Fat-shaming isn't helping fight COVID

Obesity is a problem. So is how we measure weight.

You’ve likely seen the commentary: the predominant number of people dying from COVID are obese. Indeed, obesity triples the risk of hospitalization from COVID-19 and is linked to impaired immune function and decreased lung capacity, which is especially problematic with respiratory viruses. 

But those statistics are secondary to the point conspiritualists make in their “I’m proud of my amazing immune system” posts, which effectively translate as if you’re fat, that’s your fault, so suffer the consequences for your inability to be as amazing as me. 

Or, as Zoe Williams phrased it in The Guardian, obesity “conjures a fairytale world in which bad things happen only to bad people.”

According to the CDC, over 70% of American adults are overweight or obese—a problematic statistic, which I’ll get to in a moment. As this is such an emotional topic, let me preface it by stating that having grown up overweight, I know both the biases waged against fat people—I was bullied well into high school for my weight—and the emotional impact it has, as I suffered from orthorexia until my early thirties due to that bullying even though I thinned out by age 15. 

In some ways, my experience being overweight makes this topic especially difficult to discuss, because I recognize that one of the greatest diseases of affluence, obesity, is a serious problem in America and, increasingly, around the world; that for most of history, food-on-demand was not a thing, especially stores dedicated to proffering sugar-rich carbohydrates; and that obesity is a leading cause of mortality in COVID as well as many other diseases. All of these data points can easily be surfaced.

But there’s more to the story.

Behind data are people, and behind people are systemic conditions, which is what the wellness influencer fails to take into consideration. Besides being over age 65, the obese comprise the second most dangerous cohort when it comes to dying from COVID—being over 65 and obese often leads to the worst fate.

Drill down into the data more and you discover that Black and Latino populations are overrepresented in terms of obesity and COVID deaths in America. Even the CDC recognizes this, writing, 

Racial and ethnic minority groups have historically not had broad opportunities for economic, physical, and emotional health, and these inequities have increased the risk of getting sick and dying from COVID-19 for some groups. Many of these same factors are contributing to the higher level of obesity in some racial and ethnic minority groups.

Fat bias has serious downstream effects. A 2020 research article in Metabolism Clinical and Experimental notes that the higher a person’s body-mass index (BMI), the more negatively that person is viewed, which affects both their care and their willingness to seek care. The authors write, 

The implications of weight stigma are particularly alarming in the context of COVID-19. Individuals with obesity are especially likely to delay care, or avoid it completely, because of bias and humiliation experienced in healthcare settings.

What is obesity? How do you know when you’re overweight? Surely, it must rest on sound science, correct?

It likely won’t surprise you that the same immune system-cheering conspiritualists that fat-shame the less fortunate on Instagram likely aren’t aware of the blatant racist and xenophobic measuring stick known as BMI, even though it is the tool used to measure obesity.

The measurement was devised nearly 200 years ago by Adolphe Quetelet, a Belgian astronomer and sociologist—a man with no background in medicine or physiology—who co-founded a school of positivist criminology that stated people of other races are a different species. Quetelet also founded anthropometry, a pseudoscience that correlated physical features with racial and psychological traits. Quetelet’s theories laid the foundation for phrenology and, as you might have guessed, eugenics. 

Incredibly, even Quetelet never intended BMI to be used as a measure of individual body fat or health. Given that he was also a statistician, he believed his tool was perfect for populations, not people—a certain type of people, that is. 

In the early 20th century, life insurance companies began using height and weight charts based on Quetelet’s index (the original name for BMI). Doctors began referencing the index in the 1950s as part of their diagnoses. Then Ancel Keys renamed it BMI in the 1970s; unsurprisingly, his research also skewed white. As with Quetelet, Keys believed white men determined the “ideal” height and weight. 

Adele Jackson-Gibson sums this awful history up: 

Around 170 years ago, a white guy in Belgium, who was never interested in health to begin with, came up with a ratio that years later was adopted by health experts to decide whether or not to treat or insure a person — a ratio that insurance companies and doctors still use today. It's the ratio we still use to discriminate against others and harshly judge ourselves. This is the ratio that we are all told to be concerned about because body fat is supposedly killing us… But this is not the truth.

Measuring health based on ideal white bodies is a recurring theme. Different BMIs work for different populations, which is actually what Quetelet was suggesting in the first place, leaving the “ideal” part aside. But we’re a culture obsessed with looks, which has biased not only popular society but health care as well. 

The circle is vicious: while obesity causes the physiological markers of stress, so does weight stigmatism, such as being told it’s your fault for being fat and dying from Covid and, oh, you wouldn’t be so fat if you buy my supplements. Conspiritualists are fueled by fear as well as ignorance. 

Obesity is a complex issue, but one thing is certain: conspiritualists are not taking into account the biased history of weight measurement, the reasons why certain populations are more likely to be obese and less likely to receive adequate healthcare, or the fact that many autoimmune diseases are not the results of bad habits or unhealthy lifestyles. Complexity isn’t in the cards for supplement shills. It’s too bad nothing of value is.