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Welcome back to Food Psych Weekly! Every week in this newsletter, I answer your questions about intuitive eating, Health At Every Size, disordered-eating recovery, and other anti-diet topics.

This is now the most reliable place to find me every week, because today I released the last episode of my podcast for a while. I’m sad to have to push pause on the pod, but also really thrilled to have more time and mental space to focus on my next book, which is all about the problems with our culture’s current idea of “wellness”—and what to do instead to create a truly health-promoting society.

I’m recording so many interviews for the book right now that it kind of feels like I’ve started another podcast (in a good way), and I’ve been talking to some fascinating people whom I don’t think I ever would’ve had a chance to interview for Food Psych. I’m excited to share those conversations with you once the book is out!

This week’s question is from a reader named Mar, who writes:

“Hi Christy, I really appreciate your writing on Covid and fatness. As the vaccine is being rolled out though, it seems that health departments are operating under the assumption that fatness should put people into a high risk category for Covid. I’m filling out my city’s vaccine survey (which seems to be a tool that will contact you once your tier is able to access vaccines) and there’s a question asking if I have any high-risk conditions such as cancer, heart conditions, and includes “severe ob*sity” (which it defines at a certain BMI). Now, I haven’t weighed myself in years so I may be in this category. If I am in this category, should I say I have a high-risk condition? I am overall pretty healthy, no other high risk factors. While I am eager to get vaccinated, I don’t want to wrongly take a vaccine when there are people who are probably at a higher risk than me. Thanks!”

Thanks so much, Mar, for that great question. Before I answer, just 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, you’re not alone in having this question, and I appreciate your thoughtfulness in wanting to make sure the people at highest risk are prioritized for vaccination.

I also want to reassure you that if your city does give priority to people in your BMI category (or any other category you may be part of), there’s absolutely NO reason to feel guilty about claiming your place in line. In fact I’d urge you to do it, and I’ll explain why.

Granted, as I’ve been saying for months, the research linking high BMI to a greater risk for severe Covid is definitely not airtight. Some studies have shown that larger-bodied people aren’t at higher risk, including two recent ones: one study (CW: weight-stigmatizing language and BMI numbers for this and all studies linked below) of nearly 3,000 people in Madrid found that higher-weight people didn’t have any greater risk of dying from Covid than lower-weight people, and another study (CW) found no difference in the risks of ICU admission, mechanical ventilation, or death—and no difference in immune-system response—between higher- and lower-weight people.

Other studies have found that higher-weight people were at increased risk, as you’ve probably seen all over the internet (including in a recent CDC study, which I’ll unpack in a future email, and which has a number of glaring limitations). But that doesn’t mean that higher weight causes poor Covid outcomes—far from it.

In my understanding of the research, any difference in outcomes for higher-weight folks is likely due to the lower-quality medical care that larger-bodied people receive, including later initiation of treatment (CW).

As I first reported last April, we saw this issue in the H1N1 flu pandemic, too (CW)—the supposed risk from higher BMI *disappeared* once researchers controlled for the amount of time it took doctors to give patients antiviral treatment. Larger-bodied people didn’t get the necessary medication until significantly later than smaller-bodied folks. In other words, higher-weight people got lower-quality medical care. (Surprise, surprise.)

I’d say it’s highly likely that the same thing is happening now with Covid-19, given the substantial research showing that weight stigma (as opposed to weight itself) results in worse healthcare and worse health outcomes for higher-weight people.

All that being said, I do recommend that higher-weight people take the opportunity to get vaccinated as soon as they’re eligible, for two reasons:

First, simply because I want everyone who’s eligible to get vaccinated, for the good of society. The more people who get the vaccine, the more quickly we move collectively toward herd immunity, which helps reduce the number of deaths and severe cases overall. Getting vaccinated helps protect others, as well as you and your loved ones. The best thing you can do to help end this pandemic for everyone is to get vaccinated when you’re eligible.

And second, specifically for higher-weight people, getting vaccinated can help keep you from getting sick and having to engage with a healthcare system that we know is rife with weight stigma.

If you can avoid getting Covid, you can save yourself from potentially having to endure not only a serious illness and residual complications, but also weight-biased medical care that could make everything much worse.

I’ve heard from many higher-weight people that they’re still scared to even go out to the grocery store for fear of getting sick and landing in the hospital, where they might get sub-par care because of their size. (And of course that poor-quality care could be compounded by other factors, like racism or transphobia.) There are also higher-weight people who have no choice but to go to work and potentially get exposed to the virus, which is causing them tremendous anxiety.

Getting vaccinated as soon as you’re eligible can help you feel safer, less anxious, and freer to start moving around in the world again (while still following guidelines like mask-wearing and social distancing, since there’s no practical way for people in public spaces to know who’s been vaccinated and who hasn’t).

I know the rhetoric around body size and Covid-19 is incredibly stigmatizing, and I think we need to continue fighting that at every turn—along with medical weight stigma in general.

But as I recently told Business Insider (CW), it’s helpful to take whatever olive branch this healthcare system may be offering you, if only to help you avoid having to engage with that system any more than is necessary.

Or as the fabulous fat activist and writer Ragen Chastain put it, “The vaccine will help protect us from Covid and medical fatphobia—don’t let anyone make you feel guilty for getting vaccinated as soon as you’re eligible.”

Thanks again for your question, Mar, and I hope this helps you feel more confident in your right to get the vaccine if you are indeed eligible because of your BMI.

Submit your own question for an upcoming edition of the newsletter right here.

On the Pod

​This week on the podcast, I share some parting words and resources for ongoing support—including this very newsletter.

​Check it out right here, and be sure to subscribe to the pod so that you get Season 9 delivered to your device as soon as we’re back from our hiatus!

Thanks for reading! This newsletter is made possible by subscribers like you. To show your support, you can forward it to someone who’d like it, make a donation, purchase my (first) book, or join one of my courses.

Here’s to fighting medical fatphobia,

Christy