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Epidemiology and population health

Is weight associated with severity of acute respiratory illness?

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Obesity was an independent risk factor for severe disease in hospitalized adults during the 2009 pandemic H1N1 influenza season. Few studies have investigated the association between weight and severity of acute respiratory illnesses in children or in adults seeking care in the emergency department (ED) during other winter respiratory seasons.


We prospectively and systematically enrolled patients ≥2 years of age who presented to the ED or inpatient setting in a single geographic region with fever/acute respiratory illness over four consecutive winter respiratory seasons (2010–2014). We collected demography, height and weight, and high risk co-morbid conditions. Multivariable logistic regression was used for prediction of hospital admission (primary outcome), length of stay and supplemental oxygen requirement among those hospitalized, and antibiotic prescription (secondary outcomes).


We enrolled 3560 patients (N = 749 children, 2811 adults), 1405 (39%) with normal weight, 860 (24%) with overweight, and 1295 (36%) with obesity. Following multivariable logistic regression, very young or very old age (p < 0.001) and high-risk conditions (p < 0.001) predicted hospitalization. Risk of hospitalization was decreased for adults with overweight [aOR 0.8 (95% CI 0.6–1.0)], class 1 obesity [aOR 0.7 (95% CI 0.5–1.0)], and class 2 obesity [aOR 0.6 (95% CI 0.4–0.8)] compared to normal-weight. Class 3 obesity was associated with supplemental oxygen requirement in adults [aOR 1.6 (95% CI 1.1–2.5)]. No association was seen in children.


Overweight and obesity were not associated with increased risk of hospitalization during winter respiratory seasons in children or adults.

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This work was supported by the National Institutes of Health [R01 AI079226].

Author information


  1. Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, NC, USA

    • Elizabeth E. Halvorson
    •  & Timothy R. Peters
  2. Departments of Pediatrics and Epidemiology & Prevention, Wake Forest School of Medicine, Winston-Salem, NC, USA

    • Joseph A. Skelton
    •  & Katherine A. Poehling
  3. Brenner FIT (Families in Training), Brenner Children’s Hospital, Winston-Salem, NC, USA

    • Joseph A. Skelton
  4. Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA

    • Cynthia Suerken
    •  & Beverly M. Snively


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Conflict of interest

Dr. Poehling reports grants for observational studies from National Institutes of Health and MedImmune during the conduct of the study. Dr. Peters reports grants from MedImmune during the conduct of the study. Dr. Snively and Ms. Suerken report grants from National Institutes of Health during the conduct of the study. The remaining authors declare that they have no conflict of interest.

Corresponding author

Correspondence to Elizabeth E. Halvorson.

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