Background: Peru followed strict quarantine measures to control COVID-19 but reported excess mortality rates during the pandemic that were the highest globally. High obesity prevalence in Peru may have contributed to COVID-19 mortality, although economic hardship during the pandemic could have reduced obesity. To investigate these potential associations, we updated surveys of economic status, nutritional status, and risk factors for severe COVID-19 in residents of Callao, in the Lima metropolitan area of Peru. Methods: We attempted in December 2021 to invite members of households selected randomly from a map that had provided data in previous surveys 2016-2018 and 2019-2020 to participate in another survey. Households were contacted by telephone and, if uncontactable, were visited. Demographic, economic, and health-related data were collected using the Kobo toolbox platform. Results. We interviewed 83% (305/369) of censused household members for 65% (90/138) of previously participating households. Dissaving activities were reported by all households during the pandemic, more than 2016-2018 (51%, 95% confidence interval, CI=41-62%) and 2019-2020 (44%, 95%CI=33-53%, both p<0.0001). Moreover, 90% (81/90, 95%CI=82-95%) of households reported inability to afford sufficient food and hunger rates increased 1.4 times compared with 2016-2018 (95%CI=1.02, 2.0, p=0.04). Despite financial and food insecurity during the pandemic, the mean adult body mass index was maintained unchanged from the 2019-2020 survey at 27 kg/m2 (standard deviation, SD=4.5 kg/m2), having increased (p=0.0001) from 26 kg/m2 (SD=4.1 kg/m2) in 2016-2018. Overweight/obesity was the most common risk factor for severe COVID-19, and adults were 3.1 times (95%CI=2.3-4.2, p<0.0001) more likely to be overweight/obese than they were to have a co-morbid illness. There was considerable dietary diversity and only 23% of participants had taken micronutrient supplements and 11% probiotics in the past year. Conclusion: Obesity was the most prevalent risk factor for severe COVID-19 despite economic pressure, food insecurity, and hunger during the pandemic.
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