Turning Obstacles into Opportunities: Representing YOUR Patients during COVID-19

by Christopher D. Still, DO, FACN, FACP

Co-clinical Editor of Bariatric Times; Medical Director for the Center for Nutrition and Weight Management, and Director for Geisinger Obesity Research Institute at Geisinger Medical Center in Danville, Pennsylvania.

Dear Colleagues,

Like most people throughout the past year, the topic of COVID-19 continues to dominate media headlines, healthcare discussion, and research, and for many of us, has changed our way of life forever. In our profession, we saw a tremendous impact to our patients, as obesity quickly became one of the most prevalent risk factors for severe cases of COVID-19. We all know there is no “magic bullet” for treating obesity. So that greatly affected our patients’ desperate need to address their weight and our profession, because at the heart of it, we knew our patients were at a greater risk for a severe case of COVID-19 if they contracted it. Additionally, we asked ourselves if this connection between obesity and COVID-19 would finally give obesity the legitimacy it deserves among our peers, the greater healthcare system, and even the public.

The Current State of COVID-19 and Obesity

Fast forward to today, and we now have a vaccine approved by the United States (US) Food and Drug Administration (FDA) for COVID-19. Furthermore, the US Centers for Disease Control and Prevention (CDC) has determined that individuals with obesity fall into the higher-risk 1B tier, thereby permitting early vaccination, which is highly appropriate in my opinion. Unfortunately, many people do not agree, which is a clear sign that weight bias still very much influences our beliefs around the seriousness and legitimacy of obesity as a chronic, lifelong disease.

Since the availability of the COVID-19 vaccine, there have been many accounts of stigmatization and shaming of people with obesity. This shaming further perpetuates the false narrative that “obesity is a personal choice or lack of willpower.” Even more damaging, we are now seeing that narrative mold into “people with obesity do not deserve to be included in the 1B tier for early vaccination.” 

People with Obesity Need to be Prioritized

In the first meta-analysis of its kind, published in August 2020 in Obesity Reviews, an international team of researchers pooled data from scores of peer-reviewed papers capturing 399,000 patients.¹ They found that people with obesity who contracted COVID-19 were 113 percent more likely than people of healthy weight to be hospitalized, 74 percent more likely to be admitted to an intensive care unit (ICU), and 48 percent more likely to die. These tragic numbers are being driven by the major biological factors associated with obesity—including impaired immunity, chronic inflammation, and blood that’s prone to clot, all of which can worsen COVID-19. All available evidence, including that from the CDC, indicates the following:

People with obesity might have a higher risk of severe illness from COVID-19

People with obesity and severe obesity are more likely to be admitted to the hospital to require care in an ICU and to be placed on a ventilator

People with obesity who are younger than 60 years of age are two times more likely to be hospitalized from COVID-19-related complications

The increased risk for adverse outcomes of individuals with obesity is independent of, but additive to, associated conditions, such as Type 2 diabetes and heart disease

People with two or more conditions on the CDC list of conditions are at higher risk in Phase 1 for vaccine allocation in recognition of the cumulative effect of these conditions on risk.

We Need to SPEAK UP for Our Patients

Weight bias is nothing new for people with obesity; however, the notion that people with obesity do not deserve to be prioritized for the COVID-19 vaccine, just like any other high-risk population, is new territory. Another misconception, and an “opportunity” to set the record straight, is regarding the effectiveness of the COVID-19 vaccine in people with obesity. Obesity Action Coalition (OAC) President and CEO, Joe Nadglowski, emphasized the importance of relying on data, not speculation.

“We are glad to see this data, providing reassurance that this vaccine appears to offer equally good protection for people whether or not they have obesity,” Nadglowski said. “Speculation that this would not be the case was unhelpful. This reminds us that we need to rely on facts and data in dealing with obesity. Because often, obesity is not what we think it is.”

A new perspective paper by Matthew Townsend, MD; Theodore Kyle, RPh, MBA; and Fatima Cody Stanford, MD, MPH, explains why this is an ethical problem. The article, recently published in Obesity, sums it up perfectly: “Speculation about variable effectiveness of COVID‐19 vaccines in obesity likely increases vaccine hesitancy among individuals with obesity, who face not only a higher risk of severe outcomes from COVID‐19 but also weight stigma, which reduces healthcare engagement at baseline. Clinical and public health messaging must be data‐driven, transparent, and sensitive to these biological and sociological vulnerabilities.”²

You’re probably asking yourself, “What can I do?” COVID-19 has presented us with another “opportunity” to speak up and educate the public on the topic of obesity and weight bias. The OAC has been combating weight bias for more than 15 years and has recently released a new public awareness campaign, Stop Weight Bias, that aims to educate the public about bias and the damaging effects of it. You can learn more about it at StopWeightBias.com. On this site, you can also report instances of weight bias, such as those stating people with obesity do not need to be prioritized for the COVID-19 vaccine, directly on the site by clicking the “Resources” tab and then choosing “Report Weight Bias.” There are a host of other actions you can take as well, such as donating to this very important effort.

Conclusion

COVID-19 presented the world, especially the healthcare community, with a plethora of hurdles that we haven’t had to navigate in decades. For those of us specializing in obesity treatment, COVID-19 presented us with a host of new issues to help our patients navigate. Unfortunately, in our world of obesity treatment, we’re fighting a constant battle of weight bias, which infiltrates every facet of life for someone with obesity. It is up to us, our society partners, and patient groups, such as the OAC, to stand up for people with obesity and fight with them in this battle against COVID-19 and weight bias. Until we do that, we will always struggle with the legitimacy of obesity as a disease and the lack of respect for the individual affected by it.

Be well,

Christopher D. Still, DO, FACN, FACP

References

1. Popkin BM, Du S, Green WD, et al. Individuals with obesity and COVID-19: a global perspective on the epidemiology and biological relationships. Obes Rev. 2020;21(11):e13128.
2. Townsend MJ, Kyle TK, Stanford FC. Obesity (Silver Spring). 2021 Jan 28. Online ahead of print.

Special thanks to Theodore Kyle, RPh, MBA, Founder of ConscienHealth, OAC National Board Member, and James Zervios, OAC Vice President of Marketing and Communications, for their assistance in writing this month’s message.  

Tags: Dr. Christopher Still, Editorial Message

Category: Editorial Message, Past Articles