Contemporary English speaking media and popular medical discourses on Covid-19 have been notable in their stigmatization of fatness by implicitly and explicitly arguing that susceptibility to Covid-19 is causally increased by fatness qua fatness. This is accomplished by the assertion that a causality exists between BMI, a problematic gage on its own, and comorbidities like cardiovascular disease, diabetes, and asthma. Headlines like “HEAVY BURDEN: The truth about obesity and coronavirus – from ‘crushed lungs’ to organ failure as bodies put under ‘severe strain'” (Pocklington 2020), and “Coronavirus: Obese people at greater risk of death and may stay infectious for longer” (Urwin 2020), are indicative of a media landscape that relies on ambiguous and ill-communicated science to produce clickbaity headlines that are both harmful and misleading.
This short article is less an exegesis on the science itself, i.e. whether it is, in fact, the case that medically-defined obesity is causally connected to co-morbidities that worsen Covid-19’s impact, and more of a discussion of the harms this discourse has on fat bodies – particularly on those that identify or are gendered as female (I use the term female rather than women throughout in order to reflect media usage). I thus examine the myriad ways in which a particular conception of medical risk, characterised by pathologizing rhetoric, the discounting of socio-economic determinates of health, and neoliberal responsibilisation, are harmful. In light of this, a distinction must be made between the argument that metabolic disorders are predictive of worse health outcomes with respect to Covid-19 (Bansal 2020; Clerkin et al 2020), and the assertion that medically defined obesity is itself the cause of said disorders and thus a visible indicator of risk and danger. For me, it is the visibility of fatness, coupled with implied causality, that is of particular concern.
What is important in this piece are the consequences of how current media and medical discourses on Covid-19 and fatness draw on biomedical discourse to normalize particular kinds of bodies over others by pathologizing fatness, papering over the ways in which ill-health is a product of structural and socioeconomic discrimination, and mobilizing neoliberalism in order to frame ill-health as the result of ones’ own bad choices. This results in the multiplication of oppression by responsibilising health onto individuals and into the private sphere. The gendered elements of each of these are discussed in what follows.
First, a short discussion is required with respect to the degree to which causality is being asserted between Covid-19 severity, mortality, and BMI designated obesity over and above a few headlines. On the side of medicine, there are already dozens of peer review articles that use the language of obesity as a kind of shorthand for metabolic disorders to assert that fatness is strongly correlated with worse health outcomes for Covid-19 patients (Dietz and Santos-Bugoa 2020; Yang, Hu, and Zhu 2020). While some are careful in the language they use by, for example, highlighting cases in which clinically obese patients that develop pneumonia have better health outcomes and reiterating the fact that more than just BMI is needed to assess risk, their headlines and the attendant media coverage of their findings betray a strong anti-fat bias based on the conflation of bodily comportment with ill health (Stefan et al 2020; Sattar, McInnes and McMurray 2020). With respect to media, as the headlines above indicate, a similar framing of fat bodies as a social problem that contributes to yet another health crisis is present and made effective through the linking of the war on obesity with the war on Covid-19.
Feminist discussions of the body are rooted in the belief that the body is political and a site of both oppression and liberation (Bordo, 2004; Bartky 2015). Normalization of the idea that some bodies are better than others by connecting fatness with illness plays out materially in discussions around Covid-19 where the obesity-morbidity/mortality nexus has become entrenched. This, in turn, reproduces socially constructed beliefs about appropriate and desirable forms of identity and subjectivity in which “slimness is associated with health, beauty, intelligence, youth, wealth, attractiveness, grace, self-discipline, and goodness,” and “Fatness and obesity are by contrast associated with ugliness, sexlessness, and undesirability but also with specifically moral failings, such as a lack of self-control, social irresponsibility, ineptitude, and laziness” (Brewis et al 2013, 269; Bordo 2004; de Vries 2007). For females, the association of fatness with immorality and deviancy is especially pronounced such that it, when coupled with medical expertise, results in the reification of the belief that to be fat is to be a risk to oneself and others (Skeggs 2005; Foucault 1979). This is a novel addition to the study of fatness wherein medically defined obesity is seen as not only a social drain, and indicative of individual failing, but as a site of danger – what Vrecko refers to as ‘risky bodies’ (Vreko 2016). A similar kind of biomedical Othering occurs in relation to racialised minorities and non-citizens (Adeyanju and Neverson et al 2007). The result is a discursive compounding effect with tangible real-world implications such that so-called obese individuals are simultaneously blamed for their own situation and feared by society as a vector of disease.
