No matter where you live in America right now, you are at risk for being exposed to coronavirus. Various health organizations have released announcements regarding prevention and safety measures, including awareness on medically vulnerable and high-risk groups for contracting this illness. The CDC lists numerous chronic conditions putting one at an increased risk for COVID, including cancer, chronic kidney disease, and serious heart conditions (1). Those with a body mass index (BMI) greater than 30 is also included in this list- BUT...what about those with an underweight BMI of less than 18.5?
This is weight stigma. Those with an underweight BMI are also at risk for many complications, including those that come alongside malnutrition. Those who are underweight, whether due to an eating disorder or other medical conditions, have compromised immune systems due to lack of nutrition. People with a BMI less than 18.5 are likely not consuming enough calories, leading to vitamin and mineral deficiencies. Vitamins A, C, and E are antioxidants, which help us fight free radicals and infection in the body. Vitamins A and E cannot be absorbed with inadequate fat consumption, common in those with eating disorders. A recent review found that those with an underweight BMI presented with the highest risk of all-cause mortality (2).
On the other hand, assuming those of a higher BMI are at a greater risk of COVID-19 is also weight stigma. This assumption is indicating that those at a higher BMI are “unhealthy.” BMI is an inaccurate indicator of health for various reasons, including:
It does not consider muscle or bone mass.
It only focuses on two measurements: weight and height.
It is not gender specific.
It was created by a mathematician, not a healthcare professional.
The equation was created in the 1830s- a lot of new research on weight and health
status has been released since then.
It was created for populations, not individuals.
The categories of BMI are very rigid- only a decimal point can take you from underweight to normal weight, normal weight to overweight, and overweight to obese.
Weight stigma is present everywhere, for people of all shapes and sizes. Research has shown that exposing women to weight stigma leads to health complications, including increased levels of cortisol reactivity and oxidative stress (3). These findings were independent of BMI. High levels of oxidative stress can damage our cells and lead to inflammation in the body.
In particular to those with anorexia nervosa, weight stigma has led them to delay seeking treatment (3). This is significant as having a low body weight puts one at risk for many health conditions, including a weakened immune system, osteoporosis, amenorrhea in women, muscle loss, cardiovascular distress, gastrointestinal complications, and dehydration, amongst many other concerns.
Weight stigma is present almost everywhere and affects people of all body types and body sizes. The idea of BMI may contribute to this stigma as it categorizes people’s health solely based on height and weight. There are many other indicators of health that have nothing to do with weight, including: energy levels, sleep adequacy, lab values, and mood, including many others. As society, we need to change the language of what health stands for and work to eliminate weight stigma.
References:
People with certain medical conditions. National Center for Immunization and Respiratory Diseases (NCIRD), Divison of Viral Diseases. 2020. Retrieved from https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-with-med ical-conditions.html
Sissi, C., Moineddin, R., Urquia, M.L., Razak, F., Ray, J.G. J-shapedness: an often missed, often miscalculated relation: the example of weight and mortality. J Epidemiol Community Health. 2014;68:683-690. doi: 10.1136/jech-2013-203439.
Puhl, R., Suh, Y. Stigma and eating and weight disorders. Curr Psychiatry Rep. 2015;17:10. doi: 10.1007/s11920-015-0552-6