Misconceptions about obesity have led to a spike in weight shaming during COVID-19, experts say

From memes about weight gain to abuse aimed at people with obesity who contract COVID-19, the narrative surrounding weight during the pandemic has been overwhelmingly unhealthy, experts say, with some using the fact that obesity is a risk factor for COVID-19 as an excuse to weight-shame people. (Obesity Canada)

TORONTO — The link between COVID-19 and obesity as a risk factor has led to a rise in weight-shaming comments on social media, with some insuinating that those with obesity are at fault if they fall ill -- a worrying trend, experts say, considering how weight stigma already negatively affects many people’s mental and physical health.

“We knew that age was a significant risk factor early on in the pandemic, and much of that discussion I felt like was relatively positive,” Sarah Nutter told CTVNews.ca in a phone interview. “You know: ‘Let's protect our seniors, and do what we can to support them.’ And I felt like the conversation around weight as a risk factor when that came out was a little bit different. Weight is something that has pre-existing stigma.”

Nutter is an assistant professor of Counselling Psychology at the University of Victoria, where she trains future counsellors, but also researches weight stigma in order to better understand how it affects healthcare.

She said that when people hear that those with obesity may be more at risk for COVID-19, some react with disgust or anger instead of compassion because they perceive obesity as a thing a person chooses to be, or is in full control of.

“It turns into this really moral thing,” she said. “[It’s] pitting oneself against another like: ‘Oh, look at me, I'm amazing, and look at these horrible fat people who are getting COVID and dying, like I'm so much better.’ And so I think that kind of hierarchy that these comments can create is really unhelpful and it serves to dehumanize people of higher body weights.”

The truth is that obesity has nothing to do with laziness. It’s a complicated condition caused by a huge variety of factors, including genetics, environment, emotional health or other medical issues.

The Canadian Medical Association Journal defined obesity as a “complex, progressive and relapsing chronic disease, characterized by abnormal or excessive body fat (adiposity), that impairs health,” in a clinical practice guideline posted in August 2020.

Nutter pointed out that this definition of obesity specifies excessive body fat which “impairs health,” making the distinction that not everyone with higher body weight is obese or unhealthy.

This understanding of obesity as a more complex condition isn’t new either.

A report released in 2007 looked at how controllable weight really is, and researchers found that “body weight is influenced by over 100 different factors and that there were 300 interconnections between these factors,” Nutter explained.

“It was really impactful in 2007 and why are we here at 2021 not having an evidence-based conversation? That's really frustrating for me.”

Despite scientific understanding advancing, misconceptions around obesity persists in our society.

“This type of negative attitude about people with obesity that they only have themselves to blame for their weight status has been increasing over time for decades,” Angela Alberga, an assistant professor at Concordia University, and a weight bias expert, told CTVNews.ca in an email.

“This pandemic is bringing this to light even more.”

COVID-19 AND OBESITY

The narrative surrounding weight during the pandemic has been unhealthy from the beginning, experts say.

"Even at the very start of the pandemic there were a lot of social media posts about body weight and memes making fun of people overeating, being sedentary and gaining weight during the pandemic,” Alberga said.

She added that there were jokes about the “quarantine 15,” referring to gaining 15 pounds in lockdown.

“When I think back to last March, April and May, it was like you couldn't go on social media without seeing those things,” Nutter said. “What troubled me about those kinds of memes, [is] we're seeing loss of life in the hundreds and thousands every day at that point last year, and is gaining weight the worst thing that could happen to you in a deadly pandemic?”

Research began to show a correlation between obesity and more serious outcomes if people contracted COVID-19. One study from the fall found that those with morbid obesity made up 41 per cent of COVID-19 patients who needed mechanical ventilation or died.

The contributing factors behind this have not been fully unravelled, and research so far doesn’t suggest that a higher body weight is the direct cause for a more severe outcome for COVID-19.

Although the correlation makes obesity a clear risk factor, the conversation around this is often mismanaged, Alberga said, leading to abusive comments on social media.

“It is upsetting to see how much focus has been placed on body weight and how many people have been shamed publicly for having COVID-19 at a higher body weight,” she said.

The problem goes beyond social media as well. The U.K. government issued an advisory in the summer that urged citizens “to lose weight” as part of their strategy to beat COVID-19, saying in a press release that they wanted “to help people take control of their own future by losing weight, getting active and adopting a healthier lifestyle.”

“If we all do our bit, we can reduce our health risks and protect ourselves against coronavirus,” British Prime Minister Boris Johnson stated in the release.

The advisory was met with criticism across the globe, with many pointing out that it scapegoated the public and seemed to shift responsibility for the pandemic away from the government.

