Weight Isn’t The Problem With COVID-19. How We Talk About It Is.

Messages about the perceived association between weight and COVID-19 risk are everywhere.

On the Centers for Disease Control and Prevention’s website, there’s a page dedicated to “Obesity, Race/Ethnicity, and COVID-19,” in which the agency blatantly states that “obesity worsens outcomes from COVID-19.”

The page goes on to say that while obesity is complex and is associated with systemic factors like poverty, education, housing and racial inequality, people should prioritize “eating a healthy diet,” “being active,” “getting enough sleep,” and “reducing stress.” These things, the CDC says, can help promote weight loss and prevent weight gain, which can then reduce “the risk of severe illness from COVID-19.”

This type of messaging is covertly stigmatizing. While the CDC talks very matter-of-factly about obesity and COVID-19, the underlying message is that fat is bad, and that fat people should prioritize ridding themselves of their fatness above all else.

But that thinking may be partially flawed: The research on weight and COVID-19 has some limitations. In an April 2020 story for Wired, dietitian Christy Harrison explained that none of the studies backing this link “control for race, socioeconomic status, or quality of care — social determinants of health that we know explain the lion’s share of health disparities between groups of people.”

They also don’t take into account comorbidities (other health conditions an individual might have) or the fact that health care professionals typically have a strong bias against fat people, which affects the quality of care they provide.

Here’s another thing to take into account: Evidence shows that the vast majority of people can’t lose weight and keep it off for more than a year, and it’s not for lack of willpower. Intentional weight loss has been shown to cause adaptations like lowered energy expenditure and leptin production (a hormone that signals fullness), and an increase in appetite and ghrelin production (a hormone that signals hunger). Thus, repeated weight loss attempts often lead to weight gain, as well as lowered self-esteem, disordered eating habits and a preoccupation with food.

That’s a lot to take in, and many people’s instinct might be to roll their eyes at the suggestion that it’s possible to be fat and healthy. Evidence aside, let’s dive into how it might feel to be a fat person during the COVID-19 pandemic. Because messaging ― especially incomplete messaging that doesn’t take in all the facts ― can affect people’s mental health. And that can have damaging consequences on overall health, too.

(Full disclosure: The individuals interviewed below reiterated during our conversations that their opinions do not represent the opinions of every person who’s at a higher weight, since each person’s experience and background is different. Still, their thoughts offer insight into how the current public health messaging around weight and COVID-19 can be harmful.)

Here’s what you need to know:

Laurie Cooper Stoll and Darci Thoune are professors at the University of Wisconsin-La Crosse, in the fields of sociology and English, respectively. Both are involved with fat studies, an interdisciplinary field of scholarship marked by an aggressive, consistent, rigorous critique of the negative assumptions, stereotypes and stigma placed on fat and the fat body.

Thoune wrote a post on their shared Two Fat Professors blog at the beginning of April about how diet culture and fatphobia was showing up as memes about quarantine weight gain, and how that perpetuates weight stigma against people at higher weights.

Cooper Stoll explained that one of the biggest issues with this kind of messaging is that “most public health professionals or physicians aren’t doing this out of maliciousness.” The problem is, they believe that being fat is inherently bad and that these messages are necessary and helpful. Because people in these fields often don’t acknowledge that these messages have negative consequences, she said, it makes it that much harder to solve the problem of weight stigma.

“Because most people feel like it’s common knowledge that fat is bad, and that’s backed up by health care and public health professionals, it actually opens the door to make it OK to beat up on fat people kind of all over the place,” Thoune added.

And many people are very resistant to the idea that fat bodies aren’t inherently bad. “I’ve been giving talks about my research on systems of oppression for years,” Cooper Stoll said. “But you start writing that fat people should have some degree of respect and be treated like human beings, and I tell you, critics just come out of the woodwork. I’ve never gotten this kind of backlash before with any of my other work.”

Ivy Felicia is The Body Relationship Coach. She helps “women of all sizes, shapes, and body types feel at peace in their body through any stage of life,” drawing from her own experience with body image struggles. She is also the founder of Fat Women of Color, and explains that intersectionality — the interconnectedness of various marginalized identities, like being a person of color and being fat — shapes people’s experiences with stigma and discrimination.

She pointed out that the messaging around weight and COVID-19 might negatively affect those at higher weights in other ways that can influence their overall health.

“Any time someone talks about the fact that they don’t want to be fat or they don’t want to gain weight, it’s inherently fatphobic,” Felicia said. “It sends the message to a person of size that, ‘I don’t want to look like you,’ or, ‘I don’t want to be what you already are.’” It may be unintentional, she added, but that doesn’t make it any less harmful.

Shira Rosenbluth is a body-positive fashion blogger and eating disorder therapist who has been open about her own struggles recovering from an eating disorder at a higher weight. No surprise, she takes issue with all of the anti-obesity and weight loss campaigns that public health officials are promoting right now.

“What’s interesting to me is that all of these messages claim to care about people’s health,” Rosenbluth said. “But as we know, extreme dieting or dieting of any kind is physically harmful.”

Not to mention the stress this might cause people in larger bodies. “Telling [higher-weight] people they’re more likely to die, for them to be under that kind of stress, is obviously also very unhealthy,” Rosenbluth said.

And although the evidence linking higher weights to greater risk of complications from COVID-19 is shaky, the fear and stress felt by those in larger bodies is warranted.

“A lot of [my higher-weight clients] are even more scared than the average person of even leaving their house,” Rosenbluth said. “There’s this fear of, ‘If they run out of ventilators, am I going to be last on the list because they’re looking at me as someone who brought this on themself.’ That does happen.”

A 2016 meta analysis on the link between weight and H1N1 found that higher-weight people were less likely to be prescribed early antiviral treatment, which itself increases their risk of poor outcomes.

As Thoune and Cooper Stoll explained, the issues of weight stigma and fatphobia, particularly during COVID-19, are so hard to address because most people don’t realize that they exist. We hear respected individuals and organizations talk about the risks of being at a higher weight, or the benefits of weight loss, and we don’t think twice about how these messages might be harmful.

The fact is, the public health and medical communities may never change their messaging on weight as a risk factor for COVID-19 and other diseases. There are, of course, cases where weight can matter for health risk. But a blanket assumption, without taking into account other factors of a person’s life, isn’t doing any favors, which is why doctors need to look at a person’s full health profile rather than just focus on someone’s body mass index (which is a deeply flawed tool also, by the way).

No matter your stance on the topic — maybe you believe that it’s possible to be healthy at a higher weight, maybe you don’t — at least make space for the idea that obesity and weight loss messaging is inherently stigmatizing to people at higher weights. Keep in mind also that weight loss isn’t possible for many people, despite what we’re led to believe.

Most importantly, be compassionate. These are traumatizing times for pretty much everyone, and there’s no need to make things worse for people who already live in marginalized bodies.