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June 8, 2021 — Obesity — an established major risk factor in the development of severe infection or death from COVID-19 infection — also appears to significantly increase the risk of developing long-term complications from the disease, a syndrome often referred to as long-haul COVID-19, according to a new study.

“To our knowledge, this current study for the first time suggests that patients with moderate to severe obesity are at a greater risk of developing long-term complications of COVID-19 beyond the acute phase,” the study’s lead author, Ali Aminian, MD, director of Cleveland Clinic’s Bariatric & Metabolic Institute, said in a press statement.

The study included 2,839 patients who tested positive for COVID-19 in the Cleveland Clinic Health System between March and July 2020 who did not require admission to the ICU and survived the initial phase of COVID-19.

The doctors looked for three indicators of possible long-term complications of COVID-19 — hospital admission, death, and need for diagnostic medical tests — that occurred 30 days or more after the first positive viral test for COVID-19.

In the 10 months after their initial COVID-19 infection, 44% of the patients required hospital admission and 1% had died.

The need for diagnostic tests after infection was 25% higher among those with moderate obesity (BMI of 35-39.9) and 39% higher in those with severe obesity (BMI of >40), compared with those of with a BMI of 18.5-24.9.

Specifically, those with obesity were more likely to require diagnostic tests for the heart, lung, and kidney; for gastrointestinal or hormonal symptoms; or blood disorders; and for mental health problems following COVID-19 infection.

Obesity was not associated with a higher risk of death during the follow-up period, however.

The findings suggest that obesity’s effects extend beyond worsening infection and influence the long-term symptoms.

“The observations of this study can possibly be explained by the underlying mechanisms at work in patients who have obesity, such as hyperinflammation, immune dysfunction, and comorbidities,” senior author Bartolome Burguera, MD, PhD, said in the Cleveland Clinic press statement.

While a wide array of milder long-term effects after COVID-19 infection including psychological symptoms, fatigue, brain fog, muscle weakness, and sleep difficulties have been reported, the current study did not include information on those symptoms.

However, even the finding that up to 44% of the patients required hospital admission after COVID-19 — regardless of weight status — is of concern, the authors noted.

“These findings suggest a profound magnitude of the public health impact of [long-haul COVID-19] in the setting worldwide infection,” they wrote.

The study is published in the journal Diabetes, Obesity and Metabolism.

SOURCES:

Ali Aminian, MD, director of Cleveland Clinic’s Bariatric & Metabolic Institute.

Bartolome Burguera, MD, PhD, Cleveland Clinic.

Diabetes, Obesity and Metabolism: “Association of Obesity with Post-Acute Sequelae of COVID-19 (PASC).”