Structural and socioeconomic racism act as forcing modalities of oppression which, when combined with anti-fatness and fears related to Covid-19, result in the elision of the causes of ill health which can be traced to factors other than race, gender, and weight. In particular, it should be emphasized that asthma and metabolic disorders like hypertension and diabetes associated with higher rates of death and/hospitalization due to Covid-19 are less an outcome of individual choice and more a function of complex social arrangements under which being raced and fat results in negative health outcomes (Johnston 2020; Schiffrin et al 2020). This includes living in close proximity to environmental hazards, high rates of poverty, lack of access to fresh food, little room to move one’s body, and an inability to obtain timely and good quality health care (Pulido 2017; Adler, Glymour, and Fielding 2016). As Meltzer et al argue, it is “economic and social marginalization that render certain populations at “greater…[risk for] chronic disease and associated risk factors” (Meltzer et al 2020). Vis-à-vis Covid-19, it would behoove researchers and those in the media to carefully examine how the structural determinants of health give rise to co-morbidities that place certain populations at risk not because of physical characteristics or identities, but because of socio-economic marginalization and a stigmatizing medical system that pathologizes race and fatness as well as gender. Going forward, it will be important, for instance, to replicate studies that show how individuals gendered as female, particularly fat females, raced males, and nonbinary individuals, experience discrimination in health care settings around Covid-19 diagnosis and care (Laurence and Weinhouse 1997; FitzGerlad and Hurst 2017).
Literature on the relationship between neoliberalism and anti-fat bias due to Covid-19 is scarce. However, I predict it is on course to increase sharply. Neoliberalism, to be clear, is an economic ideology that favours deregulation, individual responsibility and free markets which, in the domain of health care, has resulted in the gutting of social safety nets and the responsibilization of individuals to take care of themselves. According to Lupton, this produces “technologies of the self” wherein individual health practices are “viewed as a moral enterprise relating to issues of self-control, self-knowledge, and self-improvement” (Lupton 1999, 91). This plays out in recommendations about solutions to Covid-19 and associated risk which, as discussed in a recent article in Forbes, continues to centre around “lifestyle modifications, medical treatment, or bariatric surgery” inclusive of “exercise and proper diets” that treat obesity itself (i.e. via fat loss) rather than improved metabolic health through structural change (Yee 2020).
This manifestation of neoliberalism is intensified with respect to the female caring role which is significant here since it speaks directly to the reality of lived experiences. Being a fat mother, for example, is pathologized as a dereliction of duty reflective of bad individual choices and as having negative knock-on effects on children (i.e. leading to childhood obesity) (Power 2016). As such, mothers who do not “comply with… time- and energy-intensive methods of childrearing…[are seen as] suspect” (Zivkovic et al 2010, 385). The intersection of mothering and obesity is also racialised – particularly with respect to Black females for whom “tropes of black women as insatiable, lazy bad mothers who deplete the state and economy” are, when combined with Covid-19, likely to result in the further marginalizing of BIPOC females and identify them personally blameworthy (Sanders 2019, 1; Cottom 2018; Stings 2019).
This overlapping of fatness, gender, and race leaves raced, fat females triply stigmatized and, given current trends, is likely to become more pronounced in Covid-19 research, media coverage, and public discourse. Elements are already present in media and science explainers that make a cognitive leap from “self-initiated” fatness to ill health and then the risk of Covid-19. A prime example can be found in a recent BBC story which reductively states that the reason fatness is a risk factor for Covid-19 is that, “The more overweight you are, the more fat you’re carrying, the less fit you are and the lower your lung capacity” leading to the need for “assistance with breathing and support function” (BBC 2020). This rhetoric does not account for the complex relationship between body weight, illness, and mortality, and, as evidenced by research in feminist and critical fat studies, “erroneously present[s] correlations as if they were causations” (O’hara and Taylor 2018, 7; Campos 2004; Bard and Wright 2005).