Statements like this show a lack of comprehension for the actual issue, Alberga said.

“Placing blame on people telling them to just buy exercise equipment and eat healthfully by buying more fruits and vegetables during the pandemic highlights the misconceptions people have about obesity and completely disregards the social and economic inequities that exist in Canada and abroad,” she said.

HOW WEIGHT SHAMING CAUSES POORER HEALTH

It’s not just hurtful to shame someone for their weight — it can have a hugely detrimental effect on a person’s health, something that is particularly worrisome during a global pandemic.

“Countless studies show that just experiencing stigma is a form of stress that increases anxiety, blood pressure, depressive symptoms, disordered eating, less motivation to do physical activity and even avoidance of healthcare,” Alberga said. “Experiencing stigma has these negative health effects regardless of your body weight status.”

Alberga is a member of the research team with Obesity Canada, a non-profit that aims to reduce the stigma and improve healthcare for those with obesity. One of the things they stress is that abusive tactics to try and get people to lose weight never work.

“Decades of research in psychology have shown that stigma is not helpful and does not change health behaviours,” she said.

A U.S. study published this fall found that young adults who had reported experiencing weight stigma before COVID-19 experienced higher levels of depressive symptoms, stress and were more likely to binge eat to cope during the pandemic.

The fear of being faced with discrimination due to weight can also lead some to avoid going to the doctor’s office, according to a commentary on obesity during COVID-19, published last summer in the scientific journal Metabolism.

“Observed decreases in non-COVID hospitalizations indicate a general reluctance to seek even necessary medical care during this pandemic,” the article stated. “Individuals with obesity are especially likely to delay care, or avoid it completely, because of bias and humiliation experienced in healthcare settings.”

It’s far from an unfounded fear.

“There is a lot of evidence of weight bias in healthcare — equipment that does not accommodate a diversity of body sizes, health professionals attributing all health issues to excess weight,” Alberga pointed out.

Nutter said healthcare practitioners, like anyone, can fall prey to these pervasive attitudes in our society, and unconscious bias can affect how they deliver care to their patients.

“A study that I did with some colleagues a couple of years ago, we surveyed 400 family physicians from across Canada and 18 per cent of those 400 physicians responded with agree or strongly agree that they're disgusted when treating patients with obesity,” she said. “If you think about that as a baseline, that's a really significant minority of physicians in Canada. And how does the talk of weight as a risk factor influence that when they're in the stress of the pandemic, and dealing with higher weight patients?”

Weight shaming could also push people to try unhealthy tactics to lose weight, such as going on strict diets.

“If dieting were an effective weight loss method, the diet industry wouldn't be growing by millions and billions of dollars each year, it would be shrinking by that amount each year,” Nutter pointed out.

It’s common to see people attempt to cloak their weight-shaming in concern, claiming that criticizing their discrimination against those with higher weight prevents us from having a conversation about the health implications of obesity. But the framing of these conversations matter, experts say, because being abusive towards people with obesity out of a misunderstanding of the condition only contributes to poorer health overall.

Nutter said those who are genuinely concerned about the spread of COVID-19 should not be telling individuals to lose weight, but to focus on strategies that are actually controllable for the average person: wearing a face mask, social distancing, washing your hands.

STIGMA AND THE MEDIA

Weight stigma during COVID-19 is still under-researched, but it’s clear the media plays a huge role.

An article published in Frontiers in Psychology in September 2020 pointed out that “media portrayal of obesity has long been identified as one of the most influential sources in contributing to the development and maintenance of weight stigma attitudes and discriminatory behavior.”

A July call to action published in the Lancet surveyed people with obesity in the U.K. and reported that among the concerns brought up, a “recurring theme was stigma, largely related to comments on social media and fuelled by the media.”

Nutter is currently working on a research study to look at whether media reports about obesity as a risk factor for COVID-19 have a measurable impact on weight stigma based on pre-existing attitudes. She hopes to have results later in the spring.

“There is so much media attention on obesity as a risk factor for COVID-19, but considering how prevalent weight stigma is and its negative health effects, it would be important for the media to be careful about how they report findings that make causal links between obesity and COVID-19 and avoid perpetuating obesity myths,” Alberga said.

Nutter acknowledged that it’s difficult to navigate the conversation around the link between COVID-19 and obesity, but emphasized that we have a duty to be accurate, avoid stereotypes, and remember the humanity of those involved, particularly during a pandemic that has taken so many lives.

“It's important in any sort of discussion like this about obesity and higher weights […] to reinforce that weight isn't controllable and that it's not a personal responsibility, and to, I guess, nudge attitudes in a way that will be more helpful,” she said.

Edited by CTVNews.ca Writer Ben Cousins