The “obesity paradox” refers to an association between obesity and better outcomes (contrary to expected worse outcomes) . For example, lower mortality has been observed in diabetes patients with obesity compared to normal/overweight. An analytical cohort of n=5712 patients with diabetes was selected from the RUSH COVID Registry and electronic medical records data, spanning 21 months. Sociodemographic and diabetes characteristics were obtained on or before COVID diagnosis. Severe COVID was defined as fatal or requiring hospitalization. After excluding 23 cases without BMI, univariate and multivariate logistic regression with restricted cubic spline models were conducted to evaluate the association of BMI with severe COVID after adjustment for age, sex, race/ethnicity. The resulting diverse cohort included 37.6% Latino, 37.5% Black, 19.5% White, and 5.3% other; 53.7% were women. Type 1 diabetes was identified in n=140, Type 2 diabetes in n=2730, and other/hybrid diabetes in n=2820. After adjustment for sex, age, race/ethnicity, diabetes type, and A1c a U-shaped relationship was observed between BMI and severe COVID with a nadir at BMI=30-45 kg/m2 (see figure) . A similar U-shaped relationship was seen in the association of fatal COVID in British diabetes patients with a nadir at BMI=25-29 kg/m2. The proposed explanation for the “obesity paradox” may be related to unintentional weight loss in diabetes patients with multimorbidity.


R. Kazlauskaite: None. P. Desai: None. A. M. Jackson-morris: None. C. Ngongo: None. N. Cuplinskas: None. R. Nugent: Consultant; AstraZeneca, Other Relationship; Novo Nordisk A/S, Speaker's Bureau; Abbott Diagnostics.


RTI International, and Rush University (R3 pilot grant 0272101.001.001)

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