As states began to expand COVID-19 vaccination eligibility to persons with pre-existing medical issues in March, a considerable number of people discovered that they were eligible for the vaccination just based on their height and weight. Anyone with a body mass index (BMI) more than 25 (what the CDC calls “overweight”) is officially at risk of severe COVID-19, according to the Centers for Disease Control and Prevention (CDC). According to the CDC, those with BMIs exceeding 30—the “obese” category are much more at risk. These two groups account for 74% and 43% of the country, respectively.
Getting the immunization early was an uncommon and pleasant bonus in a medical system where people with larger weights face prejudice regularly. However, specialists in weight stigma warn that naming Obesity as a risk factor for COVID-19 has drawbacks. It’s not just challenging to assume that a high BMI produces worse COVID-19 results; it’s also hazardous to the health of people who live in larger bodies.
BMI is a straightforward calculation that takes into account the connection between two variables: weight and height. Divide your weight (in kilos) by square of your size to obtain yours (in meters). The BMI has a long history as well. The quantification was created 190 years ago by Adolphe Quetelet, a Belgian astronomer, mathematician, and sociologist, as part of a broader endeavor to chronicle the dimensions of “the ordinary man.” Over a century later, epidemiologists discovered Quetelet’s ratio and concluded that it might be used to predict body fat—and hence health.
However, according to Gregory Dodell, an endocrinologist at Central Park Endocrinology in New York City, “it was never designed as an individual index of health.” Furthermore, Quetelet’s data was exceedingly limited: it was entirely based on the measurements of white European men. “So you’re rejecting a huge spectrum of people from various nationalities and genetic backgrounds.”
In today’s society, it’s assumed that being obese and having a higher BMI means you’re ill, both in medical field and in popular culture. Obesity was officially recognized as a condition by the American Medical Association in 2013. However, they went against the advice of their scientific advisory body, The Council for Scientific Affairs, which noted “a lack of distinctive indications or symptoms associated with obesity” and “insufficient evidence of any actual causative links between obesity and morbidity and/or death.” (It’s worth noting that fat activists and scholars studying weight stigma see the phrases “obesity” and “obese” as extremely stigmatizing.) The adjectives “fat” and “overweight” are preferable since they are less laden and more objective descriptors.)
According to medical experts, higher BMI is linked to a variety of illnesses such as diabetes, high blood pressure, and heart disease—all of which put persons at risk for severe COVID-19.
However, a body of evidence, including long-term research with large numbers of participants, refutes this claim. Over nineteen years, scientists evaluated the health of 14,685 volunteers, categorizing them as “healthy” or “unhealthy” based on their blood sugar, cholesterol, triglycerides, and blood pressure. Their findings, which were published in the journal Obesity in 2015, revealed that BMI had no impact on whether or not individuals suffered heart disease or stroke. Or on their mortality. It had a minor influence on diabetes risk, but only among patients with “healthy” blood sugar, cholesterol, and blood pressure. Even though participants gained weight on average throughout the almost two-decade research, health indicators remained constant. Another study published in JAMA in 2016 looked at mortality among 2.88 million people across five continents. It showed that persons in the “obese” BMI group had a relative risk of death as those in the “normal” category, but those in the “overweight” BMI category had a lower risk of death than those in the “normal” BMI group.
The relationship between BMI and COVID-19 risk is also a bit hazy. According to several studies, patients with higher BMIs are more likely to be brought to the ICU with COVID, require a ventilator to live or die from the condition. Some experts argue that simply having a larger physique might make COVID-19 treatment more challenging. For example, a bigger chest might make breathing more complex, and ventilators were built for smaller bodies, even though most Americans live in larger ones.
According to Paula Brochu, a social psychologist at Nova Southeastern University in Florida who studies prejudice and stigma, much of the research on the link between BMI and COVID-19 uses small groups of participants and doesn’t account for characteristics like socioeconomic position or quality of care, both of which influence COVID-19 risk. She said in an email that the information we have isn’t adequate to make a broad conclusion and that “study findings in this area are diverse and conflicting.
BMI was not related with poor COVID-19 results in more significant research of more than 10,000 veterans published in September in JAMA Network Open, while a study of almost 7,000 persons published in Annals of Internal Medicine revealed that only male patients with BMIs higher than 40 (representing fewer than 8% of the population in the United States) had more unsatisfactory results.
“I believe a little caution is required in settling on weight as a risk factor since this is a fast-changing area of research,” says Jeffrey Hunger, a social and health psychologist at Miami University who studies weight stigma. “At end of the day, once the epidemic is over and all the data is in, we could detect a link between obesity and COVID risk.” However, jumping to that conclusion too soon might be harmful to persons with larger bodies, he noted.
Weight stigma, or discrimination based on body size, has been linked to poor mental and physical health, according to research. Udo researches the effects of weight stigma on health and has discovered that those who report experiencing more weight stigma are more likely to develop arteriosclerosis, mild cardiac problems, and diabetes, independent of their BMI, physical activity levels, or socioeconomic status.
These impacts can be felt without being subjected to overt prejudice, according to Hunger. He claims that weight stigma is visible in the way we talk about persons who are overweight. During the COVID-19 epidemic, there was no shortage of stigmatizing rhetoric and images. Hunger points to stock photos of faceless obese individuals in ill-fitting clothes that frequently accompany headlines on COVID-19 danger and “obesity,” hand-wringing about the “quarantine-15,” and op-eds are lamenting the pandemic weight gain accompanying the rise in drinking.
“Implicit in this talk of obesity as a risk factor is a notion that overweight individuals deserve poor COVID results since they brought it on themselves,” Hunger explained.
Discrimination is a greater dread for some than the virus itself. According to research, a higher BMI is linked to more inferior medical treatment quality. Fat individuals should make a “connection kit” if they need to go to the hospital for COVID-19 issues and are unable to advocate for themselves, according to the No Body is Disposable project. A “humanizing” image and a little self-introduction, using keywords like “community organizer” and “someone’s child,” are suggested on the website. The idea is that medical professionals would treat people as individuals rather than as numbers on a scale, resulting in equal care.
People may resist seeking medical help out of fear of being judged. “I’m in a larger body now, and I’ve been diagnosed with COVID. So, speaking from personal experience, it’s quite difficult for me to get someone to take my health issues seriously,” says Marquisele Mercedes, a Brown University Ph.D. student in critical public health. “If a fat person has a problem, it is handled as a weight problem; it is not caused by anything else.”
According to Hunger, it causes a void in our research when we analyze BMI but fails to account for stigma and quality of treatment. “If we never investigate those things, if we never evaluate them, then the dominant narrative will always be that weight predicts COVID issues and that there is a direct link between the two.”