Patty Nece hasn’t been inside a retail store for an entire year.
Even though most Virginia businesses reopened by July and grocery stores remained opened throughout the pandemic, the 62-year-old hasn’t dared to step inside one since last March, as her obesity puts her at risk for severe COVID-19.
Because of her disease, she’s eligible to get the vaccine and has an appointment for her first dose on Wednesday. While she’s looking forward to getting vaccinated, she’s also disappointed some Americans have criticized people with obesity who are prioritized to get the vaccine.
“It displays a misunderstanding … weight isn’t always within your control,” said Nece, who is also the chairwoman of the Obesity Action Coalition. “Like many diseases, there’s personal responsibility involved but that’s not the end. The mantra of eat less and move more – which I’ve heard my entire life – isn’t the answer.”
In one instance, a news anchor for WTTG-TV in Washington, D.C., sent a tweet criticizing health officials for prioritizing obesity patients for the vaccine.
“I’m annoyed obese people of all ages get priority vaccine access before all essential workers,” Blake McCoy said in the since-deleted tweet. “Vaccinate all essential workers. Then obese.”
The local station told the New York Daily News McCoy was “suspended pending further review” after deleting the offensive tweet and posting an apology on Twitter, but health experts say it’s another example of how weight bias permeates the health system and American society.
Obesity and COVID-19
Roughly 40% of adult Americans have obesity, according to Centers for Disease Control and Prevention data from 2018. Studies have shown people with obesity are more likely to have worse outcomes from COVID-19 than others with a lower body mass index (BMI).
Researchers at the University of North Carolina at Chapel Hill found people with a BMI above 30 had a 113% higher risk for hospitalization, a 74% higher risk for ICU admission and a 48% higher risk of death, according to a study published in August 2020 in Obesity Reviews.
At first, health experts believed people with obesity were more at risk for severe COVID-19 because the disease also is associated with numerous underlying risk factors including hypertension, heart disease, type 2 diabetes and chronic kidney and liver disease.
But after controlling for those factors, researchers found people with obesity were still at higher risk for COVID-19, said Dr. Rekha Kumar, medical director of the American Board of Obesity Medicine and associate professor of clinical medicine at Weill Cornell Medicine. This may be partly due to the excess fat tissue producing more inflammation, she said.
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“People’s bodies are mounting such a severe inflammatory response (to COVID-19), and that response is already existing at a baseline in obesity,” Kumar said. “So, when you add another stimulus, they’re getting even sicker.”
Some patients also may suffer from obesity hypoventilation syndrome, a breathing disorder that causes someone to have too much carbon dioxide and too little oxygen in the blood, according to the National Heart, Lung and Blood Institute.
“It’s not from carrying the weight,” said Dr. Ethan Lazarus, president-elect of the Obesity Medicine Association. “Their lungs are restricted so they’re not able to expand to get the oxygen they need.” This puts them at further risk for COVID-19 complications.
Patients with obesity also have an impaired immune system, health experts say, which not only makes them more prone to infectious diseases but also makes it harder to fight them off.
Obesity can change the metabolic state of immune cells and how they function, said Dr. Nancie MacIver, associate professor at Duke University School of Medicine. The excess inflammation may be an indication the immune system is dysfunctional.
Obesity and the COVID vaccine
Obesity patients’ altered immune system has led experts to worry about their response to the COVID-19 vaccine, especially as past studies have suggested they may not respond as well to influenza vaccines.
Researchers at UNC Chapel Hill found that among vaccinated individuals, nearly 10% of patients with obesity were infected with the flu compared to about 5% of participants with a lower BMI, according to a 2017 study published in the International Journal of Obesity.
But health experts say obesity patients shouldn’t be discouraged, and urge them to get the COVID-19 vaccine when it is available to them.
“People should understand the difference between not effective and reduced efficacy,” Kumar said. “Even if a vaccine works less, it’s still better than somebody becoming critically ill in an ICU.”
Nece worries, as a patient with obesity, others like her may delay care during the pandemic due to decades of weight bias in the health care system.
Obesity Awareness Week and weight bias
Weight bias in the medical setting manifests itself in a myriad of ways, from having ill-fitted gowns and weighing patients in public, to misdiagnosing a life-threatening illness due to a doctor’s inability to look past a person’s excess weight.
After years of weight lecturing and bad experiences at the doctor’s offices, many patients internalize that bias and avoid treatment or preventative care altogether, said James Zervios, vice president of marketing and communications at the Obesity Action Coalition.
Nece delayed her mammogram by 15 years to avoid the stress and embarrassment of a doctor’s visit.
“You get tired of dealing with it," she said. "You get tired of the shame and blame that gets heaped on you and it doesn’t help.”
But during Obesity Care Week, which ends Saturday, advocates like Zervios and Nece want to spread awareness that obesity is not just a behavioral disease and can be influenced by genetics, hormones and even medications.
They also urge those who are suffering with obesity to seek help from health care providers despite weight bias, especially during the pandemic.
“We encourage people to remember that they are worth the care that they deserve and don’t take that kind of bias and deal with it,” Zervios said. “Everybody deserves to be treated with dignity and respect.”
Follow Adrianna Rodriguez on Twitter: @AdriannaUSAT.
Health and patient safety coverage at USA TODAY is made possible in part by a grant from the Masimo Foundation for Ethics, Innovation and Competition in Healthcare. The Masimo Foundation does not provide editorial input.