Starting March 15, California is changing the rules for who can get in line for a COVID-19 vaccine. The move adds people with a number of health conditions, including severe obesity.
Experts say the change will vastly expand eligibility in California, particularly in communities of color.
Only people with a body mass index of 40 or higher are included on the new list, which also includes people with cancer, Type 2 diabetes and compromised immune systems. Multiple recent studies have found that obesity is a predictor for COVID-19 hospitalization, though some nutritionists have criticized the metric.
The BMI measure is based on height and weight. For example, someone who is 5 feet, 7 inches tall would have to weigh about 256 pounds to meet the threshold. Other states have opened vaccination to people with a BMI as low as 30.
Anyone can calculate their BMI online using the U.S. Centers for Disease Control’s calculator tool, but state health officials say it will ultimately be up to doctors to decide which of their patients to prioritize for vaccines. The state says people who schedule appointments at pharmacies or mass vaccination clinics will be asked to show a “form of verification” about their health condition, but has not provided further details.
In California, obesity affects one quarter of white adults, 33% of Black adults, 34% of Hispanic adults, 29% of American Indian/Alaskan Native adults and 10% of Asian adults, according to a Kaiser Family Foundation analysis of 2019 CDC data.
CapRadio talked with Denise Payán, an assistant professor of public health at UC Merced, about how those trends factor into the vaccination rollout.
On using body mass index as a criteria for COVID vaccination
I am really excited that we're at the point in California where the eligibility criteria is also covering people who are adults, but under the age of 65, who are at highest risk for severe illness of COVID-19.
[BMI] does correspond to higher risk of being hospitalized or dying from COVID-19, is what the research has found. So this just really supports the recommendation. And so in California, again, it's going to be severe obesity first. But I would think that in the future, it would kind of go down, for people who have a lower BMI but who are obese, to get vaccinated.
On why obesity increases a person's risk of complications from COVID-19
It speaks to malnutrition, and so people who are obese may be at higher risk of malnutrition as well.
Food insecurity has gotten much worse during COVID-19. And so access to healthy, fresh, nutritious food has really been disrupted. So there are more people who are at risk and are missing out and don't have access to healthy food. That could be perceived as a way of helping your immune system fight disease and fight COVID-19 as well.
Communities who have higher risk of obesity also have higher risk of some other conditions. So they kind of go hand in hand, it’s also a risk factor for Type 2 diabetes and cancer and other conditions that also interact and, you know, make it more difficult for your immune system to fight off the condition.
On communities hardest hit by the conditions on the new list
Black and Latino communities disproportionately have much higher rates of obesity and some of these chronic illnesses, including Type 2 diabetes, some heart conditions. So it's really going to be critical that Latino and Black communities are reached and have access to the vaccine … as soon as possible.
Something else that's important to think about is the reasoning of being at higher risk of obesity. There are so many structural issues. Some of the work I do focuses on the role of the built environment. Certain communities, because of disinvestment, also structural racism and other components ... it does influence what fresh fruits and vegetables or recreational facilities are accessible and safe in your neighborhood. And people are just spending so much more time in their neighborhood during the pandemic because we are at home, working from home or taking care of children who aren’t in school.
On ensuring an equitable roll-out
Right now, this new eligibility criteria, it's really promising. But one of the recommendations is to contact your health care provider. And in communities that are less likely to have health care providers ... having community fairs, going to communities with high percentages of Black and brown individuals … will be really critical for an appropriate rollout, to actually give people who are suffering from these racial, ethnic disparities the chance to get vaccinated.
I just want to encourage these communities — there may be hesitation — but it’s really important for yourself, your family, if you are at high risk of severe illness, to get vaccinated.
Correction: In a previous version of this story UC Merced Assistant Professor of Public Health Denise Payán was misquoted. It has been corrected.
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