The effect of this uncritical elision of scientific complexity coupled with neoliberal health discourse produces a permission structure for discrimination based on bodily comportment. Moreover, neoliberal Covid-19 science communication and media coverage, paradoxically, undermines the very autonomy it professes to be working towards. As McNay argues, “the remodeling of the subjective experience of the self around an economized notion of enterprise subtly alters and depoliticizes conventional conceptions of individual autonomy. Individual autonomy becomes not the opposite of, or limit to, neoliberal governance, rather it lies at the heart of its disciplinary control” (McNay 2009, 62).
Taken together, this amalgamation of fat stigma with Covid-19 panic has resulted in materially impactful media and medical discourses that are harmful to females and racialised minorities. The mixture of pathologizing rhetoric that elevates some bodies over others, a generalised discounting of the socio-economic determinates of health, and the rise of individualising neoliberal discourses work to socially construct Covid-19 as a disease of the unfit and the irresponsible female. Further, data-driven research establishing the persistence and harm of this rhetoric is needed, as is the cultivation of resistance-oriented counter-discourses. While I am working on the former in my own research, I turn to activists like Finn Gardiner for the latter who, in a recent article for Disability Visibility Project, eloquently argues that “The devaluation of marginalized bodies and minds leads people in power to treat our lives as expendable if we don’t–or can’t–meet their criteria for ‘normality.'” They call for a humane healthcare policy that “looks beyond actuarial tables and at the complex social, material, and medical realities in which we [the marginalized] live” (Gardiner 2020). Doing so requires active work, but ignoring these spaces of oppression will result in a pandemic recovery that leaves many of us behind.
Adeyanju, Charles T., and Nicole Neverson. “‘There will be a next time’: Media discourse about an ‘apocalyptic’ vision of immigration, racial diversity, and health risks.” Canadian Ethnic Studies 39, no. 1-2 (2007): 79-105.Adler, Nancy E., M. Maria Glymour, and Jonathan Fielding. “Addressing social determinants of health and health inequalities.” Jama 316, no. 16 (2016): 1641-1642.
Bansal, Manish. “Cardiovascular disease and COVID-19.” Diabetes & Metabolic Syndrome: Clinical Research & Reviews (2020).
Bartky, S.L., 2015. Femininity and domination: Studies in the phenomenology of oppression. Routledge.
BBC. “Coronavirus: Does being overweight or obese affect how ill people get?” BBC. May 8 2020. https://www.bbc.co.uk/news/health-52561757.
Bordo, Susan. Unbearable weight: Feminism, Western culture, and the body. Berkley: University of California Press, 2004.Brewis, Alexandra A., Amber Wutich, Ashlan Falletta-Cowden, and Isa Rodriguez-Soto. “Body norms and fat stigma in global perspective.” Current Anthropology 52, no. 2 (2011): 269-276
Campos, Paul F. The obesity myth: Why America’s obsession with weight is hazardous to your health. Penguin, 2004.
Clerkin, Kevin J., Justin A. Fried, Jayant Raikhelkar, Gabriel Sayer, Jan M. Griffin, Amirali Masoumi, Sneha S. Jain et al. “Coronavirus disease 2019 (COVID-19) and cardiovascular disease.” Circulation (2020).
Cottom, Tressie McMillan. Thick: and other essays. New York: The New Press, 2018.
De Vries, Jantina. “The obesity epidemic: medical and ethical considerations.” Science and Engineering Ethics 13, no. 1 (2007): 55-67.
Dietz, William, and Carlos Santos‐Burgoa. “Obesity and its Implications for COVID‐19 Mortality.” Obesity 28, no. 6 (2020): 1005-1005.
FitzGerald, Chloë, and Samia Hurst. “Implicit bias in healthcare professionals: a systematic review.” BMC medical ethics 18, no. 1 (2017): 19.
Gard, Michael, and Jan Wright. The obesity epidemic: Science, morality and ideology. Milton Park, Abingdon: Routledge, 2005.
