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CONVERGE COVID-19 Working Groups for Public Health and Social Sciences Research
Research Agenda-Setting Paper
This paper was written to help advance convergence-oriented research in the hazards and disaster field. It
highlights areas where additional research could contribute new knowledge to the response to and recovery
from the pandemic and other disasters yet to come. Questions about the research topics and ethical and
methodological issues highlighted here should be directed to the authors who contributed to this paper.
Working Group Name:
Ethics, Equity, and Risk for Higher Weight People
Working Group Description:
This Working Group brings together a multi-disciplinary team of experts in academic, activism, and law, to
address ethical and justice issues relating to the experience of higher weight people during the COVID-19
pandemic. Public health emergencies typically hit vulnerable groups hardest and exacerbate existing social,
economic, and political inequalities. Higher weight people already experience anti-fat stigma, epistemic
injustice, discrimination, barriers to care, and poorer health outcomes. Of relevance at this time, the origins
of fat stigma and discrimination are embedded in colonization and anti-blackness. Our research agenda is to
investigate the impact of COVID-19, including the public health, medical, and media response to COVID-
19, on the health and well-being of higher weight people. For example, some resource allocation and triage
protocols deprioritize higher weight people. Anti-fat stigma is strong in mass media, and weight-gain memes
are viral on social media. These issues will be critically analyzed from evidentiary, equity, and ethics
perspectives.
Research Timeline—Issues Relating to Ethics, Equity, and Risk for Higher Weight People:
Pre-Pandemic
1. Medical marginalization of higher weight bodies.
2. Public health policy and initiatives persist with prioritizing weight loss, despite evidence this is ineffective
and harmful.
3. Social location and the intersection of race, socio-economic status, gender identity, and weight amongst
other identities in personal risk profile for exposure to COVID-19 and infection
through living arrangement, employment type and geographic location.
Early Pandemic
1. Prolific negative mainstream and social media narratives about and portrayal of higher weight bodies in
relation to COVID-19 infection and illness.
2. Early publication and pre-publication of speculative research around body mass index (BMI) and COVID-
19, with limited peer review or robust commentary for accessible interpretation by the general populace -
heightening anxiety in response to alarmist headlines and media soundbites.
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3. Renewed energy and reinvigoration of calls for collective action toward weight loss in higher weight
patients
Mid/Peak Pandemic
1. Surge planning: Allocation and reallocation of medical resource under scarcity/saturation event.
2. Treatment and diagnostic concerns, chronic underfunding of R&D for equipment, imaging tools, and
training that is fit for purpose.
3. Conflicting advice and protocols about best practice for mechanical ventilation of higher weight patients.
4. Emergence of statements from U.S. public health officials asserting school closures secondary to the
“pandemic could make obesity worse”.
5. Emergence of “infodemic” with individuals and companies capitalizing off the pandemic. For example,
see the book, “The 21 Day Immunity Plan: How to Rapidly Improve Your Metabolic Health and Resilience
to COVID-19”.
Post-Pandemic Risks
1. De-prioritization of higher weight people from receiving early/timely vaccination, secondary to literature
asserting reduced vaccine efficacy in higher weight patients.
2. Triaging of patients for “catch up,” business as usual care and elective surgeries, weight as exclusion
criteria to reduce caseloads.
3. Reinvigoration of governments’ appetites for action targeting anti-higher weight as a result of COVID-19.
Priority Research Topics and Specific Research Questions:
Priority Research
Topics
Potential Research Questions and Research-Informed Actions
1. Issue: Fat in
association with
COVID-19
• RQ1.1: What are the range of issues relating to ethics, equity, and risk for higher
weight people before, during and after the COVID-19 pandemic? Are these real or
artefact? (see detailed questions and actions below)
• RQ1.2: What are the ethics of proposed rationing and triage protocols on the
grounds of weight or BMI (and successes in e.g. California)?
• RQ1.3: Ethics and analysis of presenting dual pandemic: “Obesity” colliding with
COVID-19?
2. Risk and
relevance:
Paper(s) to
respond to the
association of
higher weight,
acquisition
and impact of
COVID-19
• RQ2.1: Are the associations between BMI and risk of COVID-19 acquisition (as
presented in the literature) robust after accounting for potential confounding
variables?
• RQ2.2: Are the associations between BMI and COVID-19 health outcomes (as
presented in the literature) robust after accounting for potential confounding
variables?
• RQ2.3: What are the ethical issues that arise from publishing associations between
BMI, risk of COVID-19 acquisition and COVID-19 health outcomes?
• RQ2.4: What are the ethical issues that arise from differential treatment of people
based on assumptions made about associations between BMI, risk of COVID-19
acquisition, and COVID-19 health outcomes?
• RQ2.5: Who is most at risk from the harms arising from assumptions made about
associations between BMI, risk of COVID-19 infection and outcomes?
• A2.6: Create a document detailing risk and outcomes for dissemination to the
general public.
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3. Living Fat
During
COVID-19
• RQ3.1: What are the lived experiences of higher weight people during and after
COVID-19 (including impact of media coverage, various guidelines, research
papers, triggers)?
• RQ3.2: What are the impacts of the public health measures enacted to reduce
COVID-19, including travel bans, stay at home, and physical/social distancing
recommendations or orders, mandatory quarantine, and recommended or mandatory
face masks in public (in some countries) for higher weight people?
• RQ3.3: What is the impact of media coverage about COVID-19 infection and
transmission mechanisms, morbidity and mortality rates, and public health
measures for higher weight people?
• RQ3.4: What is the impact of social media memes about weight gain due to stay at
home requirements for higher weight people?
• RQ3.5: What is the impact of these factors on mental, physical, social, spiritual, and
financial health and well-being for higher weight people?
