Patients With Obesity at Greater Risk for COVID-19 Complications and Mortality

Intubation or death up to 30 days after diagnosis of COVID-19 served as the primary endpoint in a population-based study analyzing obesity as an independent risk factor for COVID-19.

Patients infected with coronavirus-2019 (COVID-19) who were obese had poorer outcomes compared with the general population. These findings, from a retrospective cohort study, were published in Gastroenterology.

This study mined the TriNetX database, which aggregated electronic medical records from multiple large healthcare organizations in the United States. The investigators collected data from adults who tested positive for COVID-19 from January 20 to May 31 2020. Patients were stratified by obesity or body mass index (BMI) and data were propensity matched 1:1 for patients with normal and high BMI.

Data from 41,513 adults positive for COVID-19 were collected. Of those patients, 8641 were documented as obese with a BMI of 30 or greater (n=5879) or diagnosed as obese (n=2762). The patients in the obese group significantly differed by age (P <.001), were predominantly women (62.19% vs 52.66%; P <.001), had significantly more comorbidities (P <.001), were more likely to be Black (36.04% vs 24.09%; P <.001), and less likely to be Asian (1.11% vs 3.36%; P <.001) compared with the patients without documented obesity, respectively.

At 30 days, the patients with obesity had a higher rate of hospitalization (25.66% vs 14.27%; P <.001), intubation (8.46% vs 3.32%; P <.001), and mortality (4.57% vs 3.32%; P <.001) compared with the general patient population, respectively. Patients with obesity were at an overall increased risk for 30-day mortality or to require mechanical ventilation (risk ratio [RR], 1.99; 95% CI, 1.84-2.15; P <.001). After propensity score matching, the 30-day risk estimate decreased (RR, 1.56; 95% CI, 1.41-1.73). The patients with obesity still had elevated risk for hospitalization (RR, 1.40; 95% CI, 1.32-1.49; P <.001), intubation (RR, 1.83; 95% CI, 1.62-2.07; P <.001), and mortality (RR, 1.17; 95% CI, 1.01-1.36; P =.035). The rate of event-free 30-day survival was lower in patients with obesity compared with general patients (87.7% vs 90.5%; P <.0001).

A limitation of this study was that it was based on electronic medical record codes, making it impossible for the investigators to validate observations or to detect errors.

The study authors concluded that patients with obesity were at an increased risk for complications or death from infection with COVID-19. Clinicians should be aware of the increased risk in this patient population and manage patient symptoms aggressively. They believe these data also highlighted the need for developing weight-loss strategies to combat the epidemic of obesity in the United States.

Disclosure: An author declared affiliations with industry. Please refer to the original article for a full list of disclosures.


Singh S, Bilal M, Pakhchanian H, et al. Impact of Obesity of Outcomes of Patients with COVID-19 in United States: A Multicenter Electronic Health Records Network Study. Gastroenterology. 2020;S0016-5085(20)35067-8. doi:10.1053/j.gastro.2020.08.028