Are Fat Cells Really a Covid Risk Factor?
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Welcome back to Food Psych Weekly, the newsletter where I answer your questions about intuitive eating, Health At Every Size, disordered-eating recovery, and how to survive in diet culture without falling into its traps.
This week I’m back for a second time to answer a rare bonus question, since a bunch of people have asked about this topic. The weekly missives are currently scheduled out weeks in advance as I prepare for my maternity leave, but I wanted to make sure to address this question as soon as possible, since I know it’s probably on a lot of people’s minds thanks to recent media coverage.
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The question is from a reader named Eliza, who writes:
I just read this article in The New York Times that claims that Covid-19 is more dangerous for people in larger bodies because of how it attacks fat tissues. Here’s the article [Content Warning: weight numbers, weight-stigmatizing language].
It made me feel scared and overwhelmed as a person in a larger body, once again reading that just the size of my body alone is a risk factor.
I know you’ve done a lot of work to fact check and challenge these type of articles. I’m curious if you’ve read it and what your thoughts are?
It can be so hard to fully embrace the principles of HAES when there are so many articles and so much research out there that continually concludes that being in a larger body is unhealthy and dangerous.
Thanks!
Thanks for this great question, Eliza, and before I answer, here’s my standard disclaimer:
These answers are for informational and educational purposes only, aren’t a substitute for individual medical or mental health advice, and don’t constitute a provider-patient relationship.
First of all, I just want to offer compassion for how you’re feeling in response to this article, and to say that you’re definitely not alone. These kinds of media reports are incredibly upsetting to many people in larger bodies—a group that’s already been unjustly stigmatized throughout this pandemic—and I wish journalists would think about the unintended consequences of these pieces and reconsider publishing them.
To me this article is a particularly egregious example, because it uncritically reports on one study without noting its significant limitations (more on those below) and extrapolates from it broadly in a way that feels premature at best. Unfortunately, this story has now been picked up by a number of smaller media outlets around the world, many of which are running their own similarly uncritical versions of it.
But instead of focusing on the NYT article here, I want to go straight to the source and look at the study it’s reporting on. That’s often very telling when it comes to news reports like this—and in this particular case, looking at the study itself significantly undercuts the message of the article.
For those who want to read it (which I’d recommend doing with extreme caution or not at all if you’re recovering from disordered eating), here’s the full text of the study (CW: BMI numbers, weight-stigmatizing language). The first important thing to note is that it’s a preprint that hasn’t been peer reviewed, and it’s unclear where or whether it ever will be published. Many Covid-related preprints have been retracted throughout the pandemic, including several that were highly publicized before the retractions. Preprint research really shouldn’t be reported on as fact or used to guide clinical decisions (as the disclaimers on many preprint servers say), but in practice these warnings often get ignored when big media outlets write long pieces on preprint studies, with maybe one line urging caution in interpreting the results (as was the case in the NYT piece).
Even if the results of this particular preprint ultimately hold up under peer review, this study is TINY and should be viewed more as a pilot than anything else. The researchers don’t highlight that fact, but in combing through this very long manuscript it becomes evident that the study is only based on in vitro experiments in fat cells from three people, plus in vivo experiments from the autopsies of another eight people. That’s WAY too small a sample size to be anything other than perhaps a jumping-off point for future studies in much larger samples. Even the researchers acknowledge that limitation.
What’s more, seven of the eight autopsy participants were age 65 or older (the other one was 58), and most were in their 80s. We know that age is a major independent risk factor for severe Covid-19 outcomes, and yet the researchers don’t control for age when making pronouncements about the role of fat tissue in Covid. The same is true for other confounding variables like preexisting disease—diabetes, heart disease, etc.—which many of these participants had. To be fair, this study wasn’t really designed to control for those things; it simply looked at whether and to what extent Covid-19 was present in different types of fat cells. But by presenting these limited findings as though they might explain the supposed connection between higher weight and severe COVID-19, the researchers are making a cognitive leap that isn’t warranted given what we know about confounding variables like age and preexisting conditions.
Finally, I’m always wary of studies of fat cells for the simple fact that those cells come from *people* whose stress/inflammatory responses were inevitably shaped by the conditions of their lives (likely including weight stigma and other forms of discrimination, weight cycling, disordered eating, etc.), and yet researchers treat these disembodied cells as somehow more “objective” than studies in living human beings. Of course there are many things we can learn from cell studies, but I personally don’t think the (supposed) impact of fatness on health is one of those things, given the huge role that we know sociocultural factors play in determining outcomes for higher-weight people.
To me this is enough evidence to say let’s put this study's results aside for now (along with the uncritical media reports about the study) and focus on more important things, like access to vaccines and reducing weight stigma and racial inequities in care for Covid-19. I’ll be interested to follow this preprint to see if it makes it to publication, and I’ll continue to watch the science on weight/fatness and Covid. But to date I’ve still seen nothing to refute the point I’ve been making since early in the pandemic that weight stigma—including healthcare providers’ biases about body size that can lead to poorer-quality care for higher-weight Covid patients, as we also saw in the H1N1 pandemic—is a major, unappreciated risk factor that must be taken into account in any research or reporting on Covid and weight. (Interestingly, even some high-profile diet-culture adherents seem to agree with me on this and other points, as this article exemplifies [CW: BMI numbers, weight-stigmatizing language].)
By the way, if you’re looking for a relatively quick and easy way to make sense of articles like this, you might check out a method called SIFT that’s become popular in media-literacy courses. I learned about SIFT while reporting on how to avoid wellness misinformation for my next book, and I think the method also can be useful for stories like this NYT article on Covid and fat cells, or really any media reporting on early-stage health or nutrition research. (Not saying these articles are all misinformation per se, just that the framework is useful for many situations in which the quality of information is uncertain; in fact, I’ve been instinctively practicing something like SIFT for years without realizing it, thanks to my training in journalism and public health.) The method has four principles, each of which may be more or less useful in different instances (although the first one arguably is always necessary):
Stop. (As in: don’t rush to share the piece, or internalize its message. Pause to collect yourself. Breathe.)
Investigate the source. (That is, consider the claims and the potential agenda of the person making them. If an article is quoting a lot of members of the diet industry, for example, that’s good to know.)
Find better coverage. (Look for reputable sources that are reporting on a particular story in a more nuanced or complete way.)
Trace claims, quotes, and media to the original context. (So for stories about scientific studies like this, you might read—or at least skim—the text of the actual study to get the full picture.)
In many cases, you’d be hard pressed to “find better coverage” than The New York Times (which is why I’ve been a longtime subscriber and occasional contributor). But in situations like this, where they’re reporting on tiny preprint studies in ways that raise anxiety and alarm among an already stigmatized group, even the Times has some stories that need to be SIFTed out. To me, for all the reasons cited above, this story about Covid and fat cells is one of them.
I hope that helps you put this article in perspective, Eliza, and thanks again for the great question.
Ask your own question for a chance to have it answered in an upcoming edition of the newsletter.
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Here’s to thinking critically about health and wellness media,
Christy
P.S. If you want to learn more about how to critically interpret weight-related research and the media that report on it, check out my book, Anti-Diet. It’ll help you understand the deeper reasons why diet-culture thinking is so rampant in the media and scientific communities, so that you can make more informed and self-caring choices about the ideas you allow to hold sway in your life.