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Obesity Deadlier in Men with COVID-19 Than Women

photo of covid 19 virus

May 10, 2021 – Men with obesity are more likely to have severe cases of COVID-19 than women, with increased rates of death, the largest study to date exploring the impact of obesity between the sexes on COVID-19 has found.

Men with a body mass index greater than 35, and women with a BMI of 40 or more, were significantly more likely to die in a hospital from COVID-19 than patients with a ‘normal’ BMI of 18.5-24.9

“Particular attention should be paid in protecting the population living with severe obesity from SARS-CoV-2 with priority to vaccination access, remote work, telemedicine, and other measures,” write Arcelia Guerson-Gil, MD, the of University Hospital for the Albert Einstein College of Medicine in New York, and colleagues.

And “patients with severe obesity diagnosed with COVID-19 should be treated with particular attention given the high risk for worse outcomes,” they stress.

The study is published in the May 6 edition of the European Journal of Clinical Microbiology & Infectious Diseases.

Level of Obesity Tied Poor COVID-19 Outcomes

Other studies have shown an association between worse overall outcomes with COVID-19 and patients who are male, older, and those who a number of underlying conditions, including obesity. Obesity alone, has been shown to be an independent risk factor for hospitalization, severe disease, and death in patients with COVID-19.

But the question remains as to whether all classes of obesity are prone to worse outcomes in COVID-19 or whether this is specific to severe obesity alone.

As a primary outcome, the researchers asked which classes of obesity are associated with higher rates of death, and whether this is linked to patients’ sex.

The study of patients admitted to hospital between March and May 2020 (some in intensive care) with COVID-19 included 3,530 patients, 1,579 of whom were women and all of whom were over the age of 18.

Patients were classified into six groups according to BMI: 896 patients had a BMI of less than 25, 1,162 had a BMI of 25 to 29, 809 had a BMI of 30 to 34 (class I obesity), and 663 had a BMI of 35 or higher (class II and III obesity).

Links were explored between these groups and rates of death, the need for artificial breathing techniques and the development of severe pneumonia.

Men Drove the Association with In-Hospital Death

The odds for in-hospital death were higher for men of a given BMI than women even after adjusting for other factors, including but not limited to age, high blood pressure, diabetes, heart disease, and chronic kidney disease.

Sex-Based Analysis for the Risk of Death

BMI

Women (odds ratio)

Men (odds ratio)

Less than 18.5

1.92

1.01

25-29.9

1.19

1.00

30-34.9

1.08

1.25

35-39.9

1.0

1.99

Over 40

1.72

2.26

Higher levels of obesity men and severe obesity in women were found to carry higher risk of death in patients with COVID-19.

Also, underweight patients, those with a BMI less than 18.5 -- were also found to have an increased risk of death.

Is it Down to Differing Body Shapes Between Women and Men?

The researchers say men and women differ in the way that their fat tissue is distributed and that this “might help explain the disproportionate impact of severe obesity in … men compared to women.”

They caution also that the study design does not allow for conclusions about cause and effect, and that the rapidly changing management of patients with COVID-19 during the first wave of the pandemic might have affected the results.

Further studies are needed to confirm the findings and pilot clinical trials would be useful to assess whether drugs may improve outcomes.

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