or inactivity during lockdown, here are recommendations from health care professionals for reaching and maintaining a healthy weight.

Check with your doctor. Ask your physician about the best weight loss strategy for you. He or she also can review your medications to see if any trigger weight gain, like pregabalin (Lyrica) and gabapentin (Neurontin), which are used for neuropathic pain in MS, fibromyalgia, and peripheral neuropathy, says Dr. Callaghan. "Don't try to lose weight if you have a neurodegenerative disorder such as Parkinson's disease, amyotrophic lateral sclerosis (ALS), or Huntington's disease," says Dr. Feldman. "It could worsen symptoms."

Consult a specialist. If your body mass index is 30 or higher, book an appointment with a physician who specializes in weight loss, says Caroline Apovian, MD, professor at Boston University School of Medicine and director of the Center for Nutrition and Weight Management at Boston Medical Center. "People with significant obesity should not just try to do things on their own," she says. "They need to see an obesity medicine specialist or a primary care doctor with knowledge of obesity or a dietitian. There's more than one way to lose weight, and different strategies work for different people. It's something patients can figure out with a health care professional, who can then guide them."

Lose weight slowly. Losing one to two pounds per week is a healthy goal for most people who are overweight, Dr. Apovian says. "Crash diets and extreme exercise aren't a good idea, especially if you're living with fatigue or pain," adds Matthew Plow, PhD, associate professor of nursing at Case Western Reserve University in Cleveland, who studies weight management and exercise in people with stroke or MS. Fast, drastic weight loss may also reduce muscle mass, he says. "For people with neurologic conditions who may also have mobility issues, you don't want to lose muscle mass. You need it for everyday activity and for exercise."

Rethink meals. Fill your plate with vegetables and fruit; whole grains; lean protein like fish, skinless poultry, tofu, and beans; and small amounts of healthy fats such as avocado. Use olive and canola oil in cooking instead of less healthy alternatives. Swap out soda and sugary snacks for unsweetened tea and fruits. Replace processed and fast food with whole foods, and look for whole grains instead of refined carbohydrates like white bread, says Molly Kimball, RD, who manages the nutrition program at the Ochsner Fitness Center in New Orleans. "I never count calories. I don't want to," she says. "Focusing on healthy, satisfying foods makes more sense to me, and I've seen it work for many of my clients."

Shop wisely. Keep your favorite fruits and vegetables on hand for snacks. Pack your freezer with fruits and veggies too, Kimball says. And buy low- or no-sodium beans for your pantry. "Keep a wide variety of filling foods on hand, along with Greek yogurt and avocados and herbs and spices so you can make creamy sauces for toppings," she suggests. "And look for healthy alternatives to higher-calorie foods, such as chickpea pasta instead of regular pasta. It's high in protein and fiber but tastes and feels like regular pasta. Try Greek yogurt instead of mayonnaise in tuna or chicken salad."

Embrace exercise. A stroll around the block or marching in place while you watch your favorite TV show won't torch enough calories to compensate for that extra slice of birthday cake. But exercise does burn some calories, and if you strength-train, you'll build muscle mass, say Dr. Plow and Dr. Apovian. Exercise can also reduce stress and boost levels of feel-good brain chemicals, which may make it easier to lose weight.

Track your activity. If you're living with pain or fatigue, Dr. Plow recommends monitoring the amount of exercise you do in a day and how it makes you feel afterward. "If you walk, I recommend using a pedometer or the step counter in your smartphone. See how you feel two hours after your walk. If you tend to feel tired or in pain after a certain amount of time or number of steps, you might want to cut back a little," he says. "It's trial and error. If you're not feeling great when it's time to exercise, try your activity for five minutes and see how you feel. You may want to continue or know it's time to stop. Self-monitoring is important for customizing your routine."

Do what you can. "If you have pain or fatigue or mobility impairments, cooking healthy meals and exercising can be a bigger challenge," Dr. Plow says. "Working with an occupational therapist to adapt activities like cooking or working in your garden can help. Modify activities you love so you can keep doing them. Maybe you use your scooter to ride around the path at the park a few times, then walk a little, so you're outdoors and exercising."

Make sleep a priority. "A lack of sleep can increase levels of hunger hormones and decrease hormones that make us feel satisfied when we eat," Dr. Apovian says. "Making sure you get eight hours a night, or whatever is optimal for you, can help with weight management." If you snore, consider getting evaluated for sleep apnea, says Bruce H. Cohen, MD, FAAN, director of the NeuroDevelopmental Science Center at Children's Hospital Medical Center of Akron in Ohio.

Expect slipups. "One splurge isn't going to make a big difference in weight loss," Kimball says. "Letting it derail you could. What matters is progress, not perfection."