COVID-19 Obesity

Updated January 24, 2022

1 APR 2020: Obesity and COVID-19 Severity in a Designated Hospital in Shenzhen, China (Lancet preprint)
“This is the first study showing that obesity, especially in men, significantly increases the risk of developing severe pneumonia in COVID-19 patients.”

1 JUL 2020: How important is obesity as a risk factor for respiratory failure, intensive care admission and death in hospitalized COVID-19 patients (European Journal of Endocrinology)
“Obesity is a strong, independent risk factor for respiratory failure, admission to the ICU and death among COVID-19 patients. Whereas a BMI ≥ 30 kg/m2 identifies a population of patients at high risk for severe illness, a BMI ≥ 35 kg/m2 dramatically increases the risk of death.” 
Press Release Link 16 Jul (MedicalExpress)

24 JUL 2020: Excess Weight and COVID-19: Insights from new evidence (Public Health England)

“The only striking positive comorbidity was obesity. However,
in NYC, obesity is also much more prevalent among low-income groups who are more likely to live in densely populated neighborhoods and to work in high-exposure jobs. Thus, it is quite possible that NYC’s obese population has a higher infection rate”

25 JUN 2020: When Two Pandemics Meet: Why Is Obesity Associated with Increased COVID-19 Mortality? (Cell Med)

26 JUN 2020: Impaired glucose metabolism in patients with diabetes, prediabetes, and obesity is associated with severe COVID-19 (Journal of Medical Virology)
“Severe COVID-19 occurs in the presence of impaired glucose metabolism in patients, including those with DM, preDM, and obesity.”

11 AUG 2020: Overweight, obesity, and risk of hospitalization for COVID-19: A community-based cohort study of adults in the United Kingdom (PNAS)
“In summary, overall and central obesity are risk factors for COVID-19 hospital admission. Elevated risk was apparent even at modest weight gain. The mechanisms may involve impaired glucose and lipid metabolism.” 

12 AUG 2020: Obesity and Mortality Among Patients Diagnosed With COVID-19 (Annals of Internal Medicine)
“Obesity plays a profound role in risk for death from COVID-19, particularly in male patients and younger populations.”

14 AUG 2020: Hospitalization Rates and Characteristics of Children Aged <18 Years Hospitalized with Laboratory-Confirmed COVID-19 (CDC Early Release)
“This study, along with other studies of hospitalized children with COVID-19, found that obesity was the most prevalent underlying medical condition. Childhood obesity affects almost one in five U.S. children and is more prevalent in black and Hispanic children” 

26 AUG 2020: Individuals with obesity and COVID‐19: A global perspective on the epidemiology and biological relationships (Obesity Reviews)
Press Release (University of North Carolina at Chapel Hill)
“Researchers examined the available published literature on individuals infected with the virus and found that those with obesity (BMI over 30) were at a greatly increased risk for hospitalization (113%), more likely to be admitted to the intensive care unit (74%), and had a higher risk of death (48%) from the virus.”

17 NOV 2020: Obesity and COVID-19 in New York City: A Retrospective Cohort Study (Annals of Internal Med)
This study of 1687 adults hospitalized with COVID-19 in New York City showed that obesity was an independent risk factor for respiratory failure but not for in-hospital mortality. Our findings, at least in part, explain the extensive use of invasive mechanical ventilation reported in the United States (1), where the prevalence of obesity exceeds 40%.”

23 FEB 2021: Exhaled aerosol increases with COVID-19 infection, age, and obesity (PNAS)

25 FEB 2021: Coronavirus Disease 2019 Hospitalizations Attributable to Cardiometabolic Conditions in the United States: A Comparative Risk Assessment Analysis (Journal of American Heart Association)

  • Among >900 000 US coronavirus disease 2019 hospitalizations through November 18, 2020, nearly two thirds (63.5%) were estimated to be attributable to these cardiometabolic conditions, that is, preventable if these conditions had not been present.
  • Top risks were obesity (30.2%), hypertension (26.2%), and diabetes mellitus (20.5%).

2 MAR 2021: Diabetes, obesity, metabolism, and SARS-CoV-2 infection: the end of the beginning (Cell Metabolism)
“New data informing genetic predisposition, epidemiology, immune responses, disease severity, and therapy of COVID-19 in people with obesity and diabetes are highlighted. The emerging relationships of metabolic disorders to viral-induced immune responses and viral persistence, and the putative importance of adipose and islet ACE2 expression, glycemic control, cholesterol metabolism, and glucose- and lipid-lowering drugs is reviewed, with attention to controversies and unresolved questions. Rapid progress in these areas informs our growing understanding of SARS-CoV-2 infection in people with diabetes and obesity”

28 APR 2021: Associations between body-mass index and COVID-19 severity in 6·9 million people in England: a prospective (Lancet)
“At a BMI of more than 23 kg/m2, we found a linear increase in risk of severe COVID-19 leading to admission to hospital and death, and a linear increase in admission to an ICU across the whole BMI range, which is not attributable to excess risks of related diseases. The relative risk due to increasing BMI is particularly notable people younger than 40 years and of Black ethnicity.”

15 SEP 2021: Hyperglycemia in acute COVID-19 is characterized by insulin resistance and adipose tissue infectivity by SARS-CoV-2 (Cell Metabolism)
“Together these data suggest that SARS-CoV-2 may trigger adipose tissue dysfunction to drive insulin resistance and adverse outcomes in acute COVID-19.”

25 OCT 2021: SARS-CoV-2 infects human adipose tissue and elicits an inflammatory response consistent with severe COVID-19 (bioRxiv preprint)
“our findings indicate that adipose tissue supports SARS-CoV-2 infection and pathogenic inflammation and may explain the link between obesity and severe COVID-19”

7 NOV 2021: The majority of SARS-CoV-2-specific antibodies in COVID-19 patients with obesity are autoimmune and not neutralizing (Nature Obesity)
“The results from this study show that the majority of COVID-19 patients with obesity make almost undiscernible amounts of neutralizing anti-SARS-CoV-2 antibodies, suggesting that obese individuals may be at a higher risk to respond poorly to SARS-CoV-2 infection. … All of our recruited participants with obesity, however, made autoimmune antibodies.”

10 DEC 2021: Replication of SARS-CoV-2 in adipose tissue determines organ and systemic lipid metabolism in hamsters and humans (Cell Metabolism)
“we show here that SARS-CoV-2 infection of adipose tissue profoundly affects organ and systemic lipid metabolism in hamsters and humans.”

29 DEC 2021: Association of Weight Loss Achieved Through Metabolic Surgery With Risk and Severity of COVID-19 Infection (JAMA Surgery)
previous weight loss surgery was significantly associated with a 49% lower risk of hospitalization, 63% lower risk of need for supplemental oxygen, and 60% lower risk of severe disease during a 12-month period after contracting COVID-19 infection.”

4 JAN 2020: The coronavirus may cause fat cells to miscommunicate, leading to diabetes (ScienceNews Article)

18 JAN 2022: Obesity associated with attenuated tissue immune cell responses in COVID-19 (medRxiv preprint)
“…these findings show blunted tissue immune responses in Ob COVID-19 patients, with clinical implications.”