Gardiner, Finn. “Fatphobia, Ableism, and the COVID-19 pandemic.” Disability Visibility Project. March 2020. https://disabilityvisibilityproject.com/2020/03/30/fatphobia-ableism-and-the-covid-19-pandemic/
Johnston, Sebastian L. “Asthma and COVID‐19: is asthma a risk factor for severe outcomes?” Allergy (2020).
Laurence, Leslie, and Beth Weinhouse. Outrageous practices: how gender bias threatens women’s health. New Jersey: Rutgers University Press, 1997.
Lee, Bruce Y. How can obesity affect your COVID-19 Coronavirus risk? Here are some possibilities. Forbes. April 26 2020. https://www.forbes.com/sites/brucelee/2020/04/26/how-can-obesity-affect-your-covid-19-coronavirus-risk-here-are-some-possibilities/#6c02371d690f
Lupton, Deborah, ed. Risk and sociocultural theory: New directions and perspectives. Cambridge: Cambridge University Press, 1999.
McNay, Lois. “Self as enterprise: Dilemmas of control and resistance in Foucault’s The Birth of Biopolitics.” Theory, Culture & Society 26, no. 6 (2009): 55-77.
Meltzer, Gabriella Y., Beverly-Xaviera Watkins, Dorice Vieira, Judith T. Zelikoff, and Bernadette Boden-Albala. “A Systematic Review of Environmental Health Outcomes in Selected American Indian and Alaska Native Populations.” Journal of Racial and Ethnic Health Disparities (2020): 1-42.
O’hara, Lily, and Jane Taylor. “What’s wrong with the ‘war on obesity?’ A narrative review of the weight-centered health paradigm and development of the 3C framework to build critical competency for a paradigm shift.” Sage Open 8, no. 2 (2018): 2158244018772888.
Pocklington, Rebecca. “HEAVY BURDEN: The truth about obesity and coronavirus – from ‘crushed lungs’ to organ failure as bodies put under ‘severe strain.'” The Sun. May 15 2020. https://www.thesun.co.uk/news/11605412/truth-obesity-coronavirus-crushed-lungs-organ-failure/
Power, Elaine. “Fat children, failed (future) consumer-citizens and mothers’ duties in neoliberal consumer society.” Neoliberal governance and health: Duties, risks, and vulnerabilities (2016): 43.
Pulido, Laura. “Geographies of race and ethnicity II: Environmental racism, racial capitalism and state-sanctioned violence.” Progress in Human Geography 41, no. 4 (2017): 524-533.
Sanders, Rachel. “The color of fat: racializing obesity, recuperating whiteness, and reproducing injustice.” Politics, Groups, and Identities 7, no. 2 (2019): 287-304.
Sattar, Naveed, Iain B. McInnes, and John JV McMurray. “Obesity a risk factor for severe COVID-19 infection: multiple potential mechanisms.” Circulation (2020).
Schiffrin, Ernesto L., John M. Flack, Sadayoshi Ito, Paul Muntner, and R. Clinton Webb. “Hypertension and COVID-19.” American Journal of Hypertension 33, no. 5 (2020): 373-374.
Stefan, Norbert, Andreas L. Birkenfeld, Matthias B. Schulze, and David S. Ludwig. “Obesity and impaired metabolic health in patients with COVID-19.” Nature Reviews Endocrinology (2020): 1-2.
Strings, Sabrina. Fearing the black body: The racial origins of fat phobia. New York: NYU Press, 2019.
Urwin, Rosamund. “Coronavirus: obese people at greater risk of death and may stay infectious for longer.” The Sunday Times. May 3 2020. https://www.thetimes.co.uk/article/coronavirus-obese-people-at-greater-risk-of-death-and-may-stay-infectious-for-longer-9vk9qgv2l.
Vrecko, Scott. “Risky bodies, drugs and biopolitics: On the pharmaceutical governance of addiction and other ‘diseases of risk'” Body & Society 22, no. 3 (2016): 54-76.
Yang, Jun, Jiahui Hu, and Chunyan Zhu. “Obesity aggravates COVID‐19: a systematic review and meta‐analysis.” Journal of medical virology (2020).
Zivkovic, Tanya, Megan Warin, Michael Davies, and Vivienne Moore. “In the name of the child: The gendered politics of childhood obesity.” Journal of Sociology 46, no. 4 (2010): 375-392.