Like many of you, I’m beyond excited for the rollout of the COVID-19 vaccines. 

The vaccine is a light at the end of the tunnel. It means less worries about the health and wellbeing of myself and loved ones. It also represents the ability to safely and ethically travel again. 

Glenn and I feel confident enough that things will be in a good place this winter that we have started to confirm bookings on a few big international trips for late in 2021 (with trip insurance, just in case).

We’ve already received some pretty extensive COVID-19 protocols for one of the trips, which includes expectations around vaccinations, the requirement for several negative COVID-19 tests at various times prior to departure, and strict guidelines for required mask wearing and social distancing while on the trip. 

A strange sense of calm came over me as I read these COVID-19 safety guidelines. 

While it may be years before everything is “back to normal,” it was clear that this travel company had put together a plan that would maximize the safety of their staff, guests and communities visited, while at the same time enabling grand adventures to be had.

One of the critical components to enabling our future travel is getting vaccinated. Like many states in the U.S., Oregon is rolling through various eligibility categories beginning with health workers and those living in assisted living facilities, then moving on to teachers and older adults, etc. 

At the end of this month Oregon is slated to begin vaccinating folks with certain underlying health conditions that make them more vulnerable to serious complications and death from the virus. This will include folks with cancer and people with donated organs, chronic kidney disease, HIV, etc. 

Glenn will be eligible to get vaccinated in this next wave due to his degenerative heart condition (hypertrophic cardiomyopathy). It turns out I’ll be eligible to get vaccinated early at this time as well. 

That reality is something I’ve found myself quite conflicted about. 

One of the underlying health conditions that will make someone in Oregon eligible for early vaccination is obesity. In this case, obesity is defined as a Body Mass Index (BMI) of 30 or more (which is calculated by dividing your weight by your height in kg/m2).

I currently have a BMI of 34, which is categorized as “obese.” I used to have a BMI of 51, which is categorized as everything from “class III obese” to “clinically obese” to “super morbidly obese.” Pick a lane people!

The BMI measure is complete bullshit.

Use of BMI in the medical profession is actively harming health, especially for people of color. It was invented nearly 200 years ago by a Belgian dude (Adolphe Quetelet) who was studying astronomy and statistics, not medicine. He was looking to define the mathematical mean of a population based solely on the measurements of white Western Europeans. 

It was never intended to measure individual health, yet it is used erroneously as a proxy for that today — COVID-19 vaccine eligibility being just one example. Its continued use implies that the further you are from the mathematical mean of the population (of predominately white people), the more unhealthy you are…which simply isn’t true.

Of all of the reasons someone might be eligible to get vaccinated before the general public, obesity is one of the most polarizing.

We exist in a fat-phobic society. Meaning, a society with a pathological fear of fatness. Nearly every magazine cover promises to deliver the latest cure for fatness (which, if the headlines are to be believed, can be achieved in just 30 days!) 

Billion dollar industries are built on selling specialized equipment, supplements and diet programs to eradicate fatness. Fat shaming is acceptable behavior and deadly eating disorders are on the rise especially among young women and children. 

Akin to living in a society whose foundation is built on racism (like the U.S.) where whiteness is privileged and being Black or brown is stigmatized — in a fat-phobic society, thinness is privileged and fatness is stigmatized. 

In fact, these two issues are deeply intertwined. Research has found that fat-phobia is not actually based on health concerns, but instead is rooted in racism and religion. (If you are interested in learning more, I’d encourage you to check out “Fearing the Black Body: The Racial Origins of Fat Phobia” by Sabrina Strings.) 

One of the reasons obesity is included as an underlying health condition that warrants early vaccination is because of various reports and research findings that obese people are more likely to experience complications and death from COVID-19. 

What the headlines don’t covey is that these studies have found a correlation between the two, not causation. 

Meaning, they have not found evidence that simply being fat itself causes increased complications and deaths. Along that same vein, Black and brown folks are also more greatly impacted by COVID-19, but that isn’t a result of the increased melanin in their skin. There are other more complex and intertwined dynamics at play that are resulting in these disparate outcomes.

Biases fueled by weight stigma have been repeatedly documented in the medical profession. I believe that part of the reason obese folks fare more poorly in their fight against COVID-19 has to do with receiving poorer health care — not just while they are fighting the virus, but over their lifetime. 

There are countless studies documenting fat-phobia in the medical profession including one that found 24% of nurses are repulsed by their patients that are obese. It’s pretty hard to provide quality care to a patient that repulses you (Maroney and Golub, 1992). 

I have experienced weight shaming in a doctor’s office countless times myself. 

I need only compare what it was like to seek medical advice when I weighed 307 pounds versus what it is like today at 207 pounds. That experience is night and day. From how I am treated, how I am listened to, and what solutions and options are presented to me, everything has changed.

At 307 pounds I was regularly dismissed and told that losing weight was the only needed solution to whatever ailed me – no further discussion was warranted.

I have experienced the shame of weigh-in scales that maxed out before reaching my weight, blood pressure cuffs that didn’t fit my arm, exam tables that couldn’t support my weight and dressing gowns that I couldn’t close.

