I live in New York state, which in February opened up eligibility to people with a Body Mass Index (BMI) of 30 or higher. When my roommate told me about BMI eligibility, I weighed myself for the first time in years and wasn't surprised to find I made the cut. I would've qualified before the pandemic, but -- ironically -- my extra Covid-19 pounds put me more solidly in range.
At first, I thought that I would not sign up for a vaccine appointment because there is nothing wrong with me. I didn't want to take a slot from someone who actually needed it.
But there is clear evidence connecting Covid-19 outcomes and weight. Studies have found that coronavirus death rates are higher in countries with higher rates of obesity. And while having a higher BMI does not increase the chances of contracting Covid-19, it has been linked to a greater risk of becoming seriously ill from the disease.
Within a few weeks of the pandemic spreading in the UK, general practitioner Dr. Natasha Larmie started to see the first published studies linking poor Covid-19 outcomes with obesity.
"All that that showed was that there were more obese people suffering with sort of serious Covid than there were non-obese people," Larmie, who is working to end weight stigma in medicine, told me.
"I am never going to deny that that is an issue because the facts speak for themselves. The problem is that people then went on to assume that it was the obesity that was causing these poor Covid outcomes."
There are many factors that contribute to and influence weight, Larmie noted, factors most of the studies so far have left out. They include social determinants like poverty, education, access to health care, and even weight stigma itself.
Studies show that weight stigma can result in delayed or misguided treatment for people with high BMIs and can cause some to avoid the doctor altogether. No complete conclusion can be drawn about obesity without considering these details, and no one's weight is a complete picture of who they are.
The BMI metric was first used in the 1800s for population studies, and it doesn't measure excess fat or account for body shape, weight distribution or muscle mass. It was never meant to be used as an individual assessment. But it's easy to calculate and widely used worldwide, which makes it convenient for vaccine distribution.
Larmie doesn't think very highly of using BMI as a medical tool. If it were up to her, she said, obesity wouldn't be considered a medical condition at all.
"If I want to diagnose diabetes, I look at your blood sugar, you'll be able to see and there's a cutoff. If I want to diagnose gallstones, I give you an ultrasound scan. If I want to diagnose cancer, we have to do a biopsy and look at it underneath a microscope," she said. "If I want to diagnose obesity, the only way right now to diagnose it is to use the Body Mass Index."
As empowering as Larmie's approach is, I still felt deeply conflicted about signing up for a vaccine appointment. I alternated between shame at qualifying for something because I'm fat, and outrage at how fatness is based on such an outdated, unspecific standard.
The thought of showing up somewhere and publicly "admitting" to being obese was nearly insurmountable. That's thanks to the weight-based stigma and derision that has come from my closest loved ones, my doctors and society. Was bowing to my BMI tantamount to letting them win?
Aurielle Marie, a cultural strategist who advocates for and consults on body positivity in the United States, helped me sort through this internal conflict.
"I think that I'm able to hold two truths at the same time," they told me. "And those two truths are I want access to a vaccine that is proven to keep people ... safer. And the other truth is that I don't agree with the system that has told me that my body is a risk, and I don't prioritize their understanding of fatness over my own, even though their understanding of fatness grants me access to the vaccine."
Aurielle Marie asked not to include their last name due to online harassment. They have, unfortunately, learned a lot about dealing with the health care system from personal experience, like when a doctor refused to investigate the cause of their pain further until they lost weight, because he said it would be expensive and a waste of his time.
Since then, Aurielle Marie is their own strongest advocate in the doctor's office. They've actually started going into medical appointments by telling the provider they know they're fat and to please skip the monologue. Aurielle Marie says it both eliminates time spent on a topic they're not at the doctor to address and helps them gauge how a provider is going to treat them.
Their take on my vaccine anxiety? Go get what you qualify for. "Feel no shame and feel no fear in getting into line for the vaccine because we're not jumping line or we're not jumping ahead of someone else, quote unquote, more worthy. We are standing at the spot that someone told us to be in because of our body size," they said.
Ultimately, I agreed. I got my first dose of the Pfizer vaccine earlier this month. My next dose is on April 7. I didn't make the rules that allowed me this measure of security and peace of mind after a devastating pandemic year, and I'm not doing anything wrong by following them.
My body is no less deserving of health and protection than anyone else's just because of its size. These words are easy to write but believing them is a lifelong struggle I'm not sure I'll ever win. All I know for sure is that it's worth it to try.