Obesity Specialist Says BMI Is A 'Good Measure' For Vaccine Priority Group : Coronavirus Updates As cities offer vaccine appointments for people with a BMI of at least 30 — the medical benchmark for obesity — Dr. Fatima Stanford pushes back against the shame faced by those with the disease.

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

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Obesity is one of the most prevalent chronic diseases in the United States, so much so that many cities consider it an underlying condition and have opened COVID-19 vaccine appointments to those with a body mass index of 30 or higher, those technically obese. Dr. Fatima Cody Stanford is an obesity specialist at Harvard Medical School and Massachusetts General Hospital and joins us now from Boston to talk about obesity and COVID.

Welcome to the program.

FATIMA CODY STANFORD: Thanks so much for having me. It's a delight to be here.

GARCIA-NAVARRO: What do you make of the decision to qualify people with a high BMI as an underlying condition?

STANFORD: So, actually, I think that overall it's a good measure. What we have seen with obesity as a disease is that it has been shown to be one of the greatest risk factors for both morbidity - meaning sickness associated with the disease of COVID - and mortality. And the reason why we see this interplay, Lulu, is because 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. Now, BMI by itself is an arbitrary cutoff, but it is a decent population-wide measure. 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.

GARCIA-NAVARRO: I mean, essentially, what you're saying is that the medical estimation is that it is quite dangerous that people with obesity not get the vaccine.

STANFORD: Exactly. And, you know, Lulu, it's very interesting because we've also seen a dramatic rise in the number of patients that are seeking care for us at our weight center due to people recognizing the high predisposition of patients with obesity to poor outcomes regarding COVID-19. So our waiting list right now, Lulu, at Mass General exceeds a thousand patients.

GARCIA-NAVARRO: So on the one hand, you're seeing more people want to try and address their obesity because of COVID.

STANFORD: Exactly.

GARCIA-NAVARRO: But we do live in a society that stigmatizes overweight or obese people. What are you seeing in regards to hesitancy for getting the vaccine among your patients?

STANFORD: Yeah, actually, Lulu, I'm going to change one of your words. So I never use the word obese because that actually promotes stigma. Obese is a label, and obesity as a disease. So we want to make sure that we use the right language to decrease weight bias and stigma in our population. Now, getting back to your question about this idea of stigma and bias, unfortunately, we have these preconceived notions because we haven't recognized obesity for the disease that it is that people that have obesity did this to themselves. And that is indeed a fallacy. We do know that the most powerful organ that's regulating weight status is the brain. And the brain tells us not only how much to eat, Lulu. It tells us how much to store. And so there are many different factors that are playing a role in how one's brain decides to do that work. And when we recognize the myriad of factors, maybe this can begin to change the high prevalence of weight bias and stigma that we have here in the United States.

GARCIA-NAVARRO: I mean, there is a guilt that goes along with getting the vaccine because you are overweight. It's about somehow being undeserving. I mean, I've had serious weight gain during this pandemic. And it feels shameful. And critiques I've heard about, including people with obesity in sort of the tiers for the vaccine, is that it is, quote, "like a reward for being fat," essentially.

STANFORD: Yeah, and that is absolutely absurd. I know I usually don't use words like that, but the idea that we would penalize any patients for having this disease of obesity is really indeed problematic. Should I feel shame as a health care provider that I am now fully vaccinated? Should persons that are advanced in age - right? - over the age of 65 in certain states - should they feel shame in the fact that they're now advanced in age? Absolutely not. I think that we have to recognize that, obviously, 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. But this idea that - I think going back to the question that you - sort of a statement you made really goes back to the idea that obesity is a person's fault. And I want to undo that myth that obesity is not a person's fault. 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. 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.

GARCIA-NAVARRO: Dr. Fatima Cody Stanford is an obesity specialist at Harvard Medical School and Massachusetts General Hospital. Thank you very much.

STANFORD: Thank you.

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