I have encountered the malpractice of a doctor that told me to simply “embrace my hunger” as her solution to a medical problem that wasn’t weight related (uterine fibroid pain), and that of a doctor that refused to investigate a growing mass in my back because I was so overweight that he “couldn’t fathom how to collect a biopsy sample of the tumor rather than my back fat.”

Knowing what awaited me at the doctor’s office, why would I, or any other obese person, seek out medical care for something until it was absolutely necessary? By extension, why would an obese person show up for treatment of COVID-19 and not have any number of underlying health conditions already at play that could result in complications?         

It is socially acceptable to disapprove of people who are affected by obesity.

This results in discrimination, stereotyping and marginalization based on a person’s weight. Obesity is seen as a simple issue of personal responsibility. When in fact, obesity is the result of a complex interconnected array of mental, emotional, physical and environmental factors – all well documented in countless research studies. Contrary to popular belief, it’s not just a matter of simply having the willpower to eat less and exercise more. 

Unfortunately, the stereotypical perception persists that obese people simply lack self-control and wouldn’t be in such shameful bodies if they weren’t so gluttonous, sloppy, unsuccessful, lazy…or insert any negative adjective of your choice here. It is a pervasive pattern of viewing people affected by obesity with disdain, not empathy. It’s this perception that makes early vaccination for obese folks so polarizing. 

When I realized that I would be eligible for an early vaccine due to obesity, my heart flipped in my chest. 

Not because I was excited that I could get vaccinated as soon as possible, but because I immediately envisioned the judgement-filled reaction of others. How the person checking me in at the vaccine site would look down their nose at me, or how acquaintances would be angry that I could get vaccinated before themselves or their loved one that was more deserving in their eyes. 

I wondered if they might say to themselves “why do fat people get to jump the line just because they have no self-control?”

About once a year at Weight Watchers we do a session focused on getting clear about the “why” behind our desire to get and/or stay healthy. My “why” is always focused on having the ability to travel and enjoy the outdoor physical adventures for which I am passionate. Those very things that much of this blog is about. 

I’ve written in past blog posts about how my initial journey toward improved health was driven by my desire to be physically able to ride a bike across Vietnam and to hike the Inca Trail to Machu Picchu. My “why” for getting healthier – which included losing weight to make physical activity easier – has always been about experiencing life, never about reaching an idealized body size.  

I don’t perceive of myself as a person who much cares what others think of my weight and I don’t tend to let my pants size dictate my worth.

But every once in a while something happens that shows me how much I have internalized fat-phobia and weight shaming. They are insidious beasts (fat-phobia and weight shaming) and no matter how much I may have tamed them, they claw their way forward in my psyche from time to time. 

One of my most popular blog posts (in terms of monthly views) is one I wrote about one such experience called “I jiggle, therefore I am” – which was about feeling self-conscious in a pair of shorts. I often ponder why that blog post seems to resonate so much with people around the world. No doubt it is because challenges with negative body image are so pervasive and universal. 

The rollout of the vaccines has brought the deeply embedded structural inequities of our society into stark relief. Exploring all of the reasons why a disproportionate number of white folks (in the U.S.) are getting early access to the vaccine could be its own lengthy blog post! 

Similarly, the vaccine eligibility process has also made more visible the somewhat warped pseudo-meritocracy that we exist within. Meaning, how we sort people into categories based on their perceived talents, efforts and achievements…or their “merit.” 

In this case, being a doctor or a teacher is a noble profession that merits early vaccination…yet other workers that are forced to be in close contact with the public or co-workers to do their jobs — like restaurant service staff, grocery store clerks, meat-packers, hair dressers — don’t merit early vaccination. Similarly, someone with a degenerative heart defect or cancer is likely seen as more worthy of early vaccination than someone with type 2 diabetes or obesity.

Where we all fall in that pecking order — how institutions and society have defined our individual merit or worth — determines when we can get in line for the vaccine. That inherently flawed value judgement has real world, potentially life or death consequences for each one of us.        

In the end, the faster we get more people vaccinated — for whatever reason — the better for all of us. 

Many people in our community suffer inequitable outcomes when fighting the virus. For some of those folks, that vulnerability is augmented by a lifetime of marginalization, sub-standard medical care and complex interacting mental, emotional, physical and environmental factors. That includes many obese folks and people of color.

I haven’t yet decided when I’ll get in line for my vaccine. Will I do it in a couple of weeks when I’m technically eligible to get vaccinated? Or, will I wait another couple of months for when vaccines open up to the general public? I honestly don’t know.  

I’d love to get vaccinated soon because it means I could provide more direct physical and emotional support to some highly isolated and medically compromised loved ones in my life.

On the flip side, I know I can wait a bit longer to get it done. Although I’m obese, I’m healthy and active and have several things going for me that reduce my risks related to COVID-19, including my wealth and privilege, good health insurance, white skin and the fact that I don’t have a job that requires me to be regularly exposed to others.

For now, I’m going to continue to sit with and process the various emotions and internal narratives that came to the surface for me about how being obese has positioned me — both in perception and reality — relative to others in this moment. 

My internalized fat-phobia and weight shaming came roaring to the surface when I learned I qualified for early vaccination. Clearly, I have some emotional baggage to unpack in this arena before I can begin packing my literal baggage for the future trips enabled by getting vaccinated.