Kim NH, Kim KJ, Choi J, et al. - For coronavirus disease 2019 (COVID-19) outcomes, metabolic health holds a greater importance than obesity itself. Thus, considering metabolic health status is recommended for a precise and tailored management of COVID-19 cases.

• An analysis of 4,069 COVID-19 patients, grouped as metabolically healthy normal weight (MHNW), metabolically unhealthy normal weight (MUNW), metabolically healthy obesity (MHO), and metabolically unhealthy obesity (MUO).

• A composite of ICU admission, invasive mechanical ventilation (IMV), extracorporeal membrane oxygenation (ECMO), and death was the primary outcome.

• Critical COVID-19 incidence rate was the lowest in the MHNW group (0.90), followed by the MHO (1.64), MUNW (3.37), and MUO (3.37) groups.

• Risk of critical COVID-19 was significantly elevated in MUNW (HR, 1.41) and MUO (HR, 1.77) but not in MHO (HR, 1.48), vs MHNW.

• Only MUO had increased risk of ICU admission or IMV/ECMO but MUNW and MUO had a significantly higher risk of death.

• Per 1 kg/m ² BMI rise and per 1 metabolically unhealthy component increase, there was a 2% (insignificant) and 13% (significant) increase in the risk of critical COVID-19, respectively, even after mutually adjusting for BMI and metabolic health status.