COVID-19: HAES and Fat Shaming Become Cartoons

On Friday, the BMJ released the largest peer-reviewed prospective study of risk factors for severe symptoms or death with COVID-19 to date. Age over 50, being male, obesity, and other chronic diseases stand out as important risk factors. By now, this is a pattern that is quite familiar. But it does more than just make the connection between severe symptoms of COVID-19 and obesity painfully obvious. It makes the polar extremes of rigid HAES advocates and fat shaming seem like cartoons.

However, these cartoons are not entertaining in the least.

An Impressive Study

The new study in the BMJ is impressive because of the careful planning, preparation, and data collection that made it possible. It’s observational, so it cannot, by itself, establish cause and effect relationships. But it does make it abundantly clear that advanced age, male gender, obesity, and other chronic diseases are important risk factors for poor outcomes when a person develops COVID-19.

These are facts demand our attention.

Cartoonish Extremes

We do not see advocates for older persons trying to deny these facts. Nor do we see advocates for men’s health disputing them. But despite the accumulating evidence, we do have adamant HAES advocates arguing “high BMI on its own just isn’t a risk factor” and “being in the ‘o*ese’ category may actually lower people’s risk.”

At the other extreme, we have House Speaker Nancy Pelosi doubling down on irrelevant fat shaming of the President. She refused to back away from inaccurately trying to label him with outdated and offensive terminology as morbidly obese. “I didn’t know he would be so sensitive,” she said.

In a recent essay, Andrew Sullivan described these absurd extremes:

Polarized to absurdity, reductionist in their analysis, the arguments for both “fat studies” and “fat shaming” are almost designed for Twitter, and catnip for the hot-take culture war. On one side are helpless victims . . . on the other are brutal realists.

Neither of these extremes of HAES or fat shaming is helpful. The concept of promoting health at whatever size a person might be is quite important. But asserting that obesity is not a real health concern is not.

Likewise, bigoted and ignorant thinking that dismisses the role of physiology in obesity is the foundation for fat shaming. That thinking is stuck in the 20th century.

It’s time to back away from those polarized extremes and move on.

Click here for the new study in the BMJ and here for a related editorial.

Cartoons, illustration by Harry James Westerman / Wikimedia Commons

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May 23, 2020