Weight Loss and Chronic Rhinosinusitis in the Obese Population: Associations With Disease Risk and Burden

Objective: Obesity is associated with increased risk and severity of chronic rhinosinusitis (CRS), yet the impact of weight loss (WL) on CRS development and burden is not well defined. This study investigates whether weight reduction influences the likelihood of developing CRS and improves clinical outcomes among obese adults. Methods: Retrospective cohort study using the NIH All of Us database. Obese adults (BMI ≥ 30) with complete demographics and follow-up were included. To assess CRS onset, patients were stratified into sequential WL cohorts and followed for 1 year. To assess CRS outcomes, patients who lost ≥ 5 BMI points were categorized into any WL (AWL), unsustained WL (UWL), or sustained WL (SWL; ≥ 1, 2, 3 years) and compared with no WL (NWL) controls matched on demographics and healthcare visit frequency. Time-to-event analyses used Kaplan–Meier and Cox models to evaluate CRS onset. Among CRS patients, follow-up visits, new nasal symptoms, and medication use were analyzed using odds ratios (ORs). Results: Among 3203 obese patients, a ≥ 5-BMI decrease was associated with reduced CRS risk versus NWL (HR 0.57, 95% CI 0.37–0.87). Of 2714 obese CRS patients, 537 lost weight. Two-year SWL was associated with fewer follow-up CRS visits versus NWL (10.4% vs. 20.1%; OR 0.46, 95% CI 0.24–0.90). Any SWL demonstrated lower odds of nasal symptoms, and 2-year SWL demonstrated reduced antibiotic usage (OR 0.43, 95% CI 0.21–0.88). Conclusion: Sustained WL may reduce both the risk of developing CRS and the burden of ongoing disease, supporting its relevance as a potential adjunctive management strategy. Level of Evidence: Level III.