Patients who are overweight or obese have more severe COVID-19 and are more likely to require invasive respiratory support, according to a new international study published in Diabetes Care.

Investigators at the Murdoch Children’s Research Institute (MCRI) found that obese or overweight patients are at high risk for having worse COVID-19 outcomes and are more likely to require oxygen and invasive mechanical ventilation compared to patients with a lower weight. In a press release, MCRI researcher Danielle Longmore said the findings highlight the need to introduce strategies to address the complex socio-economic drivers of obesity, as well as public policy measures such as restrictions on junk food advertising.

“Although taking steps to address obesity in the short-term is unlikely to have an immediate impact in the COVID-19 pandemic, it will likely reduce the disease burden in future viral pandemics and reduce the risks of complications like heart disease and stroke,” Longmore said in the press release.

Investigators looked at hospitalized SARS-CoV-2 patients from 18 hospitals in 11 countries, including China, America, Italy, South Africa, and the Netherlands. Among the 7244 adult patients, 31.8% were overweight and 30.8% were obese.

Patients with COVID-19 and obesity were more likely to require oxygen and had a 73% greater change of requiring invasive mechanical ventilation, according to the study. The results were slightly more modest in overweight patients, although no link was found between being overweight or obese and dying in the hospital from COVID-19.

Cardiovascular and preexisting respiratory diseases were associated with higher risks of in-hospital deaths but not a greater risk for needing oxygen or mechanical ventilation. For patients with preexisting diabetes, the investigators found an increased chance of needing invasive respiratory support, but there was no increased risk in those with obesity and diabetes.

Men were at an increased risk of severe COVID-19 outcomes and of needing invasive mechanical ventilation. In patients aged 65 years and older, there was an increased chance of requiring oxygen and higher rates of in-hospital deaths. Kirsty Short, who co-led the research, noted that nearly 40% of the global population was overweight or obese.

“Obesity is associated with numerous poor health outcomes, including increased risk of cardiometabolic and respiratory disease and more severe viral disease including influenza, dengue, and SARS-CoV-2,” she said in the press release.

Short added that although previous research indicated that obesity was an important risk factor in the severity of COVID-19, almost all of these data had been collected from single sites and many regions were not represented. Furthermore, there was a limited amount of evidence available about the effects of being overweight or obese on COVID-19 severity.

“Given the large scale of this study, we have conclusively shown that being overweight or obese are independent risk factors for worst outcomes in adults hospitalized with COVID-19,” Short said in the press release.