Toggle Main Menu Toggle Search

Open Access padlockePrints

A Global Country Level Analysis of The Relationship between Obesity and COVID-19 Cases and Mortality

Lookup NU author(s): Shaun HiuORCiD, Professor Dawn Teare, Dr Salman Razvi



This is the authors' accepted manuscript of an article that has been published in its final definitive form by Wiley-Blackwell Publishing, Ltd, 2021.

For re-use rights please refer to the publisher's terms and conditions.


Background: Obesity is being recognised as a risk factor for COVID-19 infection and severity. However, it is unclear if obesity is associated with COVID-19 at the ecological population-level, independent of other putative risk factors. This analysis assesses the association of country-level obesity prevalence with COVID-19 case and mortality rates, to evaluate the impact of obesity prevalence towards this worldwide variation. Methods: Data on COVID-19 prevalence and mortality, country-specific governmental actions, socioeconomic, demographic, and healthcare capacity factors were extracted from publicly available sources. Multivariable negative binomial regression was used to assess the independent association of obesity with COVID-19 case and mortality rates. Findings: Across 168 countries, for whom data was available, higher obesity prevalence was associated with increased COVID-19 mortality and prevalence rates. For every 1% increase in obesity prevalence, the mortality rate was increased by 8·3% (incident rate ratio [IRR] = 1·083; 95% CI: 1·048 to 1·119, p<0·001) and the case rate was higher by 6·6% (IRR = 1·066; 95% CI: 1·035 to 1·099, p<0·001). Additionally, higher median population age, greater female ratio, higher Human Development Index, lower population density, and lower hospital bed availability were all significantly associated with higher COVID-19 mortality rate. As well, stricter governmental actions, higher Human Development Index and lower mean annual temperature were significantly associated with higher COVID-19 case rate. Interpretation: These findings demonstrate that obesity prevalence is a significant and potentially modifiable risk factor of increased COVID-19 national case load and mortality. Future research to study if weight loss improves COVID-19 outcomes is urgently required. Funding: This study is non-funded.

Publication metadata

Author(s): Foo O, Hiu S, Teare D, Syed AA, Razvi S

Publication type: Article

Publication status: Published

Journal: Diabetes Obesity and Metabolism

Year: 2021

Volume: 23

Issue: 12

Pages: 2697-2706

Print publication date: 01/12/2021

Online publication date: 16/08/2021

Acceptance date: 10/08/2021

Date deposited: 15/08/2021

ISSN (print): 1462-8902

ISSN (electronic): 1463-1326

Publisher: Wiley-Blackwell Publishing, Ltd


DOI: 10.1111/dom.14523


Altmetrics provided by Altmetric