Higher BMI and SNOT-22 Scores in Chronic Rhinitis
The evidence does NOT support that higher BMI correlates with worse baseline SNOT-22 scores in chronic rhinitis patients, though obese patients may experience reduced relative improvement after treatment.
Baseline SNOT-22 Scores Across BMI Groups
The available evidence directly contradicts the premise that higher BMI correlates with worse baseline SNOT-22 scores:
- No significant differences were found in mean preoperative SNOT-22 scores between normal weight, overweight, and obese patients with chronic rhinosinusitis 1
- Similarly, obese and normal weight patients with allergic rhinitis showed no differences in baseline SNOT-22 scores prior to treatment 2
This finding is consistent across both chronic rhinosinusitis and allergic rhinitis populations, suggesting BMI does not independently predict worse symptom burden at baseline.
Treatment Response and BMI
While baseline scores are similar, the relationship between BMI and treatment outcomes reveals important nuances:
Post-Surgical Outcomes
- All BMI groups (normal, overweight, obese) achieved significant improvement in SNOT-22 scores following endoscopic sinus surgery 1
- However, overweight and obese patients demonstrated reduced relative percentage improvement compared to normal weight patients (40% and 29% improvement respectively vs 48% in normal weight patients) 1
- The absolute mean improvement did not differ significantly between groups, but the proportional gains were diminished in higher BMI categories 1
Medical Treatment Response
- Both obese and normal weight patients with allergic rhinitis showed similar clinical improvement in SNOT-22 scores after nasal corticosteroid treatment 2
- Despite similar symptomatic improvement, obese patients demonstrated impaired anti-inflammatory cytokine responses (particularly IL-10) during treatment 2
Clinical Implications
The key clinical takeaway is that BMI does not predict baseline disease severity as measured by SNOT-22, but may influence the magnitude of treatment response:
- Obese patients should not be assumed to have worse symptoms at presentation based on BMI alone 1, 2
- Higher BMI is associated with increased comorbidities (diabetes, asthma, depression) that may independently affect quality of life 1
- Treatment decisions should not be altered based on BMI, as both surgical and medical interventions remain effective across all weight categories 1, 2
Common Pitfalls
- Do not conflate reduced percentage improvement with treatment failure - obese patients still achieve clinically meaningful improvement despite lower relative gains 1
- The SNOT-22 minimally important difference is 8.9 points 3, and this threshold is achievable across all BMI categories
- SNOT-22 scores above 35 indicate poorly controlled symptoms regardless of BMI 4