Obesity Specialist Says BMI Is A 'Good Measure' For Vaccine Priority Group

Feb 28, 2021
Originally published on February 28, 2021 7:35 am

Several cities across the country that count obesity as an underlying condition have opened COVID-19 vaccine appointments to people with a body mass index of 30 or higher — the medical benchmark for obesity.

While BMI isn't a foolproof standard by which to assess potential health risk factors, obesity medicine physician Dr. Fatima Stanford told NPR, "overall, it's a good measure" in this case.

It would be dangerous for people with obesity to not get vaccinated, she said, given that obesity is a risk factor for both severe illness and hospitalization from COVID-19.

"We're talking about two inflammatory conditions. We have chronic inflammation associated with obesity, the disease, not playing well with the acute inflammatory process of COVID-19," said Stanford, who works at Harvard Medical School and Massachusetts General Hospital.

More than 42% of adults in the U.S. have obesity, one of the country's most prevalent chronic diseases, according to the Centers for Disease Control and Prevention. Obesity is more common in Black people, and slightly more common in Hispanic people, compared to white people. Black and Hispanic people have been suffering from COVID-19 at disproportionately higher rates.

"BMI by itself is an arbitrary cutoff, but it's a decent population-wide measure," Stanford said. "It's important though if you're talking with physicians and their work with individual patients to not use BMI as the sole cutoff for how we navigate treatment strategies for patients that have this disease of obesity."

As awareness grows about the negative health outcomes from COVID-19 for people with excess weight, Stanford said she's seeing an uptick in patients at her hospital who are looking for ways to address their own obesity.

The brain is the body's biggest decision-maker between all the body's organs in regulating weight, she said.

"The brain not only tells us how much to eat," she said, "it tells us how much to store. So there are many different factors that are playing a role in how one's brain decides to do that work."

It's one reason why she distinguishes between the terms "obesity" and "obese," because of blame and bias attached to the latter.

"I never use the word obese because that actually promotes stigma. Obese is a label and obesity is a disease," she said.

Writer Emma Specter explored such stigmas in an opinion essay for Vogue last week, titled, "Millions of Americans Qualify for the COVID-19 Vaccine Based on BMI. Why Should We Apologize for It?" Stanford agreed with Specter's assessment that doctors are among the "worst groups" when it comes to perpetuating "fat shaming."

Those attitudes are part of preconceptions, Stanford told NPR, that promote the idea that people with obesity "did this to themselves — and that is indeed a fallacy."

"Are there things that that person might do that may have contributed? Absolutely. But are there things that may have contributed to that person having a particular cancer, or having high blood pressure, or having other disease processes? Absolutely," she said. "We don't shame people in that same way for any other disease process like we do for obesity and I think it has to stop."

Instead, she suggested that obesity should be viewed as yet another risk factor for COVID-19 illness, just as other underlying health conditions and older age.

"We are going to want everyone to get vaccinated at some point, but why not allow those that have higher risk factors get access to the vaccine as soon as they can?"

Peter Breslow and Hadeel Al-Shalchi produced and edited this interview for broadcast.

Copyright 2021 NPR. To see more, visit https://www.npr.org.

LULU GARCIA-NAVARRO, HOST:

Obesity is one of the most prevalent chronic diseases in the United States, so much so that many cities consider it an underlying condition and have opened COVID-19 vaccine appointments to those with a body mass index of 30 or higher, those technically obese. Dr. Fatima Cody Stanford is an obesity specialist at Harvard Medical School and Massachusetts General Hospital and joins us now from Boston to talk about obesity and COVID.

Welcome to the program.

FATIMA CODY STANFORD: Thanks so much for having me. It's a delight to be here.

GARCIA-NAVARRO: What do you make of the decision to qualify people with a high BMI as an underlying condition?

STANFORD: So, actually, I think that overall it's a good measure. What we have seen with obesity as a disease is that it has been shown to be one of the greatest risk factors for both morbidity - meaning sickness associated with the disease of COVID - and mortality. And the reason why we see this interplay, Lulu, is because we're talking about two inflammatory conditions. We have chronic inflammation associated with obesity the disease not playing well with the acute inflammatory process of COVID-19. Now, BMI by itself is an arbitrary cutoff, but it is a decent population-wide measure. It's important, though, if you're talking with physicians and their work with individual patients to not use BMI as the sole cutoff for how we navigate treatment strategies for patients that have this disease of obesity.

GARCIA-NAVARRO: I mean, essentially, what you're saying is that the medical estimation is that it is quite dangerous that people with obesity not get the vaccine.

STANFORD: Exactly. And, you know, Lulu, it's very interesting because we've also seen a dramatic rise in the number of patients that are seeking care for us at our weight center due to people recognizing the high predisposition of patients with obesity to poor outcomes regarding COVID-19. So our waiting list right now, Lulu, at Mass General exceeds a thousand patients.

GARCIA-NAVARRO: So on the one hand, you're seeing more people want to try and address their obesity because of COVID.

STANFORD: Exactly.

GARCIA-NAVARRO: But we do live in a society that stigmatizes overweight or obese people. What are you seeing in regards to hesitancy for getting the vaccine among your patients?

STANFORD: Yeah, actually, Lulu, I'm going to change one of your words. So I never use the word obese because that actually promotes stigma. Obese is a label, and obesity as a disease. So we want to make sure that we use the right language to decrease weight bias and stigma in our population. Now, getting back to your question about this idea of stigma and bias, unfortunately, we have these preconceived notions because we haven't recognized obesity for the disease that it is that people that have obesity did this to themselves. And that is indeed a fallacy. We do know that the most powerful organ that's regulating weight status is the brain. And the brain tells us not only how much to eat, Lulu. It tells us how much to store. And so there are many different factors that are playing a role in how one's brain decides to do that work. And when we recognize the myriad of factors, maybe this can begin to change the high prevalence of weight bias and stigma that we have here in the United States.

GARCIA-NAVARRO: I mean, there is a guilt that goes along with getting the vaccine because you are overweight. It's about somehow being undeserving. I mean, I've had serious weight gain during this pandemic. And it feels shameful. And critiques I've heard about, including people with obesity in sort of the tiers for the vaccine, is that it is, quote, "like a reward for being fat," essentially.

STANFORD: Yeah, and that is absolutely absurd. I know I usually don't use words like that, but the idea that we would penalize any patients for having this disease of obesity is really indeed problematic. Should I feel shame as a health care provider that I am now fully vaccinated? Should persons that are advanced in age - right? - over the age of 65 in certain states - should they feel shame in the fact that they're now advanced in age? Absolutely not. I think that we have to recognize that, obviously, we are going to want everyone to get vaccinated at some point. But why not allow those that have higher-risk factors get access to the vaccine as soon as they can. But this idea that - I think going back to the question that you - sort of a statement you made really goes back to the idea that obesity is a person's fault. And I want to undo that myth that obesity is not a person's fault. Are there things that that person might do that may have contributed? Absolutely. But are there things that may have contributed to that person having a particular cancer or having high blood pressure or having other disease processes? Absolutely. We don't shame people in that same way for any other disease process like we do for obesity. And I think it has to stop.

GARCIA-NAVARRO: Dr. Fatima Cody Stanford is an obesity specialist at Harvard Medical School and Massachusetts General Hospital. Thank you very much.

STANFORD: Thank you. Transcript provided by NPR, Copyright NPR.