Can reduction in infection and mortality rates from coronavirus be explained by an obesity survival paradox? An analysis at the US statewide level

Coronavirus disease 2019 (COVID-19) is a declared global pandemic with multiple risk factors. Based on recent empirical studies, obesity is considered by several researchers as one of the serious risk factors for coronavirus-related complications. Yet, other scholars argue in favor of the existence of an obesity survival paradox. The objective of the current study is to analyze the potential relationships between different corona indicators and obesity on a statewide level. Since the United States is ranked as one of the OECD countries with a high level of overweight and obesity among its citizens—the majority of US states exceed the 30% benchmark of obese population—it is an especially interesting case study to explore this issue. In an attempt to estimate projected probabilities for infection by coronavirus and mortality rates as a function of obesity prevalence, the fractional logit regression is employed. Findings may support the counter-intuitive possibility of an obesity survival paradox. Consequently, ethical guidelines referring to priority in intubation and intensive care treatments should account for these complex relationships between obesity and corona. Both projected rates of infection and mortality drop with elevated prevalence of obesity. The reasons for these findings might be explained by several conditions such as elevated social distancing from more obese persons, increased metabolic reserves, more aggressive treatment, and unidentified factors that should be examined in future research.