The impact of mean body mass index on reported mortality from COVID-19 across 181 countries

• Published in: Frontiers in public health Vol. 11; p. 1106313
• Main Authors: Gabbrielli, Ruggero, Pugno, Nicola Maria
• Format: Journal Article
• Language: English
• Published: Switzerland Frontiers Media S.A 13.03.2023
• Subjects: Body Mass Index; COVID-19; Global Health; Humans; mortality; Nutritional Status; overeating; Public Health; SARS-CoV-2; COVID-19; mortality; overeating; body mass index; public health
• ISSN: 2296-2565; 2296-2565
• DOI: 10.3389/fpubh.2023.1106313

Accountability for global health issues such as a pandemic and its devastating consequences are usually ascribed to a virus, but a comprehensive view should also take into account the state of the host. Data suggests that excessive nutrition is to blame for a yet unknown but not negligible portion of deaths attributed to severe acute respiratory syndrome coronavirus 2. We analyzed the correlation between mean body mass index (BMI) and 2-year coronavirus disease 2019 (COVID-19) mortality rates reported by 181 countries worldwide. Almost two thirds of the countries included had a mean BMI greater or equal to 25, with death rates ranging from 3 to 6,280 per million. Death rates in countries with a mean BMI below 25 ranged from 3 to 1,533. When the analysis was restricted to countries where the extent of testing was deemed more representative of actual mortality, only 20.1% had a mean BMI <25 but the mortality difference persisted. A second analysis looking at pre-vaccination mortality obtained from a different source led to similar conclusions. Due to the nature of the variables, reverse causation can be excluded while common causation can not. A mean BMI <25 for a country seems to spare its citizens from the highest COVID-19 mortality rates. The impact of excess weight on global COVID-19 mortality is suspected to have been much higher than what currently perceived, here estimated at no less than a fourfold increase in mortality. Countries with normal mean BMI constitute precious test beds for the quantification of the effects of overeating on COVID-19 mortality.