COVID vaccine eligibility brings feelings of 'shame,' 'guilt' to some who meet BMI requirement

When states began to announce body mass index (BMI) would be a factor in determining early eligibility for COVID-19 vaccines, Sydney Greene experienced "a lot of complicated feelings," ranging from apprehension to shame.

"As someone who does have a high BMI and is considered by the medical field as obese, I felt a lot of complicated feelings about being a part of this group and once again being told that because of my weight, I'm unhealthy," Greene, a 24-year-old living in Austin, Texas, said.

Wil Williams, 28, shared a similar sentiment. Williams explained "being a fat person – so much of your life is already wrapped up in shame and being guilted because of your body."

“(I’m) trying to just accept myself. Accept that it is a good thing that I can get this vaccine, accept that it helps people and then try to unlearn all of this (shame and discomfort) with the resources that I know about," they added. "I don’t think that most people have this many thoughts about getting the COVID vaccine... And it’s exhausting.”

The BMI eligibility also sparked conversation on social media. Nirit Pisano, a licensed clinical psychologist and chief psychology officer at Cognovi Labs, said she is seeing an increase in "fat talk" that is wreaking havoc on self-esteem.

“It's not just select few people having this reaction but a huge backlash, a huge response happening around this eligibility of BMI," Pisano said. 

Some expressed excitement and gratitude that they could receive the highly sought after vaccine; 95.7 million vaccines have been administered in the United States as of Thursday.

"Just occurred to me that because my BMI permits me to get the vaccine tomorrow, and because the vaccination will enable me to protect myself and others, my thick thighs will in fact save lives," user @AudreLawdAMercy tweeted.

But many echoed Green and Williams' reactions.

Twitter user @MrsLFlower, for example, wrote, “I’ve been feeling a bit ashamed about sharing some really good news... yesterday I got my first dose of the vaccine. The shame comes from my BMI being one of the factors for me receiving it, but I’m working on my perception of this!”

“According to BMI numbers, I’m considered obese, which is a qualifying condition for an earlier vaccine... but also one I’ve spent my entire life absorbing the lesson of — namely that I’m a Fatty McFatterson who did this to herself, for shame, and probably deserves COVID,” Twitter user @pagooey wrote.

Pisano explained the shame around BMI stems in part from the idea of categorizing someone. 

"Labeling them, putting them in a box in a way, (saying) 'you are one thing,' can in general can be very difficult, very painful," she said, adding that the topic of weight itself can also trigger strong emotions, especially for "people who have struggled potentially around this or (who are) working hard towards health or towards sustaining a healthy weight." 

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BMI has long been a controversial measurement

For some, the complex feelings around the BMI eligibility stems from an issue with the measurement itself.

The Centers for Disease Control and Prevention explains that BMI is measured by taking a person’s weight and dividing it by their height.

The CDC says a high BMI "can be an indicator of high body fatness" but "is not diagnostic of the body fatness or health of an individual." 

An article published in the British Journal of General Practice labels the measurement as "overly simplistic."

"BMI fails to distinguish fat adequately from fat-free mass, such as muscle and bone and other bodily tissue," the journal states. 

In an article published in Nutrition Today, Frank Q. Nuttall, M.D., Ph.D., writes, "it is increasingly clear that BMI is a rather poor indicator of percent of body fat."

The faultiness of the measurement also added a layer of guilt for some who qualified based on their BMI. 

"Even though I'm considered fat, does that mean I should still get the vaccine? Are there other people who deserve it more than me?" Greene wondered.

Ultimately, she got vaccinated to protect herself and her community.

"If I interact with someone in my community who didn't have any access to get the vaccine, if I know they can be better protected because of me, then I feel a lot better," she said, explaining that she lives in a predominately Black and Brown community that has been deeply impacted by COVID cases.

Pisano advises people who are eligible but feeling apprehensive to "keep in mind the big picture" and "go out and get vaccinated."

"Realize (BMI) is just one piece... that gives you access to this vaccine, which is an important part of protecting yourself," she said. "This is just one small item, that happens to give you access here, but doesn't define the full picture of who you are."

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