TABLE 1.
Studies reporting on the outcomes of obese patients with COVID-19.
| References | Study population | BMI (kg/m2) | Outcomes |
| Simonnet et al. (140) | 124 patients admitted to ICU | 30 < BMI ≤ 35 (47.6%) BMI > 35 (28.2%) |
The proportion of patients requiring mechanical ventilation (p < 0.01): BMI > 35 (85.7%) 30 < BMI ≤ 35 (75%) 25 < BMI ≤ 30 (60.4%) BMI < 25 (47.1%) |
| Lighter et al. (141) | 3,615 SARS-CoV-2 positive patients | 30 ≤ BMI < 35 (21%) BMI ≥ 35 (16%) |
Critical disease: BMI of 30–34 is 1.8 times more than normal. BMI > 35 is 3.6 times more than normal. |
| Cai et al. (142) | 383 confirmed inpatients | 18.5 ≤ BMI ≤ 23.9 (53.1%) 24.0 ≤ BMI ≤ 27.9 (32.0%) BMI ≥ 28 (10.7%) |
Probability of developing severe cases: BMI: 18.5–23.9 (19.2%) BMI: 24.0–27.9 (29.3%) BMI ≥ 28 (39.0%) (p = 0.001) |
| Hamer et al. (7) | 334,329 cases of samples 640 confirmed inpatients |
BMI > 25 (66.6%) | Possibility of hospitalization compared to normal weight: BMI: 25–30 (OR 1.39) BMI: 30–35 (OR 1.70) BMI > 35 (OR 3.3) |
| Giacomelli et al. (18) | 233 confirmed inpatients | BMI > 30 (16.3%) | Obesity rate among survivors (13.5%) Obesity rate among non-survivors (27.1%) Mortality of BMI > 30 (aHR 3.04) |
| Huang et al. (6) | A summary of 33 articles | Not reported | Univariate analysis of COVID-19 patients with obesity: Risk of hospitalization (OR 1.76, p = 0.003) Risk of ICU admission (OR 1.67, p < 0.001) Risk of death (OR 1.37, p = 0.014) Risk of IMV (OR 2.19, p < 0.001) |
| Palaiodimos et al. (17) | 200 confirmed inpatients | BMI < 25 (19%) BMI: 25–34 (58%) BMI ≥ 35 (23%) |
In-hospital mortality rate: BMI < 25 (31.6%) BMI: 25–34 (17.2%) BMI ≥ 35 (34.8%) Intubation rate: BMI < 25 (18.4%) BMI: 25–34 (16.4%) BMI ≥ 35 (34.8%) |
| Kass et al. (143) | 265 patients admitted to ICU | BMI < 26 (25%) BMI > 34.7 (25%) |
Younger individuals admitted to hospital were more likely to be obese. |
| Bhatraju et al. (144) | 24 patients admitted to ICU | BMI: 18–25 (3) BMI: 25–30 (7) BMI > 30 (13) |
BMI > 30 (85% required mechanical ventilation and 62% died) BMI < 30 (64% required mechanical ventilation and 36% died) |
| Petrilli et al. (145) | 4,103 confirmed patients | BMI > 30 (26.8%) | Rate of obesity among hospitalized patients: 39.8% BMI > 40 kg/m2 is the biggest risk factor for hospitalization (OR 6.2) |
| Goyal et al. (146) | 393 confirmed inpatients | BMI > 30 (35.8%) | Obesity accounted for 43.3% of patients requiring invasive ventilation. Obesity accounted for 31.9% of non-invasive ventilation patients. |
| Caussy et al. (14) | 340 patients with severe condition | BMI > 30 (25%) | After standardization of age and sex, compared to the average French person: The incidence of obesity in severe COVID-19 is 1.35 times higher (p = 0.0034). The prevalence of obesity in the ICU is 1.89 times higher (p = 0.0011). |
| Du et al. (15) | 109,881 patients with COVID-19 in the meta-analysis | Not reported | The observational studies showed that patients with a BMI ≥ 30 kg/m2 were 2.35 times more likely to develop critical COVID-19 and had a 2.68-fold risk for mortality, compared with patients with a BMI < 30 kg/m2. Random-effects dose-response meta-analysis showed that the incidence of critical cases and mortality augmented by 9 and 6% for each 1 kg/m2 increase in BMI, respectively. |
| Tartof et al. (147) | 6,916 patients with COVID-19 | BMI: 18.5–24 (n = 1,240) BMI: 25–29 (n = 2,207) BMI: 30–39 (n = 2,537) BMI: 40–44 (n = 372) BMI ≥ 45 (n = 262) |
Compared with patients with 18.5 ≤ BMI<24 kg/m2, those with BMI of 40–44 kg/m2 and greater than 45 kg/m2 had relative risks of 2.68 and 4.18, respectively. |
| Hendren et al. (9) | 7,606 patients hospitalized with COVID-19 | Underweight, BMI < 18.5 (n = 194) Normal, BMI: 18.5–24.9 (n = 1,793) Overweight, BMI: 25.0–29.9 (n = 2,308) Class I obesity, BMI: 30.0–34.9 (n = 1,623) Class II obesity, BMI: 35.0–39.9 (n = 846) Class III obesity, BMI ≥ 40.0 (n = 842) |
