‘SARS-CoV-2 Infection, Body Weight Changes, and Implications for Cardiometabolic Risk Profile’

Obesity is a multifactorial disease influenced by genetic, physiological, behavioral, and environmental factors, including infections. The relationship between obesity and infections is bidirectional. While obesity increases susceptibility to severe infections, certain infections contribute to weight gain and metabolic dysfunction. SARS-CoV-2 infection, which causes COVID-19, is linked to poor clinical outcomes in individuals with obesity, leading to increased hospitalization rates, intensive care admissions, and mortality. However, the possibility for SARS-CoV-2 infection to influence body weight changes and worsen cardiometabolic markers in the post-recovery phase remains underexplored. Given the global impact of the COVID-19 pandemic and the high prevalence of obesity, understanding the long-term metabolic effects of SARS-CoV-2 infection is critical for public health and clinical management. Existing evidence suggests that while acute infection may result in weight loss due to catabolic stress and inflammation, the post-recovery period is often marked by weight gain, possibly due to appetite dysregulation, metabolic alterations, reduced physical activity, and psychological distress. Additionally, weight changes following SARS-CoV-2 infection may be associated with cardiometabolic complications, including insulin resistance, dyslipidemia, and hypertension. The present study aims to investigate whether SARS-CoV-2 infection is associated with body weight changes and cardiometabolic health. Specifically, we examined, the trajectory of weight changes up to 12 months post-infection, the biological and behavioral factors associated with weight gain, and the relationship between post-infection weight changes and changes in cardiometabolic risk markers. The study utilized data from the AEGIS study, a prospective cohort that enrolled 2,100 participants across seven clinic sites in the United States. Participants were divided into three groups based on SARS-CoV-2 infection status: Pre-COVID+ (infected before enrollment), Post-COVID+ (infected after enrollment), and COVID- (never infected before or during the study period). Weight and cardio-metabolic biomarkers were assessed at baseline and at multiple follow-up visits over a 12-month period. Anthropometric measurements, including weight, blood pressure, BMI, were recorded at each visit, and cardiometabolic markers such as blood glucose, insulin, cholesterol, triglycerides, were monitored at visit 1, 4 and 7. Behavioral and psychological factors, including physical activity, stress, depression, and dietary habits, were evaluated using validated questionnaires (e.g., International Physical Activity Questionnaire (IPAQ), Perceived Stress Scale (PSS), and Center for Epidemiologic Studies Depression Scale (CES-D)). A series of regression models were employed to determine the association between weight changes and cardiometabolic markers, adjusting for potential confounders such as age, sex, race, baseline BMI, and COVID-19 vaccination status. SARS-CoV-2 infection was associated with body weight fluctuations, particularly in the Pre-COVID+ and Post-COVID+ groups compared to the COVID- group across study visits. Several biological and behavioral factors were associated with post-infection weight change, with higher baseline BMI associated with weight gain. Mild depression was associated with weight changes, highlighting a behavioral component in post-COVID weight changes, while no significant associations were found between stress, COVID 19 vaccination status, race and weight change in this dataset. Regarding cardiometabolic implications, individuals with BMI ≥30.0 kg/m2 exhibited significant metabolic disturbances, including higher fasting glucose levels increased LDL cholesterol, and elevated SBP and triglycerides. Furthermore, weight gain post-infection was strongly linked to worsening insulin and total Cholesterol abnormalities, along with a notable decline in HDL cholesterol, increasing overall cardiovascular risk. These findings highlight a complex interplay between SARS-CoV-2 infection, body weight regulation, and cardiometabolic risk. While some individuals experience post-infection weight gain, others may lose weight due to prolonged illness or metabolic alterations. The weight gain observed in a subset of individuals may be driven by a combination of biological (e.g., inflammation, hormonal dysregulation) and behavioral (e.g., increased caloric intake, reduced activity) factors. Additionally, the observed associations between weight gain and worsening cardiometabolic markers suggest that post-COVID metabolic dysfunction may contribute to increased long-term cardiovascular and diabetes risk. This is particularly concerning for individuals who already have pre-existing obesity, hypertension, or insulin resistance, as they may be more vulnerable to severe metabolic consequences post-infection. Given these findings, it is crucial to develop targeted post-COVID interventions aimed at preventing excessive weight gain . Monitoring cardiometabolic risk factors in individuals recovering from COVID-19, particularly those with obesity or metabolic syndrome may be important. Conducting further longitudinal research to understand whether post-COVID metabolic changes persist beyond 12 months and how they contribute to chronic disease risk is crucial.