Weight Bias and Fat Acceptance in Pandemic Times

It sounds apocryphal. Yet it’s fresh and real. Da’Shaun Harrison, an author and activist, had just arrived at an Atlanta hospital with COVID-19, was lying on a stretcher, and terrified of dying. A male nurse approached and said, “Wow, you’re big. The first thing we need to do is get this weight off you.” Neither weight bias nor the fat acceptance movement have taken a pause during the COVID-19 pandemic.

But the pandemic has certainly introduced some challenges.

Embracing the Vaccine

As a fat acceptance activist, Chrystal Bougon was thrilled to get early access to a COVID-19 vaccine:

“I’m not going to apologize for it. I’ve been in fear the whole flipping time, staying home, avoiding everybody. I couldn’t do my job. I’m an electrologist.

“It’s not every day that we get something for free because we’re fat.”

Ironically she received this early access was because of class 3 obesity – a diagnosis she rejects. Her feelings about diagnosis are strong because of a lifetime of medical providers never seeing her as a person – never seeing anything but her size. It’s epitomized by a doctor telling her to lose weight when the reason for her visit was a scratched cornea.

Rejecting the Science

Fatima Cody Stanford explained to the Los Angeles Times times why outcomes are so much worse when COVID-19 occurs in a person with obesity:

“Obesity is characterized by chronic inflammation. That condition is now interacting with an acute inflammatory process, SARS-CoV-2. The acute inflammation of a cytokines storm does not interact well with a chronic inflammation from obesity.”

But fat acceptance activists are quick to reject the science, suggesting that weight bias taints the research. Says Ragen Chastain:

“If fat bodies experience something more than thin bodies, fat bodies are to blame, rather than the unequal treatment fat people receive due to weight stigma.”

Heightened Distress

Research in the International Journal of Obesity tells us that even kids with obesity are feeling more distress in this pandemic. In survey research with 1,357 Chinese school children, researchers found higher levels of COVID-19 infection fear, stress, depression, and weight stigma in children with overweight during the COVID-19 outbreak.

In the U.S. we have seen that obesity has risen in children during the pandemic, and that weight gain has been the greatest for children who already have overweight and obesity. In a review of weight bias during the pandemic, Rebecca Pearl and Erica Schulte tell us that lifetime experiences of weight bias may have made people with obesity more vulnerable to psychological distress during the pandemic. But the research to date has real limitations.

A Better Way

Pandemic or not, weight bias in healthcare is unacceptable. People of size deserve respectful, patient-centered care. When providers can’t see beyond a patient’s size, they cannot deliver good care. But rejecting science doesn’t help. What we must reject is weight bias.

Click here for further perspective from the LA Times, here for the research by Pearl and Schulte, and here for more on the interaction of COVID-19 and weight stigma.

The Fifth Plague of Egypt, painting by J.M.W. Turner / WikiArt

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May 9, 2021