The retrospective cohort study analyzed health data from 139,320 individuals aged 5 to 20 years who had confirmed SARS-CoV-2 infections between March 2020 and September 2023. The data were drawn from 20 pediatric health systems participating in the RECOVER initiative, a nationwide research effort aimed at understanding long-term effects of COVID-19.
The participants were categorized by their pre-infection body mass index (BMI), using measurements taken within 18 months prior to COVID-19 diagnosis. BMI classifications included healthy weight, overweight, obesity, and severe obesity. The study then tracked new cardiovascular, gastrointestinal, and neuropsychiatric symptoms or diagnoses occurring between 28 and 179 days after infection.
Youth with severe obesity had more than double the risk of developing cardiovascular disorders when compared to those with healthy weight (adjusted relative risk [RR] 2.56). The risk was especially pronounced for hypertension, where severely obese participants were nearly four times as likely to receive a new diagnosis (adjusted RR 3.68).
Severe obesity was linked to a 34% increased risk of diarrhea and a 29% increased risk of gastroesophageal reflux disease (GERD). While these increases were more modest than those observed for cardiovascular conditions, they remained statistically significant and clinically meaningful. The findings on neuropsychiatric outcomes were less consistent. Some conditions showed no clear pattern, and in certain cases (anxiety and major depression) higher BMI categories were associated with lower relative risks.
For cardiovascular outcomes, the findings demonstrate a stepwise increase in relative risk from overweight to obesity to severe obesity, with the highest values consistently seen in the severe obesity group. In gastrointestinal outcomes, the pattern is similar but less steep, with statistically significant elevations mainly concentrated in the severe obesity category.
In contrast, the neuropsychiatric section of the table displays more variability, with confidence intervals in some BMI categories crossing unity, which indicated non-significant associations. Overall, the findings suggest that pre-COVID BMI status may shape the type and likelihood of post-acute complications in youth.
Source:
Zhou, T., Zhang, B., Zhang, D., Jhaveri, R., Chen, J., Becich, M. J., Castro, L., Chen, Y., Chilukuri, N., Herring, S., Lei, Y., Li, L., Lu, Y., Hornig, M., Khalsa, A. S., Liebovitz, D., Mosa, A. S. M., Taylor, B. W., Tedla, Y., … Chen, Y. (2026). Pre-COVID-19 body mass index and postacute cardiovascular, gastrointestinal, and neuropsychiatric outcomes among children and young adults with SARS-CoV-2 infection: An EHR-based cohort study from the RECOVER initiative. The Journal of Infection, 106702. https://doi.org/10.1016/j.jinf.2026.106702
Disclaimer: This website is primarily for healthcare professionals. The content here does not replace medical advice and should not be used as medical, diagnostic, endorsement, treatment, or prescription advice. Medical science evolves rapidly, and we strive to keep our information current. If you find any discrepancies, please contact us at corrections@medicaldialogues.in. Read our Correction Policy here. Nothing here should be used as a substitute for medical advice, diagnosis, or treatment. We do not endorse any healthcare advice that contradicts a physician's guidance. Use of this site is subject to our Terms of Use, Privacy Policy, and Advertisement Policy. For more details, read our Full Disclaimer here.
NOTE: Join us in combating medical misinformation. If you encounter a questionable health, medical, or medical education claim, email us at factcheck@medicaldialogues.in for evaluation.