Excess Weight Increases Risk for Neurological Symptoms in Long COVID

Excess weight and obesity are associated with the development of neurological and neuropsychiatric symptoms in long COVID, according to results of a systematic review and meta-analysis, published in PLOS One.

To evaluate whether excess weight affects the development of neurological and neuropsychiatric symptoms in long COVID, researchers searched publication databases through 2024 for studies linking weight to these symptoms. Excess weight was defined as a BMI greater than 23 kg/m².

A total of 18 studies from 23 countries across Asia, Europe, and the Americas were included, spanning cross-sectional (n=10), retrospective or prospective cohort (n=6), and case-control (n=2) designs. The pooled study population comprised 79,050 individuals with excess weight and 57,926 without, as well as 30,694 with obesity and 107,612 without.

Excess weight was significantly associated with an increased risk for several neuro-symptoms in long COVID:

• Memory problems (risk ratio [RR], 1.43; 95% CI, 1.24-1.65; I², 0.00%)
• Numbness (RR, 1.37; 95% CI, 1.24-1.51; I², 0.00%)
• Disturbed sleep (RR, 1.31; 95% CI, 1.16-1.48; I², 17.83%)
• Headache (odds ratio [OR], 1.23; 95% CI, 1.10-1.17; I², 40.36%)
• Persistent depression (RR, 1.21; 95% CI, 1.03-1.42; I², 0.00%)
• Vertigo (RR, 1.21; 95% CI, 1.04-1.41; I², 59.53%)

In addition, BMI was inversely related to persistent taste disorder (OR, 0.93; 95% CI, 0.88-0.98; I², 0.00%). No significant associations were found between excess weight and anxiety, smell disorder, taste disorder, or combined smell and taste disorder.

Obesity was also significantly associated with increased risk for neuro-symptoms in long COVID:

• Numbness (RR, 1.61; 95% CI, 1.46-1.78; I², 0.00%)
• Headache (OR, 1.45; 95% CI, 1.37-1.53; I², 0.00%)
• Vertigo (RR, 1.44; 95% CI, 1.35-1.53; I², 0.00%)
• Taste disorder (OR, 1.22; 95% CI, 1.08–1.38; I², 58.60%)
• Smell disorder (OR, 1.16; 95% CI, 1.11-1.22; I², 1.26%)

Obesity was not significantly associated with cognitive problems, memory problems, or combined smell and taste disorder.

Limitations include a small number of included studies and inconsistencies in naming long COVID symptoms between studies.

The study authors concluded, “Our results provide evidence-based guidance for healthcare professionals and policymakers in managing long COVID and contribute to ongoing global efforts to understand its underlying mechanisms, epidemiology, and identification.”