COVID-19 outcome disparities are rapidly becoming apparent for people with obesity and multiple black, Asian, and minority ethnic (BAME) groups. Researchers have reported differences in COVID-19 hospitalization and mortality rates by race/ethnicity in the United Kingdom (UK)[1, 2] and United States (US)[3, 4]. Numerous minority ethnic groups in these countries live with a greater burden of obesity and other chronic diseases. This is particularly significant as obesity has emerged as a risk factor for severe COVID-19, the disease caused by novel coronavirus SARS-CoV-2 [3, 5]. We synthesize a range of potential biological, socioeconomic, behavioral, and sociological contributors to the disparate outcomes for people with obesity and minority ethnic groups in COVID-19. Initial retrospective cohort analyses have demonstrated higher rates of hospitalization and intensive care, including invasive mechanical ventilation, for patients with obesity [5, 6]. Though these observational results do not assess mortality outcomes and adjust for few comorbidities, they signal potential biologic vulnerability for a large proportion of people worldwide living with obesity. Obesity rates are significantly higher among Hispanic and African Americans, as well as black, Bangladeshi, and Pakistani groups in the UK, than their white counterparts [1, 7]. The overlap of COVID-19 risk signals between obesity and ethnicity therefore is of consequence. The most comprehensive epidemiology on ethnicity and COVID-19 currently available is from the UK [1, 2].

BAME individuals comprise over 30% of hospitalized, critically ill patients with COVID-19 [2]. The Office for National Statistics highlights stark ethnic disproportionalities in COVID-19 mortality odds, over fourand threefold for black and Bangladeshi/Pakistani individuals respectively compared to white individuals [1]. Indeed, the first ten UK physicians to die from COVID-19 were all of BAME background. Though US national data are limited, states and municipalities report a disproportionate burden of COVID-19 cases, hospitalizations, and deaths among Hispanic and African Americans [4, 8]. In Norway and Sweden, cases among Somalis are seven-to ten times expected based on population [9]. Ethnic differences in economic status, underlying health conditions, density of residence, and household crowding all contribute to the unequal impact of COVID-19. For example, the English Housing Survey noted household overcrowding in 30% of Bangladeshi, 16% of Pakistani, and 2% of white British households [1]. The mortality gap between the most and least deprived areas is greater for COVID-19 than that normally observed for all-cause mortality, highlighting the importance of socioeconomic status [1]. However, adjustments for age, geography, educational attainment, level of deprivation, and selfreported health only partially attenuate the higher odds ratios of COVID-19 mortality for black individuals (1.9), Bangladeshi/Pakistani men (1.8) and women (1.6) compared to white individuals in the UK [1]. Further inclusion of data on socioeconomic status and specific medical conditions such as obesity (absent from this model) will enhance our understanding of the joint and independent contributions of ethnicity, class, and preexisting comorbidities in COVID-19.