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Objective This study examines the value of risk stratification by documented diagnosis of diabetes and objectively measured height and weight (BMI) in COVID-19 severity and mortality in a large sample of patients in an urban hospital located in Southern California. Methods Data from a retrospective cohort study of COVID-19 patients treated at Cedars-Sinai Medical Center between March 8, 2020, and January 25, 2021, was analyzed. Sociodemographic characteristics and pre-existing conditions were extracted from electronic medical records. Univariable and multivariable logistic regression models identified associated risk factors, and a regression causal mediation analysis examined the role of diabetes in the association between obesity and illness severity. All analyses were stratified by age (<65 and ≥65). Results Among individuals <65yo, diabetes accounted for 19–30% of the associations between obesity and COVID-19 illness severity. Among patients ≥65yo, having a BMI <18.5 was a risk factor for mortality regardless of diabetes history. Conclusion Our findings have clinical implications in documenting which patients may be at elevated risk for adverse outcomes. More in-depth prospective studies are needed to capture how glycemic regulation may influence prognosis.

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Background: Increasing evidence suggests that targeting self-regulatory processes may improve obesity treatment outcomes. Incorporating gamification principles in inhibitory control training may promote sustained training adherence and resulting benefits. This pilot study evaluated the preliminary efficacy of supplementing an evidence-based weight management program (WW) with sustained gamified inhibitory control training (PolyRules!) on change in Body Mass Index (BMI) among adults with overweight/obesity. Methods: 30 adults with overweight/obesity (M age 49.9 � 12.4, 86.7% female; 23.3% Hispanic, mean BMI 35.3 � 6.3) were randomly assigned to receive WW with or without PolyRules! for 12 weeks. The primary outcome was change in BMI from baseline to post-intervention across study arms. Implementation and process indicators were captured to inform larger trials. Results: Average change in BMI was −0.9 in the WW arm and −1.2 in the WW + PolyRules! arm (Cohen's d = 0.26). In the WW + PolyRules! arm, increased training was associated with greater decreases in BMI (r = −0.506, p = 0.0454). WW + PolyRules! participants completed an average of 60.4% sessions and reported positive experiences. There was no difference in frequency of food (d = −0.02) and weight tracking (d = −0.19) between arms. Conclusions: Studies in larger samples should evaluate training-related effects on weight. Supplementing WW with gamified inhibitory training appears feasible, with no detrimental effect on engagement.

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