The obesity-COVID association is massively overstated and being weaponized by Great Barrington Declaration signees, antivaxers, and politicians to discourage vaccination and public health measures against COVID.

How did we get here? And what do the data really say?

A thread 🧵
First, it is important to emphasize the magnitude of the problem.

Amplification of the false COVID-obesity narrative has occurred through some of the biggest individual media influencers, including @mtgreenee, @DonaldTrumpJr, and @ggreenwald.
Bill Maher @billmaher blew it up on HBO in April.
And everyone knows the controversy around @joerogan. (Please listen to me here, Joe, or I am going to keep jumping into your DMs until both of us want to kill ourselves.)
Many COVID-obesity narratives create a false dichotomy between vaccination and obesity, suggesting that what we really need is to fight obesity, not vaccinate. This is what both @mtgreenee and @DonaldTrumpJr have suggested, as you can see above.
This dichotomy is an insane lie, as I will now show.

Let us briefly review what the actual connection between COVID-19 and obesity really is, by looking at three graphs in order.
First, let us look at the risk of death from obesity versus other risk factors, such as being black, being male, and having many medical conditions.
As we can see, mild obesity confers only a very modest, almost undetectable increased risk of death, and severe obesity gives a risk comparable to being male or black.
(Yes, the risk of death in those with mild obesity is similar to those with a BMI from 18-22, which is higher than those who are overweight. We will return to this soon.) thelancet.com/journals/landi…
This is because even overweight is associated with better (not worse) outcomes in terms of death from COVID. thelancet.com/journals/landi…
Importantly, even severe obesity is outshined by simply having 2-5 medical conditions, or being an organ transplant recipient.
So much for obesity being the main risk factor for COVID. I did not even include all risk factors here. But it is not even close. Obesity is a modest risk factor, comparable to being black or being male.

And overweight might be protective.
References used to generate this graph:

Obesity & other risk factors- nature.com/articles/s4158… (Oxford, in the journal Nature)

Multiple medical conditions- cdc.gov/pcd/issues/202… (CDC)
Now let's compare all of these to vaccination status, using some of the latest data from the CDC.

Looking at this, we see that obesity and vaccination are not even in the same ballpark.

Obesity provides paltry additional risk compared to being unvaccinated.
Additional reference used to generate this graph: Vaccination status- cdc.gov/mmwr/volumes/7… (CDC)
(The striking effect of vaccination on death rates is also quite visible when looking at the original CDC data from which this graph was derived.) cdc.gov/mmwr/volumes/7…
For completeness, let us compare all of these to age.

We can see that not only does age dominate, but it dominates overwhelmingly.
COVID deaths are driven by age first, unvaccinated status second, the presence of serious medical conditions third, and then by an equal mix of obesity and other risk factors like being black, being underweight, being male, etc.
Obesity is only driving this epidemic if you ignore the data.

We will see even more of this in a moment, when it is time to shred the misinterpretations propagated by the mainstream media.
In any case, the prevalence of the dichotomy between obesity and vaccination (i.e., you don't need a vaccine if you are fit/lean) in the discussion about COVID is rapidly growing.

Despite having no factual basis.

This is a serious problem.
To show this, I have plotted the frequency of tweets, per day, mentioning "vaccine" and "obesity" in the same tweet, over the course of 2021.
As can be seen, there was a small explosion in discussion mentioning both vaccines and obesity in early March, which petered off during the summer, when COVID cases petered off.
This discussion came roaring back when COVID returned a few months ago, and is now exploding bigger than ever as antivax attitudes have mainstreamed.
But why did the initial explosion in this discussion occur in March?

There were two events that caused this, and the mainstream media is responsible for both.
These events were:

1. The release of an extremely bad (if not pseudoscientific) report by the @WorldObesity Federation and the uncritical press coverage that followed;
2. The press coverage that badly misinterpreted a CDC report on the relationship between COVID and obesity.
Make no mistake.

The mainstream media is 100% responsible for this false narrative that has exploded in antivax circles and is now threatening to undermine public health.

I will now demonstrate this.
On March 4, a report that tortured and abused the international data on overweight and COVID-19 mortality to advocate for more intervention and treatment for obesity was released by @WorldObesity.
This report was widely covered by the media.

