Heterogeneity of the Association between Obesity and COVID-19 Mortality and the Roles of Policy Interventions: U.S. National-Level Analysis

Abstract

This article examines the heterogeneity of the association between obesity and COVID-19 mortality across various dimensions, including COVID vaccination rates, mask mandates, gathering restrictions, and household income. Using multivariate regression analysis on U.S. county-level data over 2020-2021, we found that county-level adult obesity rates were positively associated with COVID death rates. Our results suggest that on average, a 10-percentage-point decrease in adult obesity rate is associated with a decrease in COVID deaths by 4.79 to 5.98 percent in the United States. Considering that the average adult obesity rate in the U.S. is higher than the global average, this finding may explain why deaths due to COVID were disproportionately large in the U.S. In addition, we found that association between obesity and COVID death rate is much more pronounced in groups with low vaccination rates, weak mask mandate, loose gathering restriction, or low household income, indicating the importance of COVID response policies and income to obese people facing a pandemic. Our results contribute to policy discussions surrounding preparation for COVID like pandemics. Food policies and health promotion strategies that encourage physical well-being to reduce obesity prevalence may help reduce mortality in future pandemics.