• RQ3.6: What is the impact of all these factors on behaviors of higher weight people
and health professionals or health agencies?
4. Intersection of Anti-
Blackness, Fatness,
and Colonization in
COVID-19
• RQ4.1: How do repeated media messages regarding the disproportionate impact of
COVID-19 on the Black community affect mental and physical health of higher
weight individuals who were at increased risk due to size and race?
• RQ4.2: Were the displays of racial/anti-black violence more impactful due to
prolonged social isolation?
• RQ4.3: Are higher weight individuals able to fully engage in peaceful protest
opportunities or do they feel restricted based on physical access or fears due to
increased risk of COVID-19 transmission?
• RQ4.4: Were the displays of racial/anti-Black violence more impactful due to
prolonged social isolation?
5. Repository
Resource
• A5.1: Create a repository of articles
• A5.2: Prepare one paragraph summary of the article and counter narrative
• A5.3: Create ‘end user’ info-visuals/videos
Ethical / Methodological Considerations:
The major ethical and methodological considerations relate to the collection and analysis of experiential
first-person accounts. One consideration is the physical distancing restrictions of COVID-19 which limit in-
person research methods. Second, we need to minimize the research burden on higher weight people. Many
higher weight people have already been subjected to significant harm during the pandemic. Recounting their
experience may cause anxiety and/or further harm; therefore, we will implement strategies to minimize and
mitigate this risk. Third, we will explore options for social media research, drawing on stories and narratives
that are already in the public domain. Here we will address ethical issues such as privacy, consent for re-use
and respecting the expectations and intents of authors with regards to their stories. In addition to the
empirical research, we will also undertake a range of reviews. We will analyze available published literature
on COVID-19 infection and outcomes among higher weight people. We will use a critical weight science
lens including socio-political analysis. This review will inform our understanding of risk and health
disparities relating to COVID-19 for higher weight people.
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Working Group Plan
Working Group members appreciate the opportunity for collaboration since formation. Members wish to
continue this group. We welcome new collaborators, in particular Black, Indigenous, and People of Colour.
Intersectionality is key and a first action being progressed is to network with other CONVERGE COVID-19
Working Groups. We will continue to collaborate via online means and plan to meet via Zoom monthly. Our
aim is to secure grant funding to pursue a number of the research questions identified. It is our hope that we
will find a donor to facilitate the creation of a website to promote and share research progress and outcomes
as well as hosting our Repository (Priority Topic 5).
Contributors:
Angela Ballantyne, Assoc Prof, Department of Primary Health Care & General Practice, University of
Otago, Wellington; Visiting Senior Research Fellow at the National University of Singapore
Angela Meadows, PhD, SSHRC Banting Postdoctoral Fellow, Department of Psychology, Western
University, Canada
Ashlea Gillon, Kaupapa Māori trans-disciplinary researcher, PhD candidate, Te Wānanga o Waipapa,
Aotearoa (The University of Auckland, New Zealand).
Ashleigh Rushton, PhD candidate, Joint Centre for Disaster Research, Te Kunenga ki Purehuroa, Aotearoa
(Massey University, New Zealand)
Brandie Sendziak, Supervising Attorney, Independent Living Resource Center, San Francisco, USA
Cat Pausé, PhD, Senior Lecturer, Fat Studies scholar, Te Kunenga ki Purehuroa, Aotearoa (Massey
University, New Zealand)
Corbett O’Toole, Elder in disability communities, writer, publisher at Reclamation Press, public speaker
and artist
Fiona Quigley, PhD candidate, Ulster University, Northern Ireland
Fiona Willer, advanced accredited practicing dietitian. Weight neutral approach, professional development
George Parker, PhD, Postgraduate Lecturer, School of Midwifery, Te Kura Matatini ki Otago, Aotearoa
(Otago Polytechnic); Lecturer, School of Medicine, Te Wānanga o Waipapa, Aotearoa (University of
Auckland, New Zealand)
Jess Campbell, Medical Student, Christchurch School of Medicine, Te Whare Wānanga o Otākou, Aotearoa
(University of Otago, New Zealand). Nutritionist & Clinic Director, Body Balance Nutrition & Dietetics,
Tamaki Makaurau, Aotearoa (Auckland, New Zealand)
Lesley Gray, FFPH, MPH, Senior Lecturer, Department of Primary Health Care & General Practice, Te
Whare Wānanga o Otākou, Aotearoa (University of Otago, Wellington, New Zealand); PhD Candidate, Joint
Centre for Disaster Research, Te Kunenga ki Purehuroa (Massey University)
Lesley Williams, MD, CEDS, Medical Team Lead, Banner Behavioral Hospital, Arizona, USA
Lily O’Hara, MPH, PhD, Associate Professor, Department of Public Health, Qatar University, Doha
Louise Adams, Clinical psychologist, Treat Yourself Well/Untrapped, University of New South Wales,
Australia
Marilyn Wann, Weight diversity speaker, author of FAT!SO?, and activist for fat rights and weight-neutral
approaches to health. San Francisco, California, USA
Max Airborne, Fat/disability/queer activist California, USA
Patty Thille, Assistant Professor, Department of Physical Therapy, University of Manitoba, Winnipeg,
Canada
Sondra Solovay, Attorney, Adjunct Professor of Law, content developer, and activist. Berkeley, California,
USA
RAPID—NSF Award #1611820 DesignSafe—NSF Award
#1520817
This COVID-19 Working Group effort was supported by the National Science Foundation-funded Social
Science Extreme Events Research (SSEER) network and the CONVERGE facility at the Natural Hazards
Center at the University of Colorado Boulder (NSF Award #1841338). Any opinions, findings, and
conclusions or recommendations expressed in this material are those of the authors and do not necessarily
reflect the views of the NSF, SSEER, or CONVERGE.