Will obesity label turn some away from vaccination?

MGH doctor says it’s a disease that can (and should) be treated

BOSTON — To some, obesity may seem a controversial reason to get a ticket to the front of the COVID-19 vaccination line. But to Dr. Fatima Cody Stanford, it makes perfect sense.

“We do know that patients with obesity are getting sicker and they’re dying up to three-to-four times more than those that don’t have this disease,” said Dr. Stanford, an obesity medicine specialist at Mass. General Hospital.

“Don’t see this as a negative thing, it is a disease, it warrants treatment. We know that it’s a high-risk factor for sickness and death from COVID, so why not get the vaccine for these individuals.”

But apparently, some individuals with obesity are having a difficult time coming face-to-face with a diagnosis they’ve tried hard to forget.

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Dr. Nirit Pisano, a clinical psychologist, noticed a certain kind of traffic increase on social media and heard from clients in her private practice soon after some states included obesity as an inclusionary criterion.

“What we saw is people talking about their fatness, a lot of body-shaming happening in both directions, people feeling really targeted for the fact they are now eligible based on BMI,” said Dr. Pisano, who also works as chief psychology officer at Cognovi Labs, a firm which tracks emotional components to widespread conversations to predict and alter behavior.

“And then on the flip side, people really kind of ranting. A lot of outrage around those who are now eligible for this reason. So we saw a huge increase in anger and disgust happening around BMI as an underlying condition [and] as a reason for eligibility for vaccination.”

Dr. Pisano said this is concerning because it could impact motivation to get vaccinated.

“There is a way to deliver this message differently so you can actually motivate people and inspire them to go get vaccinated,” she said. “Or encourage them or support them as you are pursuing their [physical] health, you’re also supporting their mental well-being.”

She said some of her clients got unsolicited letters about their obesity. Others logged on to patient portals and found their ‘obese’ BMIs.

“There’s no explanation,” Dr. Pisano said. “There’s no kind of indication of what this measure even is. It’s just sort of sitting there as a category, as a label. It’s really shattering. It’s shattering for a lot of these people. They’ve worked incredibly hard to expand beyond this label, beyond this source of bullying.”

Emily Duke is one of those who faced the BMI truth recently in order to get vaccinated.

The New York-based writer and comedian spent her teen and young adult years in an up-and-down battle with her weight. Today, she calls herself a ‘fat activist,’ who accepts her body but also exercises regularly, does yoga and eats a healthful diet. Nonetheless, her BMI is over 30.

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“As soon as I heard obesity was going to be counted, you know, I was fairly certain I would qualify. Just based on my clothing size and what I look like,” Duke said. “It was not a number that I cared to know. I wish my doctor had reached out and said, ‘Hey good news you qualify!’ and not made me look at the number. I don’t like knowing it.”

Duke’s fear was that seeing the BMI might coax her into a dieting spiral, which would mean, she said, 300 calories a day.

“When you actually have to confront objectively data like, ‘hey, I am obese,’ like that is a word that is so loaded for me,” Duke said. “So much of my eating disorder centered around doctors and the BMI. For me, it was very emotional and very loaded.”

So loaded, in fact, that while Duke was willing to tell others she qualified for the COVID-19 vaccination, she didn’t initially tell anyone why.

“Which is very ironic for somebody who is a very vocal fat activist,” she said. “Who has a lot of jokes in my stand up about my size. You know it’s very much something that I’m comfortable talking about. But to actually say it with the word obesity? It was really emotional, and I wasn’t ready to tell people.”

Finally, she told the world in an essay written for Slate: “I Am Fat. To Get The Vaccine I Had To Say I’m Obese.”

In it, Duke wrote that even though she may be heavier now than before, she’s healthier.

“When I say that I’m healthier now than if I had a dead-center BMI, I mean my mental health as a component of that,” she said. “I am healthier, and I treat my body better than when I get fixated on diets. It’s like alcoholics can’t drink, I can’t diet; it’s just not something that’s good for me.”

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