Remember back in February when the media was babbling on about medical professionals debating over whether to call the “epidemic” of COVID-19 a “pandemic”? You couldn’t wipe the drool off of news anchors’ faces fast enough given the headline turbo fuel this created. OMG, a pandemic!!!

While we are stirred by the latest confusion of the day, inflamed, panic-filled, anxiety-ridden over COVID-19 and what it actually is, where and how it began, increased and decreased and seemingly always inaccurate numbers, how best to treat it – this medicine works, no it’ll kill you, shelter-at-home quarantines that are necessary – no they aren’t, wear a mask – no don’t, dogs can catch it – no they can’t, the disease only travels 6 feet – no it can travel farther, the tests are accurate – no they aren’t, schools should re-open – are you crazy no they shouldn’t, and the list goes on and on. And let’s not forget sunlight and antacids will cure it, and the fear instilled by that “second wave” prediction. 

The economy, our education system, social relationships and mental health are eroding as we scratch our heads, but only after we’ve sung Happy Birthday twice while first washing our hands. The CDC tells us that earlier this week there were 981,246 total cases of COVID-19, with 55,258 total deaths.

There are other pandemics in our lives absent the emotional dread, horror and terror-filled fluster COVID-19 has been whipped up into in our lives. I’m talking about the disease of obesity. The CDC tells us that according to the National Health and Nutrition Examination Survey “in 2017–2018, the age-adjusted prevalence of obesity (a BMI of 30 or more) in American adults was 42.4%…” The rate of those with severe obesity, a BMI of 40 or greater, has nearly doubled from 4.7% in 2000 to 9.2% currently. 

Obesity is linked to the most prevalent and costly, chronic and disabling, often fatal, medical problems seen in our country, including type 2 diabetes, hypertension, coronary artery disease, many forms of cancer, and cognitive dysfunction.  At least 2.8 million adults die each year as a result of overweight or obesity. 44% of the diabetes burden, 23% of the ischemic heart disease burden and between 7% and 41% of certain cancer burdens are attributable to overweight and obesity. Still, no alarms, no terror, no shock.

Worldwide obesity prevalence has tripled since 1975 according to the World Health Organization. 50 years ago about 1 in 100 American adults were severely obese. Now the condition has exploded and is 10 times more common. The Woodruff Lab claims that during this year, 2020, “83% of men and 72% of women will have overweight or obesity.” They warn, “Obesity projections worse than terrorism threat for future…”

Worse than terrorism. Where’s the panic, the horror, the rattled nerves? There isn’t any. We are faced with appalling predictions from Harvard University and George Washington University that within this decade nearly one in two adults will have obesity and nearly one in four will have severe obesity. The economic cost of obesity has been estimated to be at 5–14% of health expenditure for 2020–2050. 

AMA “Recognizing obesity as a disease will help change the way the medical community tackles this complex issue that affects approximately one in three Americans”  

WHO “Obesity is a chronic disease, prevalent in both developed and developing countries, and affecting children as well as adults” 

Obesity Society “…obesity is a serious chronic disease with extensive and well-defined pathologies, including illness and death” 

Obesity Medicine Association “…a chronic, relapsing, multi-factorial, neurobehavioral disease, wherein an increase in body fat promotes adipose tissue dysfunction and abnormal fat mass

Among many healthcare issues, obesity is one of the most difficult to manage.  No-one has found the correct solution because there is no one solution. This disease is caused by multi-factorial bio-psycho-socio-neurobehavioral influences and continues to grow unabated. What’s not worked among many interventions, are naïve, amateurish urgings to simply lose weight, to “eat less and exercise more,” to “buy this diet, not that one.”

Now with COVID-19, obesity is coming to the headlines once again.

The CDC informs us, “Based on currently available information and clinical expertise, older adults and people of any age who have serious underlying medical conditions might be at higher risk for severe illness from COVID-19.” A recent study in the International Journal of Obesity reported that those with obesity tend to get more severe forms of infections other than coronavirus. Those with obesity fared worse in 2009 with the H1N1 flu epidemic and we know that those with obesity who were infected with influenza shed the virus for longer periods of time. Obesity impacts the functioning of lungs, affects the immunity system, both implicated in more serious outcomes of coronavirus infection. And in turn, COVID-19 appears to be preventing those with obesity from receiving treatment for obesity, while enforce physical distancing may be keeping many with obesity from proper nutrition and physical activity.

So where are the distress signals, the daily press briefings, the drastic measures, the significant interventions? Obesity is far more prevalent and is related to far more deaths than COVID-19. Where is the concern? 

Obesity is recognized as one of the most pressing public health issues of our time. While it has changed the face and practice of healthcare, those  working with obesity more and more are recognizing the need for a reshaped culture and approach to this population. Why?

For too long, an ignored part of helping those with obesity are the social determinants of health that those individuals with obesity face, including bias, prejudice, and discrimination…with their demonstrated negative impact on physical and emotional health. Types of weight bias that are commonly seen include stereotypes that those with obesity are noncompliant, lazy, lacking in self-control, weak willed, unsuccessful, unintelligent, and dishonest. Unlike COVID-19, simply stated, those with obesity are blamed for their disease.

Weight bias according to Rebecca Puhl and Christopher Wharton, “generally refers to negative attitudes and beliefs about body weight that are expressed in the form of stereotypes, stigma, prejudice, and unfair treatment toward children and adults because they have overweight or obese. Weight bias can be displayed in multiple forms, including verbal comments (e.g., derogatory remarks, negative stereotypes), physical aggression, and social exclusion or avoidance. Thus, it can be expressed in both subtle and overt ways.” 

These authors add, “Weight bias may compromise the quality of health services provided to those with obesity, lead to decreased health care use, negatively affect psychosocial well-being, and increase vulnerability to lifestyle behaviors that only further contribute to obesity. All of these factors lead to reduced quality of life.”

The World Health Organization defines weight bias as “negative attitudes toward, and beliefs about others because of their weight.” Weight bias can lead to obesity or weight stigma. Obesity stigma involves actions against people with obesity, including language that can cause exclusion and marginalization, impacting one’s decision to join a gym and seek healthcare or weight loss assistance.

According to the Obesity Treatment Foundation and the Obesity Action Coalition, weight bias includes stereotyping that leads to stigma, rejection, prejudice and discrimination. It may be verbal, physical, relational or cyber and is either subtle or overt.

These organizations point out that stigma and bias prevent people affected by obesity from seeking care. They point out that stigma and bias are the “last socially acceptable forms of discrimination,” and serve as an obstacle in efforts to effectively combat the disease of obesity.

Perhaps in the end, the real pandemic is stigma and bias.