The Man Made Mad by Fear

The COVID-19 “Imperative” to Tackle Obesity

As it dawns on people that obesity really is an important risk factor for severe illness with COVID-19, we’re seeing more talk about taking obesity seriously. This is a mixed blessing. On one hand, taking obesity seriously as a medical condition really would be helpful. But on the other hand, talk about the “imperative” to tackle obesity often comes from people who have no clue about the true nature of this chronic disease.

Bias clouds the view.

Talking Obesity, Targeting “The Obese”

For example, Qanta Ahmed writes in the Daily Beast that “the coronavirus shows why we have to tackle the obesity crisis.” She makes a nod to the “many causes” of obesity, but mostly she writes in terms of that suggest disgust and panic. “Universally obese” patients are filling the ICUs where she’s working. Their livers are “overfilled with fat.” She tells us that “obese people” have big disadvantages in immunity. Thus, she says, “the obese may be more contagious.”

In this short essay, Ahmed covers all four classic touchstones for stigmatizing people with a health condition. First is the mark. Everywhere she looks in the ICU, she sees “obese” people. Then comes the label – “obese.” Just doing a simple word count, it’s plain to see. She writes about about “the obese” and their weight more than she writes about obesity. Next, there’s the threat. These people are “more contagious.”

Finally, she offers up the blame. The solution is simple, she concludes. “Getting into shape” is the answer. Lose a little weight and take up some “mild to moderate exercise” and you’ll “very quickly restore innate and adaptive immunity.” It’s a “matter of urgent national public health security.”

The implication is obvious. These people need to do better. For the sake of our national health security. This is a perfect expression of implicit weight bias.

All Problem, No Solution

Catastrophizing obesity does not help. Messaging to hype the problem without offering real solutions simply makes things worse. It stigmatizes people and it paralyzes them. It’s not persuasive because people don’t really want to hear about problems that have no solution. And simply advising people to lose weight and be more active is utterly ineffective. It’s like telling someone with severe depression to cheer up.

If we want to take obesity seriously, we need to look at it like any other health condition. We need to provide care that actually helps with the problem – behavioral therapy, pharmacotherapy, and surgery.

COVID-19 does indeed make it clear that untreated obesity is a serious health problem. When we actually start taking it seriously, we will find ways to provide better access to real obesity care.

Click here for Ahmed’s essay from the Daily Beast. For an exploration of obesity and COVID-19 that is more objective and free of stigma, we recommend this piece by Allison Aubrey. It’s all about obesity and other complicating factors, not “the obese.”

The Man Made Mad by Fear, painting by Gustave Courbet / WikiArt

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April 20, 2020

4 Responses to “The COVID-19 “Imperative” to Tackle Obesity”

  1. April 20, 2020 at 3:55 pm, Mary-Jo said:

    Ted, I know doctors are very busy right now, but, maybe during these unusual days, perhaps a rapid assessment survey, designed by the OAC, could be emailed out to as many HCPs as possible asking what is top reason preventing them from providing care that actually helps, for their patients with obesity.

    • April 20, 2020 at 4:11 pm, Ted said:

      That’s a good question for the ages, Mary-Jo. It’s a number of factors working in synergy and something that we will keep exploring. Training and competency is a factor, health plan coverage is a factor, and implicit bias is a factor. We’re moving on all those fronts, but it’s slow. We will keep asking the question you’re posing.

  2. April 21, 2020 at 11:38 am, mary hager said:

    Hi Ted,

    Did you see the Nova episode on Fat this week? It focused on the evolutionary aspects of obesity. I am always delighted to see Kevin Hall at NIDDK. We worked together twenty years ago.

    • April 21, 2020 at 12:52 pm, Ted said:

      Hi, Mary. That was really a great documentary. Thanks for the reminder!