Being overweight or obese in North Carolina is considered a high-risk medical condition that allows you to receive a coronavirus vaccine as part of Group 4 starting March 24.
But the metric behind that measurement is less straightforward.
The N.C. Department of Health and Human Resources bases its list of high-risk health conditions on guidelines released by the U.S. Centers for Disease Control and Prevention.
It also defines “overweight” and “obese” in accordance with the CDC’s recommendations, which consider anyone with a BMI between 25 and 30 to be overweight and anyone with a BMI over 30 to be obese.
“The CDC may update the list of high-risk conditions as scientists learn more about COVID-19, and NCDHHS will update the list accordingly,” spokesperson Catie Armstrong said.
In North Carolina, nearly 36% of adults are overweight and 29.7% are obese, according to the CDC. WalletHub, a personal finance website that regularly releases rankings on a wide range of issues, has said North Carolina is the 22nd most obese and overweight state in America.
What is BMI?
BMI stands for body mass index and is the measure of a person’s weight in kilograms divided by the square of height in meters.
The CDC has a BMI calculator for adults who are older than 20 as well as one for children and teens between the ages of 2 and 19. Users need only submit their height in feet and inches and their weight in pounds to calculate their BMI.
According to the CDC, a BMI for adults between 18.5 and 24.9 is considered “normal,” or a “healthy weight.”
BMI is often used as a screening tool for serious diseases, but it doesn’t necessarily indicate how healthy an individual is. A person with a lot of muscle, for example, might have a BMI over 25 “because of increased muscularity rather than increased body fatness,” the CDC says.
The British tabloid The Sun calculated Dwayne “The Rock” Johnson’s BMI as 30.7 in a 2018 article, which would make him obese by America’s standards. Vin Diesel and Arnold Schwarzenegger reportedly have a BMI of over 30 as well.
Dr. Robert Shmerling, an associate professor of medicine at Harvard Medical School, wrote in a blog for Harvard Health Publishing last year that BMI is “simply a measure of your size.”
“Plenty of people have a high or low BMI and are healthy and, conversely, plenty of folks with a normal BMI are unhealthy,” he wrote. “In fact, a person with a normal BMI who smokes and has a strong family history of cardiovascular disease may have a higher risk of early cardiovascular death than someone who has a high BMI but is a physically fit non-smoker.”
Why BMI determines vaccine eligibility
Using BMI as a measurement of obesity has historically helped health care professionals identify health risks.
People who are overweight or obese have an increased risk of high blood pressure, high cholesterol, diabetes, stroke, coronary heart disease, sleep apnea and breathing problems, according to the CDC.
Since the coronavirus pandemic hit in March, studies have shown a high risk of severe illness in people who contract the virus and are obese or overweight. The CDC says the “strongest and most consistent evidence” is found in people who are obese. There is, however, “limited evidence” associated with individuals who are overweight or have a BMI between 25 and 30.
Severe illness includes hospitalization, admission to an intensive care unit, intubation, ventilation or death, according to the CDC.
“The World Obesity Federation findings were near-uniform across the globe, the report said, and found that increased body weight was the second greatest predictor after old age of hospitalization and higher risk of death of COVID-19,” The Post reported.
Some with qualifying BMIs have been hesitant to get the vaccine out of a sense of guilt or shame. Recent articles published in Vogue and InStyle detail the accounts of women, in particular, who are dealing with “fatphobia” and “vaccine envy.”
Emma Specter, writing for Vogue, said she might not have told anyone she was getting the vaccine if she hadn’t already written about it, citing her “own anxiety around having a BMI high enough to qualify me for the vaccine” and the “offhanded comments I’ve heard and seen on social media about who ‘deserves’ the vaccine and who does not.”
“While we’re on the topic,” she wrote, “let’s say it for good measure: Not all underlying health conditions are immediately visible or legible in the way we’ve been socialized to recognize them, so trying to determine how someone you vaguely know qualified for the vaccine is not only rude and invasive, it’s also pretty futile.”
In an earlier article, pecter interviewed Fatima Cody Stanford, an expert on obesity at Harvard Medical School and Massachusetts General Hospital. Stanford said obesity is in part a “disease process” involving the hypothalamus and how our body regulates weight.
“When people look at patients that have obesity — whether it’s mild, moderate, or severe — they presume, ‘Oh, it’s something they did to themselves, and they got this way because of something they did.’ We don’t put that same thought processing or blame on individuals who have cancer,” she said in the article.
Health experts recommend getting the vaccine regardless, saying it makes you and those around you safer.
Jessica Stern, a clinical psychologist at NYU Langone Health, told the “Today” show “it’s not necessarily your responsibility to decide if you’re eligible or if you’re deserving of the vaccine.”
She said pushback on social media likely comes from “fear and hopelessness and anxiety” among those who haven’t yet received the vaccine or aren’t eligible.
“If you’re feeling like you’re not sure if you should take the vaccine when you’re offered it, just remember that you’re actually using a valuable vaccine that otherwise might not be going to use,” Stern said, according to “Today.” “You’re actually doing a good service to everyone around you by making sure that nothing goes to waste.”