Background: Obesity increases the risk of severe illness, hospitalizations, and death from most acute illnesses – particularly infectious diseases. (1,2) African American communities have been greatly affected by the COVID-19 pandemic and are disproportionately impacted by the obesity epidemic in this country. (3, 4) However, little is known of their knowledge and attitudes related to the COVID-19 pandemic. To understand more about this, we conducted this study to assess COVID-19 perceptions among hospitalized African Americans with comparisons made between those with and without obesity.

Methods: This study was a cross-section survey study in a tertiary urban medical center that enrolled COVID-19 negative African American patients – with and without obesity admitted to the general medicine service. A survey instrument was designed and used for data collection between November 2020 and March 2021. It sought to assess knowledge, perspectives, and concerns related to COVID-19 infection among hospitalized African American patients.

Results: A total of 69 patients with obesity and 71 patients without obesity were compared. Mean ages between patients with and without obesity were similar (55.6 ± Standard Error [SE]: 1.6 vs 58.0 ± SE: 1.9; p 0.33). Those with obesity were more likely to be female (69.5% vs 39.4%; p <0.01). More patients with obesity had asthma (34.7% vs 17.1%; p=0.02), dyslipidemia (44.9% vs 26.7%; p =0.03), and hypertension (82.6% vs 66.1%; p=0.03). About half of both obese and non-obese incorrectly believed that at least 50% of those infected with COVID-19 require hospitalization (46.3% vs 53.5%, p=0.49). Patients with obesity were more accurate in their assessment than the non-obese that a low percentage (<=15%) of people infected with COVID-19 die from the virus (31.8% vs 21.1%, p=0.04). More obese patients thought they were at higher risk of infection from the virus – although the difference was not statistically significant (75.3% vs. 66.1%, p=0.26). The proportion of patients who were receptive to vaccinations was the same in both groups. (63.7% vs. 64.3%; p=1.0).

Conclusions: Hospitalized African American patients were reasonably knowledgeable about COVID-19 but overestimated the mortality associated with the virus. In addition, although obese patients understood that COVID represented a significant health threat, one-third were resistant to vaccination; these data expose the public health challenges that exist in eradicating COVID-19 and keeping communities safe.