Impact of metabolic health and weight transition on COVID-19 risk: A population-based cohort study

Abstract

Objectives: Obesity and metabolic health are known factors influencing COVID-19 severity. However, the effect of changes in metabolic health and weight status on COVID-19 outcomes remains unclear. To investigate the association between changes in metabolic health and weight status over time and COVID-19-related risks. Study design: Retrospective population-based cohort study. Methods: This retrospective population-based cohort study used data from South Korea's National Health Information Service collected between January 2014 and December 2021. A total of 284,719 participants who underwent health screening both in 2014–2015 and 2016–2017 were divided into the metabolically healthy non-obese (MHNO), metabolically healthy obese (MHO), metabolically unhealthy non-obese (MUNO), and metabolically unhealthy obese (MUO) groups. Results: Among initial MHNO participants, those who became MHO (hazard ratio (HR) 1·082, 95 % confidence intervals 1·01–1·16) and MUO (1·18, 1·11–1·26) had elevated risk for COVID-19 compared with those who remained MHNO. Conversely, participants who transitioned from MUO to MUNO (0·89, 0·84–0·95) were associated with a lower risk of COVID-19. Improvements in metabolic health did not mitigate COVID-19-related risks. Transitioning from MHNO to MHO (3·57, 1·38–9·26) was associated with a significantly higher risk of death due to COVID-19. Conclusions: Changes in metabolic health and obesity status significantly influence COVID-19 outcomes. Addressing obesity and promoting metabolic health are critical for mitigating the impact of COVID-19. © 2025 The Authors