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COVID-19 Resource Center

May 20, 2020
3 min read

Obesity triples odds of more severe symptoms with COVID-19

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Ming-Hua Zheng
Ming-Hua Zheng
Kenneth Zheng
Kenneth Zheng
Chen Jun
Chen Jun

In two cohorts of Chinese adults with COVID-19, those with obesity were at least three times more likely to have a severe case of the disease than those with normal weight, according to two studies published in Diabetes Care.

In addition, increasing obesity was associated with increasing odds of severe COVID-19, and the association between obesity and symptom severity was stronger for men than for women.

Those with obesity are at higher risk for respiratory complications when infected by SARS-CoV-2 and often require hospitalization,” Ming-Hua Zheng, MD, PhD, deputy chief physician and associate professor in the MAFLD Research Center in the department of hepatology and the Institute of Hepatology at the First Affiliated Hospital of Wenzhou Medical University in China and the Key Laboratory of Diagnosis and Treatment for the Development of Chronic Liver Disease in Zhejiang province, and Kenneth I. Zheng, MD, also of the MAFLD Research Center, told Healio. “Closer attention needs to be paid to this subgroup of patients in order to reduce the risk of fatalities.”

Severity increases with BMI

In two cohorts of Chinese adults with COVID-19, those with obesity were at least three times more likely to have a severe case of the disease than those with normal weight.
Source: Adobe Stock

Ming-Hua Zheng, Kenneth I. Zheng and colleagues analyzed data from 150 adults with COVID-19 (mean age, 48 years; 62.7% men) presenting to three hospitals in China between Jan. 17 and Feb. 11; all were discharged alive. Among the cohort, 75 had obesity, defined as BMI at least 25 kg/m2 (mean BMI, 27.7 kg/m2; 24% with diabetes), and 75 were normal-weight matched controls (mean BMI, 21.8 kg/m2; 14.7% with diabetes).

The patients with obesity presented with higher plasma C-reactive protein levels and lower lymphocyte counts, according to the researchers. Median hospital stay was 23 days for patients with obesity vs. 18 days for those with normal weight (P = .037), and 33.3% of those with obesity had severe COVID-19 vs. 14.7% of controls (P = .007). After adjustment for age, sex, smoking status, hypertension, diabetes and dyslipidemia, obesity was associated with triple the odds of severe COVID-19 (adjusted OR = 3; 95% CI, 1.22-7.38) vs. less severe disease, with each 1 U increase in BMI associated with 13% increased risk (aOR = 1.13; 95% CI, 1.01-1.28).

Association stronger for men

In the second study, Jun Chen, MD, PhD, professor and chief director of the liver diseases center at the Third People’s Hospital of Shenzhen and the Second Affiliated Hospital of Southern University of Science and Technology in Shenzhen, China, and colleagues analyzed data from 383 adults (52.2% women) consecutively admitted to the Third People’s Hospital of Shenzhen for COVID-19 from January 11 to February 16 and followed until March 26. Among the cohort, 4.2% had underweight (BMI 18.5 kg/m2), 53.2% had normal weight (BMI 18.5-23.9 kg/m2), 32% had overweight (BMI 24-27.9 kg/m2) and 10.7% had obesity (BMI 28 kg/m2); 17.5% of men had obesity vs. 4.5% of women.


Across BMI categories, patients had similar symptoms, epidemiologic characteristics, disease progression and treatment, but those with obesity more often presented with cough and fever than those without obesity, according to the researchers. Among the entire cohort, 23.8% progressed to severe COVID-19: none of those with underweight, 19.2% of those with normal weight, 29.3% of those with overweight and 39% of those with obesity (P = .001), with one death in each of the three groups.

The researchers found that patients with obesity were more than three times as likely to develop severe COVID-19 vs. those with normal weight (OR = 3.40; 95% CI, 1.40–8.26). The association was not significant for women, but men with obesity were more than five times as likely to develop severe symptoms vs. men with normal weight (OR = 5.66; 95% CI, 1.80–17.75).

“Most surprising about our results: Obese patients, especially male obese patients, had increased odds of progressing to severe COVID-19,” Chen told Healio. “Clinicians should pay close attention to obese patients, who should be carefully managed with prompt and aggressive treatment.”

Increased attention to obesity in COVID-19 is needed, the researchers said.

“Having limited understanding of the mechanisms linking obesity to COVID-19, more investigations are needed for discovering suitable therapeutic targets in these patients,” Ming-Hua Zheng and Kenneth I. Zheng said. “More intensive surveillance is required considering obesity is associated with an altered microenvironment conducive to emergence of potentially pathogenic variants capable of causing greater disease severity. Timelier medical intervention is warranted in response to possible mechanical dysfunction due to severe obesity causing increased severity of lower respiratory tract infection and probability of secondary infection.” – by Jill Rollet

For more information:

Jun Chen, MD, PhD, can be reached at

Ming-Hua Zheng, MD, PhD, can be reached at

Disclosures: The authors report no relevant financial disclosures.