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

People with extra weight — those that have a BMI of at least 30 — are at a greater risk of falling severely ill from COVID-19.
People with extra weight — those that have a BMI of at least 30 — are at a greater risk of falling severely ill from COVID-19.

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 stigmasin 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 is the host of Weekend Edition Sunday and one of the hosts of NPR's morning news podcast Up First. She is infamous in the IT department of NPR for losing laptops to bullets, hurricanes, and bomb blasts.