In 2020, COVID-19 was classified as a global public health emergency. The disease affects individuals of all ages and social classes, with certain populations, such as individuals with obesity, being more susceptible to developing the severe form of the disease, known as acute respiratory distress syndrome (ARDS). Recommended treatments included invasive mechanical ventilation (IMV) and improvement of oxygenation with the prone position. In this context, understanding the body mass index (BMI) profile of patients with COVID-19 who develop moderate or severe ARDS and undergo these therapies is a gap in scientific knowledge.

To identify whether individuals with COVID-19 who developed moderate or severe ARDS and underwent IMV and prone position had a characteristic BMI profile.

Multicenter, analytical observational retrospective cohort study of patients admitted to 5 hospitals in southern Brazil, admitted to intensive care units (ICU) between July 2020 and June 2021. The medical records of individuals who developed ARDS were analysed as moderate or severe and who underwent IMV and prone position. The BMI of each individual was identified and analysed to identify alterations. Comorbidities were also identified.

512 individuals were included in the study. 05 (0.9%) had low weight, 119 (23.2%) had normal weight, 183 (35.7%) were overweight, 131 (25.6%) had class I obesity, 44 (8.6%) had class II obesity, and 30 (5.9%) had class III obesity. 307 (59.5%) had a BMI <30 (NOG) and 205 (40.4%) had a BMI >30 (OG). The NOG and OG had similar characteristics concerning sex and height, but age was higher in the NOG (p<0.01). The OG had, as expected, higher values of weight and BMI than the NOG (p<0.01). The most prevalent comorbidities in hospitalized COVID-19 patients undergoing prone position were diabetes, hypertension, and cardiovascular diseases. Both groups had similar values regarding diabetes and hypertension. Other cardiovascular diseases were more prevalent in the NOG. Regarding the previous lifestyle, both groups had similar values for alcohol consumption (p=0.22) and smoking (p=0.25).

From the results found, it can be concluded that individuals with COVID-19 who developed severe ARDS and underwent IMV, and prone position were from all BMI ranges. However, there was a high proportion of individuals with obesity when considering the BMI of the general population.

Knowing that COVID-19 affects patients of all BMI ranges, especially obese individuals, is important for individual and collective decision-making in health and serves as a warning for authorities to anticipate adjustments in ICUs to receive this patient profile.