Obesity Made Even Mild COVID Worse

COVID-19 patients classified as overweight or obese had more symptoms of the illness, and their symptoms tended to last longer, researchers found.

In a prospective study, 59% of COVID-19 patients who were overweight or obese were symptomatic versus 47% of those who were not, reported Pia Pannaraj, MD, of the University of Southern California in Los Angeles, and colleagues.

These patients also suffered a higher number of median symptoms (3 vs 2, respectively), and significantly more coughing, shortness of breath, and altered taste, they wrote in Influenza and Other Respiratory Viruses.

The authors noted that while obesity puts people at risk for severe COVID-19, most research has focused on hospitalizations, even though “the majority of COVID-19 infected individuals are managed outside of the hospital.”

They enrolled participants from June 17, 2020 to Jan. 31, 2021 in the prospective study. Participants had an age range from 1 month to 84 years, and were exposed to SARS-CoV-2 within 2 weeks prior to enrollment. They were tested via RT-PCR and serology; symptoms were recorded for 28 days. Overweight was defined as a BMI of 25-29.9, and obesity was defined as a BMI of 30 and over.

Overall, 552 individuals underwent nasopharyngeal swab testing for SARS-CoV-2, 476 provided a blood sample at enrollment, and 283 did so at a convalescent visit. There were 470 individuals (85%) who tested positive for COVID-19 via RT-PCR or serology. Due to inconclusive results from five participants, the authors analyzed data from 547 individuals.

The sample was composed of 308 adults and 239 children. “Ethnicity in the cohort was characterized by a strong Hispanic/Latinx predominance, which reflects the surrounding community served by our institution,” according to the authors.

About 20% of participants had underlying health conditions, including asthma, diabetes, and cardiovascular conditions. About 62% of the population had overweight or obesity, including 75% of adults and 62% of children.

Among confirmed COVID cases, 56% were symptomatic. Notably, adolescents with overweight or obesity had higher median days of respiratory symptoms (7 vs 4), and were significantly more likely to be symptomatic (67% vs 34%) than adolescents without overweight or obesity.

Symptomatic individuals also had longer duration of PCR positivity than asymptomatic individuals (18 days vs 8 days), but the authors found no differences by age or obesity status.

Limitations to the data include that it was self-reported, and subject to recall bias, with parents and family members reporting symptoms for children unable to report them for themselves. They added that younger children are less likely to verbalize certain symptoms, such as loss of taste or headache, and added there may also have been other unmeasured confounders.

They concluded that vaccination is particularly important in populations with overweight or obesity, “ameliorating preventable complications in an at-risk population.”