An Umbrella to Deny the Rain

Discrimination, Denial, Obesity, and COVID-19

Alternative facts are never helpful. This is especially true in the midst of a health crisis. People need actual, reliable facts to make good decisions – not a self-serving story. And yet, we see facts dismissed in discussions of discrimination, obesity, and COVID-19. Yet another large study emerged this week that points to real risks for people with obesity who develop COVID-19.

But rather than dealing with those observations, we see too much energy going into denying their significance. Meanwhile, too little energy is going into solving the problems these data suggest.

Pre-Publication: A Study of 16,749 UK COVID-19 Patients

This new study, by a distinguished collection of UK researchers, is a pre-print. So, yes, it must be taken with a grain of salt until peer review is complete and it appears in final form. Nonetheless, the work is impressive. It’s an analysis of 16,749 patients with COVID-19 from 166 hospitals in the UK. Patient records cover a period from February 6 to April 18. During that time, 49 percent of these patients were discharged alive, 33 percent died, and 17 percent remained in the hospital.

Of course, this cohort of patients represents people who were the sickest of the sick. Most patients – perhaps 80 percent – with COVID-19 will have mild disease. As many as half of the people infected might not even know they have it. That’s a whole other story. This study is all about understanding the patients who have a serious problem with the new coronavirus.

The picture that emerges from this study is remarkably consistent with earlier analyses. Age is the biggest risk factor by far. For patients over 70 or 80, the risk of death is roughly a thousand percent higher than for patients under fifty. For obesity, the risk is 37 percent higher. Likewise, the risk was higher for males and people with heart, kidney, or lung disease.

Disempowerment and Denial

It’s getting harder and harder to deny that obesity is a risk factor for bad outcomes with COVID-19. But that does not stop some fat activists from trying. A common theme, voiced in an article on Health.com this week, is that fat phobia is the real killer. Pay no attention to the CDC warning that severe obesity puts a person at risk for bad outcomes.

Let’s be clear. Weight bias is a real, serious problem. We live in a culture that discriminates against people based on size. It’s wrong and it magnifies the harm that obesity causes. Routine healthcare for people with obesity is often poor and unhelpful. But obesity is a problem of physiology. It harms nearly every organ system, causes premature death and many chronic diseases. While the data on COVID-19 are messy and still emerging, it’s pretty clear that obesity brings more risk for bad outcomes. Data on obesity and COVID-19 suggest that people with obesity are getting more intensive care – not less.

Advocates for people of size are doing no one favors by telling their followers to ignore CDC guidance on this matter. Knowing your risks is essential for being your own best advocate. Blaming healthcare providers for worse outcomes with COVID-19 and obesity is irresponsible. Already, people are avoiding medical care that could save their lives. It’s disempowering to tell people that they should expect poor care in this crisis because of their size.

Telling people that they are doomed to be victims of healthcare providers is a lousy form of advocacy. A much better strategy is to empower people with good information and encourage them to demand better care.

Click here for the new UK study, here and here for more from its authors.

An Umbrella to Deny the Rain, photograph © Saad Sarfraz Sheikh / flickr

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May 2, 2020

4 Responses to “Discrimination, Denial, Obesity, and COVID-19”

  1. May 02, 2020 at 10:47 am, Ellen Glovsky said:

    You seem to be implying/assuming that people with obesity can actually change that, and become “thin” people. Almost all the evidence shows that dieting to lose weight does not work, and most people regain any lost weight. How about encouraging people to be their healthiest at whatever weight they are? I think that prescribing weight loss is unethical and irresponsible. Why would you recommend a treatment that you know almost never works? If you patient had a condition and you said, “take this medicine it almost never works” would that be ok?

  2. May 02, 2020 at 5:13 pm, Ted said:

    Thanks, Ellen, for sharing your perspective.

    I wonder where you read that I think people with obesity should “become thin people.” Because that’s not what I think.

    I do think, however, that people should do whatever they can to be their healthiest. So perhaps we agree on more than you are assuming.

  3. May 02, 2020 at 8:47 pm, Narmin Virani said:

    Fat activists and obesity clinicians both agree on the topic that people with obesity need and deserve better care due to secondary chronic medical conditions that are a result of not just their weight but multiple factors including inequities in social determinants of health and weight/race stigma (known to cause inflammation). The difference is that fat activists say that they should get access to this care without being first asked to lose weight through treatments that may not only cause side-effects and complications, likely worsening health long-term, but may also not lead to long-lasting weight loss.

  4. May 03, 2020 at 3:09 am, Ted said:

    Thanks for sharing that, Narmin. Good clinicians of any kind respect and listen to their patients. Shared decision making is the only kind that truly works.