Higher risks of in-hospital death or mechanical ventilation than normal weight group (18.5–24.9 kg/m2): Class I obesity, BMI 30.0–34.9 kg/m2 (OR 1.28) Class II obesity, BMI 35.0–39.9 kg/m2 (OR 1.57) Class III obesity, BMI ≥ 40.0 kg/m2 (OR 1.80) |
| Kompaniyets et al. (16) | 148,494 patients with COVID-19 | Underweight, BMI < 18.5 (n = 79,988, 2.5%) Healthy weight, BMI: 18.5–24.9 (n = 829,474, 25.6%) Overweight, BMI: 25–29.9 (n = 936,132, 28.9%) Obesity, BMI ≥ 30 (n = 1,397,055, 43.1%) |
aRRs for hospitalization for patients with different BMI compared with healthy-weight cohort: Hospitalization: BMI 30–34.9 kg/m2: 1.07 (95% CI 1.05–1.09) BMI ≥ 45 kg/m2: 1.33 (95% CI 1.30–1.37) Death: BMI 30–34.9 kg/m2: 1.08 (95% CI 1.02–1.14) BMI ≥ 45 kg/m2: 1.61 (95% CI 1.47–1.76) ICU admission BMI 40–44.9 kg/m2: 1.06 (95% CI 1.03–1.10) BMI ≥ 45 kg/m2: 1.16 (95% CI 1.11–1.20) IMV: BMI 25–29.9 kg/m2: 1.12 (95% CI 1.05–1.19) BMI ≥ 45 kg/m2: 2.08 (95% CI 1.89–2.29) |
| Yamashita et al. (10) | 1,236 patients with COVID-19 | Mean body: 67.6 kg Mean BMI: 24.0 kg/m2 |
COVID-19 patients with VTE showed a higher body weight (81.6 vs. 64.0 kg, p = 0.005) and BMI (26.9 vs. 23.2 kg/m2, P = 0.04) compared with those without. |
| Thompson et al. (89) | 1.1 million individuals with COVID-19 diagnostic codes in electronic healthcare records | Acute COVID-19 (n = 1,064,491) Not obese (n = 800,439) Obese I, BMI (30–34.9) (n = 151,782) Obese II (35–39.9) (n = 67,470) Obese III (40+) (n = 44,800) Long COVID (n = 4,189) Not obese (n = 2,694) Obese I (30–34.9) (n = 787) Obese II (35–39.9) (n = 411) Obese III (40+) (n = 297) |
Overweight/obesity was associated with increased odds of symptoms lasting for 4+ weeks (OR 1.24, 95% CI 1.01–1.53) but not with symptoms lasting 12+ weeks specifically (OR 0.95, 95% CI 0.70–1.28). |
| Subramanian et al. (11) | 486,149 adults with confirmed SARS-CoV-2 infection | BMI < 18.5 (n = 13,261, 2.7%) BMI: 18.5–25 (n = 148,295, 30.5%) BMI: 25–30 (n = 138,771, 28.5%) BMI > 30 (n = 121,943, 25.1%) |
Compared with patients with normal BMI, patients with a BMI of 25–30 kg/m2 reported an aHR of 1.07 (95% CI 1.04–1.10) for prolonged symptoms and those with a BMI of >30 kg/m2 reported an aHR of 1.10 (95% CI 1.07–1.14). |
| PHOSP-COVID Collaborative Group (12) | 924 post-COVID participants who had a 1-year visit | BMI < 30 kg/m2 (n = 349, 40.3%) BMI ≥ 30 kg/m2 (n = 517, 59.7%) |
In multivariable analysis, BMI ≥ 30 kg/m2 (OR 0.50, 95% CI 0.34–0.74, p = 0.0007) was an independent factor associated with being less likely to recover at 1 year. |
| Wynberg et al. (13) | 342 COVID-19 patients during the first 12 months after illness onset | Underweight or normal weight, BMI < 25 (140, 41%) Overweight, BMI: 25–30 (108, 32%) Obese, BMI > 30 (82, 24%) |
In the 1-year post-COVID recovery study, the obese patients recovered 38% more slowly than participants with normal BMI (aHR 0.62, 95% CI = 0.39–0.97). Recovery was slower in those with a BMI ≥ 30 kg/m2 compared to BMI < 25 kg/m2 (HR 0.62, 95% CI = 0.39–0.97). |
| Xie et al. (99) | 18,818 outpatients with COVID-19 | Mean BMI: 27.64 | In patients with COVID-19, obesity was independently associated with higher risk, with aHR of 1.83 (95% CI, 1.28–2.61). |
| Lacavalerie et al. (104) | 51 chronic post-COVID-19 patients | Non-obese 18, Mean BMI: 25 Obese 33, Mean BMI: 34 |
Obese patients with chronic COVID-19 develop exaggerated ventilatory drive and impaired oxygenation at peak exercise, lower lung volumes, reduced ventilatory reserve (25 vs. 40, p = 0.011) and lower peripheral capillary oxygen saturation (96 vs. 98, p = 0.036). |
COVID-19, coronavirus disease 2019; BMI, body mass index; OR, odds ratio; aHR, adjusted hazard ratio; aRRs, adjusted risk ratio; VTE, venous thrombus embolism; CI, confidence interval; HR, hazard ratio.