Overweight, obesity, and risk of hospitalization for COVID-19: A community-based cohort study of adults in the United Kingdom

Proc Natl Acad Sci U S A. 2020 Sep 1;117(35):21011-21013. doi: 10.1073/pnas.2011086117. Epub 2020 Aug 11.


The role of obesity and overweight in occurrence of COVID-19 is unknown. We conducted a large-scale general population study using data from a community-dwelling sample in England (n = 334,329; 56.4 ±8.1 y; 54.5% women) with prospective linkage to national registry on hospitalization for COVID-19. Body mass index (BMI, from measured height and weight) was used as an indicator of overall obesity, and waist-hip ratio for central obesity. Main outcome was cases of COVID-19 serious enough to warrant a hospital admission from 16 March 2020 to 26 April 2020. Around 0.2% (n = 640) of the sample were hospitalized for COVID-19. There was an upward linear trend in the likelihood of COVID-19 hospitalization with increasing BMI, that was evident in the overweight (odds ratio, 1.39; 95% CI 1.13 to 1.71; crude incidence 19.1 per 10,000) and obese stage I (1.70;1.34 to 2.16; 23.3 per 10,000) and stage II (3.38; 2.60 to 4.40; 42.7 per 10,000) compared to normal weight (12.5 per 10,000). This gradient was little affected after adjustment for a wide range of covariates; however, controlling for biomarkers, particularly high-density lipoprotein cholesterol and glycated hemoglobin, led to a greater degree of attenuation. A similar pattern of association emerged for waist-hip ratio. In summary, overall and central obesity are risk factors for COVID-19 hospital admission. Elevated risk was apparent even at modest weight gain. The mechanisms may involve impaired glucose and lipid metabolism.

Keywords: COVID-19; epidemiology; infection; obesity.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Betacoronavirus
  • Body Mass Index
  • COVID-19
  • Cohort Studies
  • Coronavirus Infections / complications*
  • European Continental Ancestry Group
  • Female
  • Hospitalization*
  • Humans
  • Male
  • Middle Aged
  • Obesity / complications*
  • Overweight / complications*
  • Pandemics
  • Pneumonia, Viral / complications*
  • Risk Factors
  • SARS-CoV-2
  • United Kingdom