At the Races

The Scramble for Vaccination Meets the O-Word

The scramble for COVID-19 vaccination is clearly messy. For one thing, people who need it most have found it hard to get. And then we have others, with sharp elbows and privilege, who want to be at the front of the line. To claim priority that public health guidelines don’t grant them. So when you add in the O-word, feelings about the vaccination scramble get even more complicated.

Clair DiYenno from upstate New York really wanted to get the vaccine. But she describes mixed feelings when she learned she could get it now because of her BMI:

“It was kind of like, shot-and-chaser. Like, oh, here’s this great thing, that I’m eligible to get the vaccine, but the fact that it’s because I’m fat – I didn’t know how I felt about it.”

Clearly a Risk Factor

The Morbidity and Mortality Weekly Report (MMWR) this week published a thorough analysis of the relationship between high BMI and COVID-19 risk. The analysis found a strong dose-response relationship between BMI and hospitalization or death due to COVID-19. In other words, the higher a person’s BMI, the more likely they are to land in the hospital or die if they get COVID. For mere overweight (BMI 25-30), the risk is modest – a seven percent higher risk of hospitalization for individuals under 65 years old. No increase in the risk of death.

But as BMI rises the risks rise. At a BMI greater than 45, the risk of hospitalization goes up by 60 percent. Risk of death doubles.

To be clear, age is the biggest risk factor for bad outcomes. That is why age comes first in prioritizing vaccination. Obesity is way behind age as a risk factor. But for younger folks, it’s clearly an important risk for bad outcomes.

Tempered by Fat Phobia

For people living with obesity, this information comes after a lifetime of experiencing weight bias in healthcare. Among other things, we see obesity blamed for every health problem that arises. The prescription is as simplistic as it is unhelpful. Just lose weight. In other words, it’s your problem, your fault.

So when the O-word comes up in connection with COVID risk and vaccination, mixed feelings result. Is this another case of catastrophizing obesity? Some HAES advocates are especially resistant to facing the risk that obesity presents in a COVID infection.

Darci Thoune is an English professor who focuses on fat studies. She describes the problem plainly to the Washington Post:

“Fat people have been abused in medicalized spaces for a very long time. It only reinforces a culture of shame and contributes to the well-documented mental health issues that a lot of fat people have because of, essentially, institutionalized weight stigma.”

Sticking with Facts

In matters of health we find it best to set aside dogma and political agendas. Tess Holliday, a model and self-described body positive activist, put it this way to the Washington Post:

“It has never been easy to exist in a plus-sized body in America. We have been ridiculed our entire existence. So honestly, if the upside of me dealing with the torment and torture because of my size my entire life means that I can get a life saving vaccine sooner, then cool.”

Amen. Regardless of how you feel about the O-word, vaccination for COVID-19 is a good thing.

Click here for more on this from the Post and here for the new analysis in MMWR on BMI as a risk factor for COVID-19 outcomes. For further perspective, click here.

At the Races, painting by Edouard Manet / WikiArt

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March 10, 2021