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The Association Between Obesity and COVID-19 Severity in Children Differed Between SARS-CoV-2 Variants: A

Yanshan Zhu1, Petra Zimmermann2,3,4, Daniel K Yeoh5,6

  • 1From the School of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, Queensland, Australia.

The Pediatric Infectious Disease Journal
|September 9, 2025
PubMed

Insights

Obesity increased severe COVID-19 risk in children during earlier SARS-CoV-2 variants. This association was not observed during the Omicron wave, even in unvaccinated children, indicating changing disease dynamics.

Area of Science:

  • Pediatric Infectious Diseases
  • Epidemiology
  • Public Health

Background:

  • Obesity posed a significant risk for severe COVID-19 in children during the ancestral and Delta variant waves.
  • The impact of obesity on pediatric COVID-19 severity during the Omicron variant surge remained undetermined.

Purpose of the Study:

  • To investigate the association between childhood obesity and COVID-19 severity during different SARS-CoV-2 variant waves.
  • To determine if vaccination status influenced the relationship between obesity and respiratory support needs.

Main Methods:

  • A multicenter, observational study analyzed hospitalized children and adolescents with confirmed SARS-CoV-2 infection.
  • Data spanned three periods: ancestral strain (T1), pre-Omicron variants (T2), and Omicron (T3).
  • The primary outcome measured was the requirement for respiratory support (supplemental oxygen or ventilation).

Main Results:

  • Obesity was linked to increased respiratory support needs during T1 (RR 3.45) and T2 (RR 3.24).
  • This association was not significant during the Omicron wave (T3) (RR 3.08).
  • Findings persisted in unvaccinated children, suggesting vaccination did not explain the diminished association.

Conclusions:

  • Childhood obesity was a risk factor for severe COVID-19 during ancestral and pre-Omicron waves.
  • The association between obesity and severe COVID-19 was lost during the Omicron wave.
  • This shift highlights evolving SARS-CoV-2 variant impacts on pediatric populations, irrespective of vaccination status.
Abstract

Keywords:
COVID-19 severitySARS-CoV- 2 variantspediatric obesityrisk factor

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