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"I am not cutting in line. I am exactly where I was told to stand."

By Reina Sultan
Feb 26, 2021 @ 3:38 pm
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BMI Vaccine Story
Credit: Yulia Reznikov/Getty Images

Lynne Gerber, a 52-year old fat liberationist and independent scholar in San Francisco, knows how to advocate for herself at medical appointments, despite the fatphobia that permeates the field. That said, she still cries and shakes each time she goes to the doctor. 

She is not alone: In fact, many fat people's reaction to medical fatphobia is to avoid seeking medical care altogether.

"I know that I'm unlikely to seek medical treatment even when I know that something's wrong," she says. "It's one of the things I've been most scared of with Covid – that I would get sick and not think it was bad enough to overcome my hesitation to go to the doctor until it was too late."

While the CDC warns that obesity does worsen Covid-19 outcomes, Lynne isn't convinced, noting there is still research to be done — particularly around triaged care. Because of fatphobia in medicine, however, she's supportive of taking advantage of the new eligibility guidelines that allow people with obesity to receive the vaccine earlier than their thin peers. This is a decision Lynne has made despite both her disappointment at the use of BMI — an archaic, racist, and largely discredited tool — to measure obesity, and the shame from thin people who see her and other fat people as "cutting the line."

"The reality of fatphobia in the healthcare system and the likelihood of poor treatment is reason enough for a fat person to take the medical qualification and get vaccinated sooner than later," she says. 

As the United States marks 500,000 deaths from Covid-19, vaccine rollout continues across the country with more or less success. According to the CDC, 17% of American adults have received at least one dose of the vaccine, after months of shortages, expiring vaccines, and overall confusion. Most states have been expanding vaccine eligibility in phases: First to healthcare workers, seniors, restaurant workers — and now, to people with comorbid conditions.

In several states, a specific BMI is listed as a so-called condition that makes one eligible for the vaccine. People in several states — including New Jersey, California, and my state of New York — suddenly realized we were eligible based on an outdated tool. Our reactions were understandably mixed, varying from excitement at being prioritized in a field that has historically mistreated us, to guilt over feeling like we were taking spots away from more vulnerable people, to shame about our bodies. 

Like Lynne, Adrie, 27, was motivated to get vaccinated by fatphobia in medicine. She assumed she would qualify for the vaccine in Philadelphia based on the fact that she has asthma, and "was annoyed at first" because she felt that her underdeveloped lungs were the "real" risk factor for Covid-19, not her weight. Upon further reflection, though, Adrie realized that this was an opportunity she needed to take advantage of. Medical fatphobia has affected her ability to get good care from doctors in the past:  It took her 11 years to get a breast reduction because doctors would not treat her until she tried to lose weight. "I am a Black woman and 'clinically' overweight, and I've spent my adult life trying to convince doctors to take me seriously about the body that I inhabit every day," she says, "I guess I should take advantage of it for the first time in my life." 

Stigma around fatness made it difficult for Olivia Zayas Ryan, 24, to accept her eligibility. As someone with an eating disorder, she hesitated to even calculate her BMI. "I don't weigh myself at all because of my eating disorder, and I was really worried that weighing myself would be even more triggering for me, but ultimately I decided this: My fear of contracting or giving Covid should be greater than my fear of being 'obese.'"

Even though she knows that BMI is not an accurate measure of health, she's struggled with eating disorder triggers since calculating hers. Regardless, she says, "I hope that people who do realize that they are eligible because of BMI are also surrounded by people and messaging that remind them that this number means absolutely nothing, and that they should get vaccinated because medical fatphobia makes them vulnerable."

When *Sarah, 25, realized that she qualified for the vaccine in New York City, she felt shame upon realizing she was considered "obese." 

"Yes, there was a sliver of excitement that I could get the vaccine because it meant I could safely see my family members once they are vaccinated ," she said, "[but] there is a lot of guilt and feelings associated with it. I've always had a weird relationship with my body. It's ebbed and flowed over the years, but recently has taken a dive." 

To make matters more emotionally complicated, one of Sarah's friends accused her of using her BMI to cut the line for a vaccine. Luckily, when she went in for her appointment, Sarah found that it was a relatively painless process without judgement, during which she wasn't required to present a doctor's note or have any metrics checked.

Chelsey, a 33 year old from New Jersey, was also relieved to discover that the clinic experience was pleasant. As someone who has been fat most of her life, she's experienced fatphobia that she's said has worsened during the pandemic.

"Now medical professionals and elected officials are pointedly telling fat people they're at risk for more severe illness. People took it as permission to say whatever the hell they wanted under the guise of 'concern' for strangers' health status," says Chelsey, which is why she was worried about going to get the vaccine. She was expecting "side glances (at best) and full on confrontation (at worst)." Instead, she said the healthcare workers and volunteers were polite and friendly, only asking if she'd ever had Covid or not. 

"Medical ableism, racism, misogyny, fatphobia, and transphobia all run rampant — and California medical providers are no exception," says Tory, 27, referring to a since walked-back rule in California that vaccines would be distributed based on "clinical judgment" rather than disability and high-risk conditions (including BMI). "I'm a fat queer disabled woman – would 'clinical judgment' mean medical providers would decide it's not worth vaccinating me, because they don't see disabled people and fat people and queer people as having lives worth living?" 

Fat people are constantly demonized by medical professionals and by their peers. Despite having a diagnosed lung problem and an eating disorder, Tory hears "constantly" that being fat is the reason why she's sick. 

Medicine isn't designed for fat people — and neither is American society. Erika, 23, from Austin, Texas says the conversation about fat people and vaccines isn't an easy one for this reason. So many people see being fat as a choice, but "they don't see the medical disorders that stem from trying to lose weight in an unhealthy way. They've never been brushed off by a doctor because of their weight." Erika got her first dose already and says fat people should feel OK getting the vaccine without fear of judgement.

"I am not cutting in line. I am exactly where I was told to stand."

*Name has been changed.