@FT reported on it.
@CNN reported on it.
@reuters reported on it.
@bmj_latest reported on it.
. @washingtonpost reported on it.
@RCPhysicians reported on it.
@guardian reported on it.
@business reported on it.
. @Medscape reported on it.
@AlJazeera reported on it.
@Independent reported on it.
@SkyNewsBreak reported on it.
. @thehill reported on it.
@seattletimes reported on it.
@NPRHealth cited it.
@forbes reported on it.
. @bbc reported on it.
@newyorkpost reported on it.
@FOX40 reported on it.

And others.
The report by @WorldObesity claimed that there was a 10-fold higher rate of death due to COVID-19 in countries whose populations had more than 50% of people overweight.
This claim of a 10-folder higher mortality rate was uncritically accepted by all mainstream media outlets that reported on it.
The @WorldObesity made use of an in-house, proprietary analysis of the international nation-level obesity and COVID mortality data.
This analysis was not peer-reviewed, nor, again, was it critically evaluated in a single mainstream media outlet, despite being wildly at odds with every known estimate about risk of death due to COVID.
This analysis used extremely primitive epidemiological tools and p-hacked the data to generate estimates of mortality rates due to overweight.
A full discussion of the problems with this report is too lengthy to go through here. We still have a lot more to talk about in this thread.

But to read my analysis of this study, see:
But we can point out a few things, briefly.

First, any well-trained epidemiologist would know that this study was misleading and wrong. Why wasn't one consulted?

Second, if one was consulted, why was the report published?
One can only guess that @WorldObesity was engaged in ends-means reasoning. The obesity pandemic is a serious public health problem. It demands our attention. Advocacy for this problem can only help improve health, even if our analyses are not quite right, right?
Well, this is obviously wrong, as the @WorldObesity report is now fueling antivax sentiment.

Let us recall the tweets at the beginning of this thread.

Health organizations need to report the truth, not exaggerations of the truth to trick people into doing the right thing.
Let us look again at this graph on frequency of tweets discussing both "obesity" and "vaccine".

See that spike at the beginning of March? Yeah. That big spike?

That's from the World Obesity Federation report.
Now let's check out another graph.

This one is tweets discussing "covid" and "obesity" (without replies).

The same spike at the beginning of March.

From the World Obesity Federation report.
But what is interesting is when you line these two graphs up together, side by side.

That is because the same discussions about obesity and COVID are feeding into discussions about obesity and the vaccine.

Wildly exaggerated claims about obesity and COVID are fueling antivax.
But if you look at the "obesity" and "COVID" graph, there is another spike at the beginning of March.

Oh, that. That was March 8th. Another media event.
On March 8th, a major story ran across most major news outlets: 78% of people hospitalized for COVID-19 are obese or overweight.
@CNBC ran it.
@Forbes ran it.
@Newsmax ran it.
@axios ran it.
@BusinessInsider ran it.
@YahooNews ran it.
@timesofindia ran it.
@NBC10Boston ran it.
@FoxNews ran it.
@abc27 ran it.
Even @BeckersHR ran it.
And this was the statistic that @billmaher shared with millions of viewers on Youtube and HBO.
See here. At 29 seconds.

And at 6:28 on Youtube:
All of these media organizations ran it.

Driven by desire for clicks (advertising revenue) and prejudice against obese people, the story was uncritically run by dozens if not hundreds of news organizations.
And it is both incredibly misleading and massively overstates the obesity-COVID connection
And here is a translation if I am being too technical:
And if you read the original CDC report (here: cdc.gov/mmwr/volumes/7…), it does not make the misleading linkages that the media decided to make. That is entirely on the media.
Contrary to what @billmaher and countless health influencers have claimed, the obesity-COVID narrative has in fact been driven by the mainstream media, not by counter-media narratives.

The antivax fallout that has resulted therefore has also been caused by the mainstream media.
If the actual truth were reported by the media, the antivax narrative would be impossible.

But if people believe that obesity is this massive, overwhelming risk factor, yeah, then antivax can weaponize it and tell people that COVID is an obesity disease, as has occurred.
Here is more.
More.
More.
And now, what we saw at the beginning of the thread, a Great Barrington Declaration signee jumping on the same narrative.
Obesity is a serious public health problem. I got into nutrition and obesity because I wanted (and want) to end the obesity pandemic, which would massively improve the quality of life of so many people.
But we need to be honest about the data and the facts if we are going to have the most effective policies.

Dishonesty about obesity has been driving widespread antivax narratives.

