According to a small Turkish study, severe obesity may reduce the efficiency of COVID-19 vaccines in people who have never been infected with the coronavirus.

Patients with significant obesity exhibited antibody levels more than three times lower than normal-weight participants in the trial who had received the Pfizer/BioNTech vaccination and had no previous SARS-CoV-2 infection. According to findings presented this week at the European Congress on Obesity in Maastricht, Netherlands, persons with severe obesity and no history of past infection had antibody levels 27 times lower than normal weight people who received Sinovac Biotech’s CoronaVac. Antibody levels were similar in those with and without extreme obesity among the 70 volunteers who had previously been infected with the coronavirus.

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Researchers evaluated immunological responses to vaccines in 124 participants with severe obesity (defined as a BMI of 40 or higher) with 166 healthy volunteers for the study (BMI less than 25). In total, 130 people were given two doses of the Pfizer/BioNTech mRNA vaccine and 160 got two doses of Sinovac’s inactivated-virus vaccine.

In persons with severe obesity, two doses of the Pfizer/BioNTech vaccine “may create much more antibodies than CoronaVac… More research is needed to see if these higher antibody levels offer better protection against COVID-19, according to study leader Volkan Demirhan Yumuk of Istanbul University.