Blog by Ximena Ramos Salas, PhD, Director of Research and Policy, Obesity Canada

At the beginning of the COVID-19 pandemic, Obesity Canada and its partners made a call to action to consider the intersection of weight bias, obesity stigma and COVID-19 and how this may impact health and social outcomes for Canadians. We called on health care professionals and policy makers to consider how the social determinants of health, vulnerability to infectious diseases such as COVID-19, and obesity stigma should be considered in public health interventions. 

As the pandemic evolved, research emerged indicating that obesity like other chronic illnesses can increase the risk for COVID-19 illness severity, hospitalization, and mortality. Over the summer of 2020, Obesity Canada reached out to Federal, Provincial and Territorial public health policy makers to advocate for the recognition of obesity as a chronic disease based on the recently published Clinical Practice Guidelines and for the inclusion of obesity as a risk factor for COVID illness and severity. We started to see an impact of our advocacy efforts when the Public Health Agency of Canada listed obesity as a risk factor for more severe COVID-19 illness and outcomes. We were particularly pleased to see the Public Health Agency of Canada using person-first language in their directive. 

Obesity Canada and its partners also prioritized important research questions about obesity, weight stigma, and COVID-19 and called for more clinical data to understand the mechanisms by which obesity increases COVID-19 illness and outcomes. We recognize, for example, that epidemiological studies use BMI as a proxy measure for obesity and that this is not an appropriate diagnostic tool. In fact, anthropometric measures such as BMI or Waist Circumference may both under- and over-diagnose individuals with obesity.   This is why the Adult Obesity Canadian Clinical Practice Guidelines recommend the use of BMI and other anthropometric tools such as waist circumference (WC) only as screening tools.

In the guidelines, we present a new obesity definition (excess or abnormal adiposity that impairs health) and ask health care professionals to conduct a full medical assessment to determine if and how a person’s excess or abnormal body fat is impairing their health.  

Unfortunately, many people living with obesity have not been diagnosed with obesity using adequate medical assessments, due in part to the lack of recognition of obesity as a chronic disease in the health system. So, until we get to a point in the health system where people with obesity are diagnosed medically, BMI is the only population level tool we have to identify individuals that could be potentially at risk for COVID-19 illness and severity. 

Scientists should also consider factors beyond BMI, such as inflammatory and metabolic factors to help us understand how obesity mediates COVID-19 outcomes. More importantly, we called on scientists looking for Coronavirus treatments to consider how they are including needs of high-risk groups, including people with obesity.

Since the COVID-19 vaccinations have become available, Obesity Canada has called on public health policy makers to prioritize high-risk groups, including people living with obesity. We were pleased to see that some provinces have included people with a BMI > 40 Kg/m2 in the prioritization lists for COVID-19 vaccination. Since the COVID-19 vaccination strategy is a population level strategy, BMI can be an easy way to try and prioritize people living with obesity. 

Unfortunately, due to the lack of understanding of obesity as a chronic disease in the health system and in the public, we have seen a backlash against people with obesity for being prioritized for the COVID-19 vaccination. This lack of understanding of obesity as a chronic disease is due in part to the pervasive weight bias and stigma that exists in our society. 

The science is clear. People living with chronic illnesses, including obesity, should be prioritized for COVID-19 vaccinations. We must challenge weight bias and confront it when we see it in our society.  We need everyone to challenge weight bias and stigma. Obesity Canada is thankful to journalists who have focused on science and educated the public about weight bias and obesity as a chronic disease.  

We are also thankful to patient advocates and healthcare professionals for standing up and sharing their voices to reduce weight bias during the COVID-19 pandemic.  The pandemic has shown that we all need to stand together and support each other. Let’s have more empathy and educate ourselves about obesity. Rather than making assumptions and stigmatizing people for their condition, illness or body size and shape.

Obesity is a chronic disease like any other chronic disease. We will continue to advocate for people living with obesity and reduce health inequalities.  Please share this blog post and infographic to help us educate the public about the science of obesity, COVID-19 illness severity, and vaccinations.