Obesity stigma could have some people putting off early COVID-19 shots: advocates

Stigma towards people with obesity could be preventing some from signing up for early COVID-19 vaccine prioritization, advocates and doctors say.

The Public Health Agency of Canada has said people with severe obesity have a higher risk of catching COVID-19 and dying from it, so some provinces such as Ontario and Alberta have been offering them early vaccine access.

But doctors and advocates say people in this at-risk group could feel hesitant to sign up because of judgment from others in line or even from medical staff.

“While most people in our community and that I have spoken to have been overwhelmingly positive about the prioritization in some provinces for obesity, I have spoken to several individuals who are hesitant to register for the vaccine in the prioritization,” Ian Patton, patient advocate and a registered kinesiologist, told CTVNews.ca in an email.

“Some are embarrassed or worried about what their friends and family will say and are terrified of having to justify their early access to the vaccine,” said Patton, who’s also the director of advocacy and public engagement at advocacy group Obesity Canada. “Especially with how brutal some of the stigma around obesity has been during the pandemic.”

He said some people are worried they’ll have “to explain that they are getting the shot early because they have obesity… they don’t know what to say or are fearful of not having something to say if they get questions or are asked to prove it.”

Patton said others carry internalized bias, feeling they aren’t worthy of help let alone early access to the vaccine.

“Either way, both of these situations are sad and keep a vulnerable population at higher risk longer,” Patton said. His comments were echoed by doctors who work with patients with obesity.

“[Being] prioritized for a medical condition -- that has a stigma attached to it -- makes it somewhat more difficult because people may be embarrassed going into that lineup,” Dr. Sean Wharton, the medical director of the Wharton Medical Clinic for weight and diabetes management in Burlington, Ont., told CTVNews.ca in a phone interview.

Wharton wants to ensure Canada doesn’t follow troubling trends in the U.S., where people with obesity reported feeling stigma from getting the vaccine early.

In Canada, only Ontario, Manitoba, and Alberta have explicitly listed severe obesity as criteria for vaccine eligibility. Between 850,000 to a million people across the country have a body mass index (BMI) higher than 40 and have a significantly higher risk of dying from COVID-19 complications.

Obesity specialist Dr. Jennifer Tsang, the co-director of critical care research at Niagara Health, told CTVNews.ca over the phone that “it breaks my heart that most of the patients with COVID in my ICU have obesity.”

Wharton explained those who have risk factors such as diabetes, or older age, lung disease or cancer are also being given early vaccine access but don’t face nearly as much stigma.

'IT'S NOT ABOUT WILLPOWER'

Tsang agreed and said obesity is not simply about diet or lack of exercise.

“It’s not about willpower,” she said, explaining that patients are often economically disadvantaged, have other medical conditions that make them predisposed to obesity, or are on medication that leads to weight gain.

Wharton said pop culture and medical professionals have contributed to people with elevated weight issues being told “that it’s their fault, and they should be blamed and shamed about it… but obesity is not a character flaw. It is a medical, biological disease.”

He said we all bear a responsibility to ensure that stigma stops.

For his part, Wharton published guidelines last year in the Canadian Medical Association Journal for medical practitioners to better understand conditions in patients with obesity.

Tsang, an associate professor of medicine at McMaster University, praised Wharton’s efforts and said when she was in medical school “I wasn’t really taught about the physiology of obesity. It’s a relatively new speciality in the medical community.”

Director of research and policy at Obesity Canada, Ximena Ramos Salas, wrote a blog post calling for an overhaul in thinking among the medical community when it comes to obesity and COVID-19 vaccine priority.

“At the level of the health-care system, there is strong evidence that by educating health-care professionals about the complexity of obesity, we can reduce weight biased attitudes and beliefs,” she told CTVNews.ca in an email, saying “health-care professionals like everyone else in society have weight bias and that they stigmatize people with obesity in their clinical practice.”

“People who have experienced weight bias and stigma from their health-care provider will avoid the health-care system for fear of being blamed and shamed for their weight. In addition, we have research that indicates that people who have experienced weight stigma from health-care providers will have less trust in health-care professionals.”

Patton said everyone knows someone living with obesity and that true change will come from a grassroots movement, “from people living with obesity who are starting to think differently about obesity and beginning to demand better from health care and those around them.”

Patton, Tsang and Wharton urged every province to give vaccine prioritization to people with obesity.

“Not doing so puts individuals who are at a higher risk in a scary position longer and makes our overall population more vulnerable for longer,” Patton said.

“Prioritization for COVID-19 vaccination is needed for people who are at high risk. It doesn’t matter who they got into higher risk,” Wharton said. “We should not be giving our own biased judgement or an opinion on whether they caused it themselves or didn’t.”

Wharton said that in the same way the government stepped in to give early vaccine access to at-risk populations, such as Indigenous communities, “there should be that same type of clarity when it comes to any group that is at higher risk for any reason.”