Another possibility is that people who have higher BMIs also tend to show higher levels of certain markers of inflammation in their bodies, like C-reactive protein. And, in fact, in Dr. Horwtiz’s study, the level of C-reactive protein that patients had in their bodies was more strongly associated with severe illness than age or any comorbid conditions. So, the thinking is that fat people are more likely to have a hard time with the new coronavirus—or, really, any illness—because they are already dealing with higher baseline levels of inflammation. But, as SELF explained previously, that line of thinking hasn’t been totally proven and often ignores the role that mental health issues (not to mention being on the receiving end of weight stigma) also have on inflammation levels.
Ultimately, even though there does seem to be a link here, researchers don’t fully understand why. And, so far, there is no conclusive evidence that it’s the fat on people’s bodies that’s driving it. “It’s one thing to say that there is an association,” Dr. Horwitz says, “and it’s another thing altogether to understand it.”
The problem with jumping to conclusions
Not only do we not fully understand the link between weight and COVID-19 outcomes, but there are also plenty of other risk factors we know more about. And, in most cases, those seem to be more important to worry about than weight. In Dr. Horwitz’s study, for instance, age was by far the most important risk factor, she says. Being 75 or older was associated with an increase of 58 percentage points, meaning that if you had, say a 10 percent risk for hospitalization at baseline, being 75 would increase your risk to 68 percent, Dr. Horwitz explains. In contrast, having a high BMI increases your risk by 10 to 15 percent depending on the exact BMI number, Dr. Horwitz says, which was on par with the increase in risk associated with diabetes and kidney disease in her study.
Although results like these may be helpful for researchers looking into how best to triage patients and get them the care they need, we all need to take extreme care in how we think and talk about these results—especially if we're just members of the general public. “We have to be really careful in looking at this research because we don’t want to blame the fatness and increase the stigma,” Bacon says.
So, how can we responsibly and respectfully give these associations the investigation they deserve? We can use them as a starting point, Bacon says. Knowing that there’s a higher prevalence of hospitalization or severe outcomes is important to know, they say, so that we can ask other important questions, like ‘Why is there higher prevalence?’ and ‘What role could fat stigma be playing in increasing the prevalence?’ We simply don’t have the answers right now.
Instead, as it stands now, people with higher weights are left with ambiguous media warnings about how they should be extra scared about the new coronavirus without any actual evidence-based guidance for how to effectively protect themselves, Flint says. There’s just the usual protective behaviors that we should all be doing, such as social distancing, wearing masks, and practicing good hand hygiene.
“If you identify people in a high-risk group and don’t provide information [for them], you’re increasing concern and anxiety,” he says, which is why he wrote a letter that recently appeared in the Lancet: Diabetes & Endocrinology explaining how problematic the current situation is. “The scarcity of information regarding the increased risk of illness for people with a BMI higher than 40 has led to ambiguity and might increase anxiety, given that these individuals have now been categorized as vulnerable to severe illness if they contract COVID-19,” the letter reads.
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