I have been reading in the press about how being obesity can increase the severity of the disease. An article in Wired, Covid-19 Does Not Discriminate by Body Weight (17 April, 2020), seems to indicate this isn’t the case.

Is there enough data to point the evidence in either direction?

  • The Wired piece complains that the 3 studies it mentions didn't control for confounders like race, etc. @Oddthinking: it's entirely possible to reanalyze just those studies while controlling for more factors. The q should be made more clear what Wired complains about. The q here is poorly phrased in terms of "enough data". – Fizz Apr 24 '20 at 17:08

Overall, yes the current literature supports the statement that a high BMI increases the severity of COVID-19 but it is not without opposing data, even in some of the supporting literature.

In Kim, et al. (2021) they state that

the obese had a higher chance of requiring mechanical ventilation and were statistically more likely to die than those without obesity (or being underweight).

In Soeroto, et al. (2020) they state that

Adult COVID-19 patients with poor outcome had higher body mass index (BMI) with mean difference of 1.12 kg/m2 (P < 0.001) and Obesity (BMI ≥30 kg/m2) was associated with composite poor outcome with OR = 1.78 (P < 0.001).

But counter research exists.

For example. The title of this paper tells you all you need to know but this study is only a small group of critically ill patients with COVID-19.

Kooistra, et al. (2021)

A higher BMI is not associated with a different immune response and disease course in critically ill COVID-19 patients.

I prefer in these situations to examine meta-analyses and Malik, et al. (2020) state that,

the results of the current study show that BMI plays a significant role in COVID-19 severity in all age groups, especially the older individuals.


Kim, T. S., Roslin, M., Wang, J. J., Kane, J., Hirsch, J. S., Kim, E. J., & Northwell Health COVID‐19 Research Consortium. (2021). BMI as a Risk Factor for Clinical Outcomes in Patients Hospitalized with COVID‐19 in New York. Obesity, 29(2), 279-284. https://doi.org/10.1002/oby.23076

Kooistra, E. J., de Nooijer, A. H., Claassen, W. J., Grondman, I., Janssen, N. A., Netea, M. G., ... & Pickkers, P. (2021). A higher BMI is not associated with a different immune response and disease course in critically ill COVID-19 patients. International Journal of Obesity, 45(3), 687-694. https://doi.org/10.1038/s41366-021-00747-z

Malik, V. S., Ravindra, K., Attri, S. V., Bhadada, S. K., & Singh, M. (2020). Higher body mass index is an important risk factor in COVID-19 patients: a systematic review and meta-analysis. Environmental Science and Pollution Research, 27(33), 42115-42123. https://doi.org/10.1007/s11356-020-10132-4

Soeroto, A. Y., Soetedjo, N. N., Purwiga, A., Santoso, P., Kulsum, I. D., Suryadinata, H., & Ferdian, F. (2020). Effect of increased BMI and obesity on the outcome of COVID-19 adult patients: A systematic review and meta-analysis. Diabetes & Metabolic Syndrome: Clinical Research & Reviews, 14(6), 1897-1904. https://doi.org/10.1016/j.dsx.2020.09.029

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    Could you in general standardise the formatting for your refs? (Eg: How do I decode your asterisk usage?) // Quotes are too short for my tastes, lack too much context. Could profit from more eval. // The 'counter-research' may be peer-preferred, but it would help if you eg include a tighter verdict, like: "an abysmally small sample junked up to include hyper-precise-looking stats to impress with math&numbers"/"'prospective' only after selection bias manifest in patients already in ICU"? A general correlational observation already firmly contradicts this study with far too much claimed reach. – LangLаngС May 27 at 9:57
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    @LangLаngС I believe the references are standard.// not sure what peer-preferred means, it is not a term that I am familiar with in the sciences, can you clarify?// I prefer short quotes and direct links to the open papers so you can read the quote and click on the link to go to the paper for context. Long quotes I think deter readers.// I prefer to let the literature speak, why I go to meta-analyses so often, I'll never give my opinion using words such as abysmal and junk as you suggest that I do as it just makes people think you are biased.// I have no idea what your last sentence means. – If you do not know- just GIS May 27 at 13:44
  • Look @ the stats for fatalities correlated with obesity: big r. The way you phrase the intro for and quote 'the counter-study': that is imo misleading. They say: "is not", they forget and you do not tell/emphasize '… in this small study with patients already on ventilators at least we didn't see.' None of your readers here gets a clue to the quality & reach of that study within A. Whatever you prefer, here that additional info/context is sorely needed as the finding may be 'true' but the external validity of the quote, esp when filtered thru this A, makes it look much stronger than it is. – LangLаngС May 27 at 14:06
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    Or in the words of the authors: "Taken together, *these data indicate that *once a COVID-19 patient becomes critically ill, the immune response and clinical course of the disease is not relevantly influenced by the patients’ BMI." (still overselling, imo) Together with generally better outcome of obese ICU patients: "Our study was underpowered", "the obese group consisted largely of mildly obese patients", "because patients … included after ICU admission and … ventilation, no statements can be made about the relationship between obesity and the risk of ICU … or requirement of…ventilation." – LangLаngС May 27 at 14:20
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    Note that the Kooistra study was of the critically ill and thus it says nothing about whether obese patients are more likely to become critically ill. – Loren Pechtel May 28 at 0:24

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