However, on social media, many people who qualify based on BMI are grappling with "vaccine guilt," feeling like they might be taking doses of the vaccine away from someone who might be more "deserving." After a viral Twitter thread highlighted the possible health risks of COVID-19 faced by people with obesity, many chimed in on the discussion.
Infectious disease experts and registered dietitians both agreed that it's important for people with obesity get the COVID-19 vaccine as they become eligible for it. TODAY Health also spoke to a clinical psychologist who offered some advice on how to deal with feelings of "vaccine guilt."
Why are people with high BMIs considered a priority for COVID-19 vaccination?
Used to indicate a person's weight and whether or not they are considered underweight, overweight or obese, having a high BMI doesn't necessarily mean someone is at additional risk for COVID-19.
However, there is data that indicates that people who are overweight or have obesity are at risk for more severe cases of COVID-19.
"A lot of the vaccine eligibility is focused on people who are at the highest risk of having complications if they get infected with COVID," said Dr. Marybeth Sexton, an infectious disease expert, hospital epidemiologist and assistant professor of medicine at Emory University in Atlanta. "You're trying to protect the individual, who may be at risk for being in the hospital or the intensive care unit or even dying, and you're also protecting the health care system ... If you can prevent the people who are the most likely to need to be in the hospital from getting sick in the first place, then you really help the stability of the hospital system."
Dr. Gabrielle Page-Wilson, an endocrinologist and assistant professor of medicine at Columbia University, said that people who are overweight or have obesity are being prioritized in the same way senior citizens and other high-risk individuals are, referencing a recent study that showed people with obesity are twice as likely to be admitted to the hospital and 48% more likely to die of coronavirus.
"What we know is that obesity is associated with increased mortality and severe disease from COVID-19," Page-Wilson said. "When we say severe complications, we mean things like being intubated, having sepsis, we mean things like needing renal replacement therapy or having kidney failure and requiring hemodialysis. ... (Being overweight or obese) in and of itself is a risk factor, and it really necessitates that these folks have a high position on the eligibility list."
Kirstin Kirkpatrick, a registered dietitian and manager of wellness nutrition services at the Cleveland Clinic Wellness Institute in Cleveland, Ohio, said that BMI isn't always an exact tool, since it is only based on weight and height and doesn't distinguish between weight that may be from muscle or fat. However, BMI tends to be the most measurable assessment of weight, so Kirkpatrick said that's why it is being used to determine vaccine eligibility.
"BMI is the best assessment we can give on a nationwide level," she said.
Page-Wilson said that because many studies were calculated using BMI, people who are eligible for the vaccine due to their BMI should get it when they can.
"You may have a high BMI because of increased muscle mass, or you may have a high BMI but not have any comorbidities, but just having that BMI potentially puts you at higher risk for COVID-19-related complications and mortality, and that makes you eligible," Page-Wilson said.
How can people deal with 'vaccine guilt'?
Jessica Stern, a clinical psychologist at NYU Langone Health, said that every eligible person who feels guilt about getting the vaccine should remember that them getting vaccinated makes those around them safer.
"Remember that it's not necessarily your responsibility to decide if you're eligible or if you're deserving of the vaccine (if you fall into an eligible category)," said Stern. "... Responding to this is very much a communal team effort, and much like we have to work as a team to adopt safety precautions, it's a communal effort to get the vaccine so that we can protect each other and protect ourselves. If someone is getting the vaccine, it's not just helping themselves. It's helping the community."
For those who might be seeing their eligibility questioned or debated on social media, Stern recommends acknowledging that the vitriol tends to come from a place of "fear and hopelessness and anxiety" as millions wait for the vaccine.
"It's absolutely not acceptable for anyone to be a victim of that, but I think if someone is receiving that and is receiving a sense of judgment or hatred, the best (thing to do), while it's easier said than done, is to remember it's not about them, it's not personal," Stern said. "If you're receiving the vaccine (when eligible) ... remember that you're following the rules and guidelines and that someone's frustration towards you is not personal."
Most importantly, remember that eventually, everyone has to be vaccinated.
"If you're feeling like you're not sure if you should take the vaccine when you're offered it, just remember that you're actually using a valuable vaccine that otherwise might not be going to use," said Stern. "You're actually doing a good service to everyone around you by making sure that nothing goes to waste."