Weight Stigma Awareness Week happened recently, and its call for everyone, not just those in larger bodies, to understand why weight stigma is important moved me to use this platform to portray the issue. And what better example of how weight stigma has hurt those in larger bodies than its infiltration into the COVID-19 risk factors. The Centers for Disease Control and Prevention has asserted that people categorized as “obese” by body mass index standards are at increased risk of falling ill from COVID-19.
But a look beyond the coveted CDC-label and into the research shows that these are preliminary findings at best and, on the whole, based on weak evidence. When organizations like the CDC and media outlets boast that higher-weight individuals are specifically in danger of contracting COVID-19, they only point to three preliminary reports released since April that cite high BMI as a risk factor.
The first report overstates the percentage of “obese” patients by failing to also state that the percentage of individuals in this category in the United States is comparable, and could thus be a proportionate representation. The second report found that those with a BMI above 35 were more likely to be put on a ventilator, and the third report was a preliminary finding that those with a BMI over 30 have a higher risk of hospitalization and intensive-care admission if they’re less than 60 years old. Weight didn’t appear important for those above 60.
Yet all of these are flawed in that they don’t control for social determinants of health, such as race, socioeconomic status and quality of care. These determinants are born out of structural racism and weight stigma is their sibling. The social determinants of health are a branch of the many systems of oppressions with us today, all of which are rooted in slavery, discrimination and racism. The system of oppression that is most at play in this particular case pertaining to COVID-19 is the health care system that disproportionately neglects the Black community and people of color, not necessarily because those working in it are explicitly racist, but because they exist under structurally racist systems.
For a better understanding of these determinants, it’s worth examining the redlining policies that concentrated Black people into communities with limited access to quality health care, not to mention foods with highly nutritious profiles. Policies like these paved the way for health disparities, and by virtue of doing this covertly, they’ve also left room to allocate individual blame.
Thus, “poor lifestyle choices” cannot be blamed for health disparities, like those in COVID-19 where Black individuals have had the highest rates of complications and death from the virus. Evoking an individual-focused argument does great harm by dismissing and excusing the racist structure that has fostered it. Weight stigma feeds on this dismissal and excusal, and stigma towards larger-bodied individuals becomes an accepted social norm. Doctors’ failure to provide adequate care and instead assert that an individual’s weight is the root of their problem, and proceed to prescribe weight loss, is a great example of this stigma in a medical setting. In everyday society, stigma takes many forms, from outright telling someone to lose weight because you think you care about them to sneering at a larger-bodied individual at the gym.
Nonetheless, a new study of more than ten thousand individuals with the virus found that high BMI was not a risk factor for hospitalization, ventilation or mortality. I learned of this study through a great podcast, Food Psych, that discussed weight stigma and its disproportionate effect on the Black community and people of color, where the social determinants of health I mentioned earlier are the main predictors of future health outcomes. Contrary to what some are led to believe by sources highlighting the disproportionate rates of illness and death by the virus in the Black community, the virus does not discriminate. The health care system, on the other hand, most definitely does, and that’s why we have such stark disparities in the demographics of those who contract the virus. It has nothing to do with race, because the color of your skin does not make you inherently more susceptible to the virus, yet it has everything to do with race, in that minority communities have been severely limited in their access to quality care. And because the prevalence of higher BMIs in minority communities is well-established, it’s easy for our society — medical professionals included — to resort to weight stigma and place blame for a systematic problem on individuals.
Patrilie Hernandez, an Early Childhood Nutrition & Health Specialist and the founder of Embody Lib, was the guest on Food Psych that beautifully articulated how individual responsibility is skewed. “I’m not trying to say that our individual choices do not matter,” she started. “They do. And when it comes to lifestyle, sure they matter, but they only really start to matter when it comes to our health, when we’re free from the restraints of all these systems that create the health disparities.” I couldn’t have said it better myself.
At this point in time, we can’t say definitely that a higher body weight is the reason an individual becomes infected or further falls very ill with the virus when there are so many other factors in place. If my POLSCI 300 class has taught me anything, it’s that substantive conclusions cannot be made when other confounding variables aren’t accounted for. And here, the confounding variables that are the various social determinants of health are complex and not accounted for in these studies. Moreover, the studies we do have on weight stigma right now continue to suggest that the stigma itself does the most harm.
Still, let’s say we were to believe that a higher body weight in itself put someone at a heightened risk for COVID-19. What can be done as a result? We know for a fact that diets don’t work, with most of the lost weight being regained within five years and sometimes even more weight gain than what was originally lost. So you can’t tell people to just lose weight because that implies intentionally restricting food, and that is a diet. So, what’s the next step? Unless the goal is weight cycling, which is known to be harmful, a restrictive diet is not the answer.
In the end, the answer is still then to adopt healthy behaviors, regardless of current weight and without weight loss goals. But that’s on an individual level. You can’t run before you learn how to walk. The overarching, multifaceted problem is still weight stigma, the harm it brings to people in larger bodies by limiting their access to high-quality health care — and its parent, systematic racism born out of centuries of racism.
I’m not stating definitively that a higher weight doesn’t increase your risk of contracting and falling ill to COVID-19. It very well could. But the outright claims that it does — that an “obese” BMI increases your risk — is unsubstantiated right now. And again, if it does, that puts individuals in larger bodies between a rock and a hard place because it is also true that intentional weight loss efforts are a fruitless endeavor most of the time. In fact, weight cycling or weight gain past the individual’s initial starting weight are likely going to be the long-term results. Finally, all this focus on weight as a risk factor, and weight loss to correct for it, allows weight stigma to continue to fly under the radar, and the social determinants of health continue to be reproduced the longer we continue to neglect its racist roots.
Nyla Booras can be reached at nbooras@umich.edu.
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