The COVID-obesity exaggeration is a case study in the importance of being honest about the facts.
. @NBC10Boston @FoxNews @abc27 @BeckersHR should all apologize, retract their horrible stories, and write new stories to accurately convey the actual, scientific association between obesity and COVID-19.
If they did that, they would be combating antivax and contributing to public health and not profiting at its expense.
Did you enjoy this thread? Please follow @healthmisinfo.

Also, for @healthmisinfo, we are also conducting a pilot project and need volunteer help. At @healthmisinfo, we are building a health misinformation surveillance system.

Please visit discord.gg/WczEuPbCjZ if interested.
Please also share this thread or others like it if you see people spreading COVID-obesity misinformation, which is widespread.

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More from @kevinnbass

15 Sep
Misinterpretations of the obesity-COVID association, propagated by the media, have been weaponized by antivaxers, quacks, and politicians.

This has discouraged vaccination.

I have generated three graphs to express this. The latest iterations are here.
References:

Vaccination status- cdc.gov/mmwr/volumes/7… (CDC)

Obesity & other risk factors- nature.com/articles/s4158… (Oxford, in the journal Nature)

Multiple medical conditions- cdc.gov/pcd/issues/202… (CDC)

Age- cdc.gov/coronavirus/20… (CDC)
For an extended discussion, please read the above references, as well as my thread here:
Read 4 tweets
28 Aug
Why do PUFAs not cause inflammation, despite serving as precursors to inflammatory mediators like prostaglandins?

Because prostaglandin production is tightly regulated. If it wasn't, then any time we ate something with fat, we would be screwed. As a species. Just imagine.

1/5
Take flushing from niacin.

Flushing from niacin is caused by the production of prostaglandins after activation of GPR109A.

Prostaglandins are generated from arachidonic acid, which is a PUFA (polyunsaturated fatty acid, found in veg oils).

Read:

ncbi.nlm.nih.gov/pmc/articles/P…
2/5
Do we normally get flushing every time we eat arachidonic acid?

No!

Why not? Because prostaglandin production is tightly regulated. In this case, only "pressing the button" of GPR109A causes prostaglandin production to take place.

(Other things can also cause it.)

3/5
Read 5 tweets
27 Aug
The case for “obesity is the real cause of COVID-19 deaths” is overstated because health influencers want to leverage it to build market share and clientele.

“Obesity not COVID is the real problem” is a cynical, fake narrative motivated by greed.
Common reply
"80% of deaths/complications/etc. are in people with obesity!!!"

Actually, the stat is: 78% of Americans hospitalized for COVID are overweight or obese cnbc.com/2021/03/08/cov…

Another stat: 74% of American adults are overweight or obese cdc.gov/nchs/fastats/o…
To help readers, what the above statistic shows is that the overweight and obese are not greatly overrepresented among people hospitalized for COVID. It means that while obesity does not increase risk, the effect is not dramatic or definitive.
Read 17 tweets
26 Aug
Hi everyone.

An introduction.
I am Kevin Bass, an MD/PhD student completing my PhD in cell and cancer biology. I have a long-standing interest in nutrition science.
I got interested in nutrition science because I had previously been interested in politics and was tired of the polarization.

I thought that, finally, here is a field where everything is obvious.

No more fighting over stupid opinions.

LOOOOOLLOOOL.
Read 13 tweets
17 Aug
Day 2 of “I wish I was not on Twitter anymore”

Here are the tweets in question

This was a thread of three tweets

I deleted and made a new tweet, adding the name “Debbie” for comedic effect, as you can see

For the record I regret in engaging in any of this & want it to be over ImageImage
If ridiculing Avi and pretending to be children and kissing “Debbie” after recess while getting slurpees is “threatening sexual assault”, I don’t want to live anymore

And if joking about a 3v1 vale tudo fight is “threatening to eyegouge other people”, I just can’t even
Some folks just have way too much time on their hands
Read 5 tweets
16 Aug
I know that I will receive universal censure for this thread, but I don’t care.

This is a lie. I blocked Nick after Avi tweeted DMs that Nick sent Avi.

Here is the rest of the story.👇
To be clear, everyone agrees on the substantial scientific issues.

I was excommunicated from a large circle of friends for taking umbrage at the absolutely insane cult-like vegan brainwashing techniques that characterize a certain corner of the Discord universe.
This goes by the name of “philosophy” but as someone who has done PhD-level coursework in philosophy with some of the best philosophers in the world (at Penn)…
Read 28 tweets

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