Dear Fat Person, Get the Vaccine and Don't Feel Guilty

Since the beginning of the pandemic, there have been stories all over the media about higher weight people being at higher risk for COVID-related complications. Now vaccine rollout plans are being created and in many places in the U.S., including New York and California, higher weight people are being prioritized along with other high-risk groups for vaccination.

Of course there’s an outcry amongst fatphobes, but setting aside their predictable, bigotry-based whining, this is causing a lot of mixed feelings amongst fat people themselves.

Activists and experts, myself included, have been discussing the problems with the claim that having a fat body causes higher risk for COVID. This, and the incessant yammering of fatphobes, is making some fat people question whether or not it is fair for them to be prioritized. I want to urge fat people to get the vaccine as soon as they are eligible without a drop of guilt. Here’s why:

When it comes to whether a fat body actually causes higher COVID-19 risk; we definitely don’t know, and there are serious questions at the most basic levels of the science. One of the first things any research methods student learns is that “correlations never, ever implies causation.” Which is to say that no matter how often Thing A and Thing B happen at the same time (are correlated), we can never conclude that Thing A causes Thing B to happen. That’s because it’s possible that B causes A, or that a third factor (Thing C) causes both A and B. So while there may be a correlation between larger bodies and COVID-19 risk, there are many other potential Thing Cs at play. Chief among them is healthcare inequality — fat people face massive inequalities in the U.S. healthcare system that can seriously impact their risk of negative outcomes.

A clear example of this issue happened during the 2009 H1N1 outbreak. During the outbreak there was a very high correlation between higher weight and severe symptoms and death. Plenty of so-called “ob*sity experts” jumped in to offer their guess as to what about fat bodies was causing this increased risk. But a study afterward found that the difference was actually that thin people were given antiviral treatment earlier than fat people and that “after adjustment for early antiviral treatment, relationship between ob*sity and poor outcomes disappeared.”

To put it clearly, it wasn’t their bodies at all — healthcare inequality in the form of delayed care harmed and killed those fat people while medical “experts” rushed to blame their bodies for their own harm and deaths. As I’ve written here before, weight stigma at literally every level of medical care negatively impacts fat people. A fat person who gets COVID faces any number of barriers to care due to weight stigma. Just a few examples include delayed treatment as we saw in the H1N1 outbreak, the lack of even basic equipment that accommodates larger bodies including everything from blood pressure cuffs to beds to surgical tools and more.

Then there is the fact that often when “best practices” for equipment use and treatment are developed (say, for example, ventilators), they are only developed for thin people, with fat people subsequently blamed if practices that weren’t created for them don’t work as well for them. By blaming fat bodies instead of weight stigma, those who are actually causing these issue evade responsibility for creating them, and for fixing them. Also, in many places healthcare rationing protocols that are triggered by shortages of equipment and staff specifically discriminate against fat people in ways that objectively devalue their lives.

The truth is that weight stigma in healthcare harms and kills fat people in any number of ways, and COVID-19 is far from an exception to this rule. It shouldn’t happen, but it does, and because it does we deserve any kind of protection that we can get, including vaccine priority (especially since they actually included fat people in the vaccine trials which so often doesn’t occur).

Writer Reina Sultan tweeted about it here:

So, I'm getting the COVID-19 vaccine on Friday because I'm fat. I'm saying this because I think a lot of people are ashamed that they are qualified bc of this and a lot of other people are judging those who get a vaccine bc of this. 1/4

— Reina Sultan (@SultanReina) February 23, 2021

And I’ll add that my tweet on the subject is the closest I’ve ever come to going viral on Twitter.

Fat people face staggering inequalities in healthcare that put us at high risk for severe symptoms and death from Covid. 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.

— Ragen Chastain (@danceswithfat) February 24, 2021

So if you are fat and want the vaccine, you should not feel even a tiny bit guilty for getting it as soon as you are eligible. Weight stigma in medical care puts us at higher risk, and higher risk should mean higher priority for vaccination.

To learn more about this, I recommend looking at the work of Nobody Is Disposable and the FLARE Project.