People with Long COVID and overweight face a double burden: their symptoms are often more severe and long-lasting, while at the same time they have an increased risk of comorbidities.
A population-based study from the Netherlands published in 2024 showed that overweight increases the risk of becoming infected with COVID-19.
Furthermore, a large meta-analysis demonstrated that an elevated body mass index (BMI), especially in combination with female sex and socioeconomic disadvantage, is a risk factor for developing Long COVID.
Another meta-analysis described inflammatory processes and changes in immune response as possible mechanisms that could explain why people with a higher BMI are more likely to develop persistent symptoms after a SARS-CoV-2 infection.
A British research team has now investigated whether structured weight reduction can also improve Long COVID symptoms—at least in selected individuals. The results require a nuanced interpretation.
Objective of the Study
The ReDIRECT study (Remotely Delivered Weight Management for People with Long COVID and Overweight) aimed to determine whether a professionally supervised, digital weight reduction program could improve Long COVID symptoms.
The study was conducted entirely online, with a total of 234 participants from the United Kingdom who had suffered from at least one distressing symptom for more than 12 weeks and were also overweight (BMI >27 kg/m², or >25 kg/m² for South Asian individuals).
Study Design at a Glance
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Design: Randomized, controlled waiting-list study
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Intervention: 12 weeks of diet (~850 kcal/day), followed by food reintroduction and maintenance phase
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Control group: Usual care, later participation in the program
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Duration: Primary analysis after 6 months
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Primary endpoint: Change in the main complaint chosen by the participant (e.g., fatigue, shortness of breath, pain) on a standardized scale
Results: Slight Improvement, but Not in All Areas
After six months, there was a statistically significant but small benefit in the intervention group compared to the control group. Fatigue, cited as the main complaint by more than half of the participants, improved more in the intervention group (−7.5 points) than in the control group (−3.7 points) on the Chalder Fatigue Scale. There were also moderate improvements for shortness of breath and depressive symptoms, the latter mainly due to a decrease in the depression subscale. However, there were no statistically significant differences between the groups for pain (p = 0.1480).
On average, participants in the intervention group lost 10.3 kg within six months. In the control group, weight remained largely stable. Moderate improvements in systolic and diastolic blood pressure were measured. Participants reported improved health-related quality of life (EQ-5D VAS), but the difference in the EQ-5D utility score was not significant (p = 0.0725).
What Remains Unclear?
The study was conducted in a real-world setting and had a low dropout rate. Nevertheless, there are some limitations:
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There is no clear evidence that the observed improvements were directly caused by weight loss. An exploratory analysis could not establish a clear link between weight reduction and symptom improvement.
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The symptom scales were validated but not specifically developed for Long COVID.
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Placebo effects or additional support from professionals may also have contributed to the improvements.
Conclusion
The ReDIRECT program was safe and led to weight loss and a slight improvement in distressing symptoms for many participants. However, the effects were moderate and not evident in all areas.
For people with Long COVID and concurrent overweight, a professionally supervised weight reduction program can be a supportive measure—but not a guarantee of lasting improvement. Further studies are needed to clarify which mechanisms underlie the effects, how sustainable they are, and for whom the intervention is particularly suitable.
