Obesity and Long COVID: intersecting epidemics?

Background: Obesity affects over 10% of the world population and has significant public health implications. With rising recognition of the long-term effects of Long COVID (LC) coupled with new agents to facilitate weight loss, it is critical to understand the influence of obesity on LC. This study assessed the association of obesity with rates of LC and degree of LC-related mental and physical health outcomes among participants up to three years after initial infection. Methods: This was a cross-sectional, multisite study of participants with SARS-CoV-2 infection from 12/11/2020–8/29/2022, with data collected through 4/2/2024. Surveys included validated tools for physical and mental health. Data were analyzed by self-reported new obesity (follow-up only), persistent obesity (baseline and follow-up), or no obesity. Results: Of 3,663 participants, 547 (14.9%) had new obesity and 805 (21.9%) had persistent obesity. Compared with persons without obesity, LC was significantly more common among those with new (39.7% vs 22.8%; aOR: 1.9, 95% CI 1.5–2.4) or persistent obesity (39.1% vs 22.8%; aOR: 1.7, 95% CI 1.4–2.1). Regardless of chronicity and current LC status, obesity was associated with lower (worse) scores for PROMIS Physical (mean differences: 2.7–4.0) and Mental Health (mean differences: 1.7–3.6) function, worse moderate-to-severe fatigue (aOR: 1.3–2.1), worse dyspnea (aOR: 1.9–3.7), worse loneliness (aOR: 1.3–1.6), and insufficient activity (aOR for SNAP ≤ 4: 1.6–2.8; aOR for EVS ≤ 150 min/week: 2.0–3.1). Conclusions: Participants with obesity had higher rates of LC and worse physical and mental health outcomes, regardless of LC status. These findings raise key questions about obesity interventions to treat LC and a possible role for obesity management before the next pandemic.