Covid-19 Does Not Discriminate by Body Weight

She is the host of Food Psych Podcast.To date, the most plausible research pointing to higher BMI as a risk factor includes three preliminary reports that have been released since April 8: a Centers for Disease Control and Prevention report with descriptive statistics on people who’ve been hospitalized for Covid-19, showing that 48 percent of those with available BMI data are in the “obese” category (a slightly higher percentage than the 42 percent in the US as a whole); a small French study that found people with a BMI of 35 and above are at higher risk of being put on a ventilator; and a letter to the editor of the journal Clinical Infectious Diseases from researchers at NYU’s School of Medicine (including one of the authors of last week’s preprint), sharing a preliminary finding that people with a BMI of 30 or above appear to be at higher risk for hospitalization and intensive-care admission, if they’re less than 60 years old. Now, those health disparities are on full display in the Covid-19 pandemic, which is disproportionately impacting black communities—not because of biology, but because of systemic inequalities like higher rates of exposure to the virus and less access to medical care.The fact that researchers have been pointing to body size as a risk factor for weeks now, even in the absence of much evidence, is a clear example of how weight stigma gets enacted in science.As it happens, that recent preprint from NYU did take race into account, in its finding that having a very high BMI was a major risk factor for hospitalization. The French study of 124 patients does control for diabetes and hypertension, as well as dyslipidemia, but not for other risk factors—even though in the study’s introduction, the authors themselves acknowledge that cardiovascular disease, chronic respiratory disease, and cancer are also likely to raise the risk of Covid-19.Moreover, these reports all fail to control for the particular ways in which clinicians’ biases and beliefs about body size are likely to be influencing Covid-19 care decisions for higher-weight people. Early US reports from public health departments also seemed to indicate that higher BMI isn’t a risk factor: In New York State, for example, “obesity” hasn’t been on the state’s list of the top 10 preexisting conditions associated with Covid-19 fatality as of this writing. “Consider the questions of whether high-BMI folks are at increased risk for contracting Covid-19—and if they do contract it, whether they have poorer outcomes,” says Lindo Bacon, a weight-science researcher and author of the books Health at Every Size and Body Respect. “There's an extra mental and emotional toll that it takes,” Cox says.Instead of trumpeting the supposed risks of high BMI and adding to the already damaging impact of weight stigma, researchers need to be asking deeper questions, and public health officials and journalists need to report on the science in more nuanced and sensitive ways.