Why people with obesity need priority access to the COVID-19 vaccine

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Sean Wharton is the medical director of the Wharton Medical Clinic, a community based internal medicine weight management and diabetes clinic, and an adjunct professor at McMaster University and York University.

Several provinces are prioritizing people with obesity for the next stages of their COVID-19 vaccine rollouts. Ontario, Alberta and Manitoba are now offering priority access, and other provinces might follow. As an internal medicine doctor, I believe this is an important step toward supporting the eight million Canadians living with the disease. However, these announcements bring to light the bias and stigma towards obesity, which must be addressed to ensure those in need are not shamed into avoiding getting the vaccine early.

Priority access to the vaccine for people with obesity is giving rise to mixed feelings in the U.S. Some people who are eligible have been reluctant to get the vaccine because of stigma. Comments have circulated on social media saying people with obesity don’t deserve vaccine prioritization and blaming them for their elevated weight. These conversations are also happening here in Canada. I think we can do better to help people living with obesity so they feel comfortable with this prioritization and take care of their health.

Obesity is a complex, chronic medical condition, just like diabetes or heart disease, that is caused by a variety of genetic and medical factors. It is not purely about weight and managing it is not simply a matter of willpower, diet or exercise. Our genetics, brain chemistry, medical conditions, socioeconomic status and other factors are all at play. But most Canadians do not understand the condition and many subscribe to the incorrect notion that those living with obesity are making a choice. This is as harmful as it is misguided.

Recent analysis, which includes data from 75 studies, indicates that individuals living with obesity are at increased risk for COVID-19 infection, hospitalization, ICU admission and death. Just like those with other chronic diseases, they need priority vaccination.

The rollout announcement from the Government of Ontario listed those with a BMI (body mass index) of more than 40 for vaccine prioritization. BMI is an imperfect indicator of health, but it is an easy calculation and can be used to predict complications. A large-scale research study assessed a medical database and determined that only 5 per cent of people with a BMI greater than 40 do not have obesity related medical conditions. The pandemic has pushed us to move quickly, and experts have had to draw a line in the sand with the BMI qualification to ensure those most at risk would be protected.

Yet, because there is an inherent stigma attached to those living with obesity, even rightly prioritizing those people inadvertently opens up opportunities for fat shaming. Bullying and stigma may lead people who actually need to be protected to avoid getting their vaccine because they are ashamed. This is a horrible outcome stemming from decades of cultural biases and misconceptions. Why should it be okay for people living with diabetes, asthma or other chronic conditions to line up to get their shot, but someone living with the chronic disease of obesity will get shamed?

Fifty years ago, if you said you had depression, people would tell you to cheer up. Do better. Be happy. But we now know chronic depression requires a holistic and scientific approach, just like obesity. The stigma and lack of access to care that was attached to mental health in the 1970s is what people living with obesity are facing today.

It takes courage to focus on your health and take action. I strongly urge all those eligible to, please, go get vaccinated. As Canadians, we need to support our fellow citizens.

At the end of the day, after decades of stigmatization and a lack of support for people with obesity, this disease being recognized and prioritized by these provinces is a massive win. While I encourage other provinces to take the same route, I also recommend they take this opportunity to reverse some the bias against people living with obesity by highlighting that it is a disease and not a failure of will power. This recognition will let people with obesity know that they are worthy of this care. Obesity is about health, not just weight, and we need to address biases surrounding the condition out of the gate or risk vaccine hesitancy.

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