Obesity, Immunity, Trauma, Covid-19: Science and Avoiding Fat Shaming


Interventions and policy must take seriously how adverse early experiences, stress and anxiety, alongside poverty, inequality and an exploitative food industry, contribute to obesity and metabolic issues in children and adults.


Obesity is increasingly recognised as a major health issue and clear links exist between it and serious cases of covid-19, especially fatal ones.

 We need a rethink of our understanding and attitudes to fat, large bodies and linked health issues, and become more aware of how obesity is linked to socio-political issues, stress and childhood trauma. There is real danger that discourses about food and obesity become another way of blaming the poor for their poverty and its effects. The overweight are often criticised for being lazy, greedy, lacking control or selfish, yet often what drives eating is far outside consciousness and developed for sensible evolutionary reasons.

 Obesity is often described in alarmist language, such as ‘an 'epidemic' or ‘public health crisis’. Prejudice against fat is endemic, with common narratives often evoking fear, disgust and blame [1] , attitudes often overlaid with social class and ethnic prejudice [2]. Prejudice against fat is one of the last remaining allowable ones, and most of us have feelings about food, fat and weight that we do not want to admit to. There are thankfully some alternative discourses, such as the Health At Any Size [3] and Fat Studies  [4] movements, which critique many poor quality scientific claims, such as those which automatically equate bodyfat and ill-health. Such movements have highlighted the overt discrimination in many health narratives about fat, including discrimination against large black female bodies [5].

 Fat shaming and fat blaming is of course pernicious, and indeed shame cycles are common contributors to unhealthy food issues such as binge eating. Over the decades I have seen too many clients full of self-blame, wracked with self-hate, feeling awful about their bodies and indulging in solutions which simply don’t work,  issues that many, such as Orbach [6] have brought to our attention over recent decades.


Science, biology, evolution and why diets don’t work

The recent science about body set-points and how bodies fight hard to protect fat stores, explains why diets don’t work in the long-term [7]. Dieting only gives short-term gains as the human body strives for homeostasis, so as we consume less calories, our body responds by using less energy, hence in time feeling tired, weak and ‘hangry’, and nearly always, reverting to old eating patterns.  In fact, nothing in our evolutionary history prepared us for living in an environment where calorie rich food was so abundantly on-tap. Our bodies evolved to conserve energy via storing fat, and our adipose tissue (fat cells), are packed with masses of important goodies set aside for future use, such as vitamins and minerals. Fat cells are alive, communicating and signalling, and have been a brilliant survival-aiding resource of millions of years [8], although they can also give rise to more worrying inflammatory processes [9].

 Such science is partly why I despair about much policy discourse and health advice, which is simplistic and prosaic, and centred on behavioural advice, like ‘consume less,' 'eat healthier', and 'move more'. Such an approach shows little understanding of basic biological processes, let alone the social, psychological, political and biological complexities of increased obesity levels. Shifting of responsibility onto individuals anyway reinforces dominant medical individualistic models [10], giving rise to worryingly pathologizing discourses, blaming the obese, and also, the parents of obese children. 

 Adverse Experiences and Obesity

The area of science which I think is too often missed is the link between obesity and adverse early life experiences, and how life-histories and our socio/political/economic contexts are expressed and ‘lived’ through our bodies, brains, minds and behaviours.  There is a growing literature on the relationship between obesity and both stress and trauma, with childhood trauma associated not only with obesity but also with a hugely increased likelihood of diseases loosely grouped under the heading of metabolic syndrome, including heart disease, diabetes and strokes [11]. The links between ACE’s (Adverse Childhood Experiences) and health issues such as obesity, diabetes, heart-disease and metabolic syndrome, is staggeringly clear, as highlighted for example in this radio 4 program. Stress and anxiety of course have many other worrying psychobiological effects, including increasing the chances of almost every kind of illness, physical and psychological, and indeed of early death [12], [13].

One study, analysing 112,000 subjects, found a very clear link between early childhood trauma and adult obesity [14], [15]. How might this happen? It seems that high stress levels disrupt our metabolisms, having an effect on our body chemistry and on weight-regulating hormones such as leptin and adiponectin, particularly in people who suffered abuse or trauma [16].  We also know that obesity also profoundly affects autoimmunity [17], hence  the possible link between obesity and covid-19 mortality. To dive into the science, in diabetes low insulin signalling undermines glutathione production which is central to antiviral action. Fructose, especially high-fructose corn syrup but also even table sugar, reduces antiviral activity, and indeed whether glucose is controlled or not is very linked to covid outcomes [18].

There is much new science about  the obesogenic effects of stress [19], poor sleep [20], and  the cascade of endocrinological and other effects of stress, including links to poor sleep which in turn links to higher body mass index, less healthy eating [21] and greater risk for obesity [22]. In addition, when stressed, anxious or traumatised a range of things happen to our bodies and brains, including less ability to self-regulate, as well as a drive towards more sweet, fatty and salty ‘obesogenic’ foods, which would have aided survival in our human ancestral past.  In experiments, those induced into stressful states of mind  are much more likely to go for fatty and sugary foods than those in a calm state [23], including even generally restrained eaters [24]. 

We can blame people for being ‘weak-willed’ or lazy, but it is ‘our evolution what done it’, for sensible survival-based reasons. We know from decades of developmental and evolutionary research [25] how extraordinarily adaptable humans are to their contexts, especially the earliest ones. Our brains, bodies and minds mould to fit into our environments, both in the physical world, where we can survive in artic cold and Saharan heat, and also in emotional worlds where we adapt to violent or abusive or loving or cut-off families and communities. Obesity is in many ways another example of our adaptability, as we see if we look at the research. Indeed childhood obesity is linked to increased numbers of fat cells that remain stable throughout the lifespan [26], as if messages about food, such as likely shortages, predispose to conserving fat stores. The more adipocytes the more desire to  consume calories, and the long-term effect is that childhood obesity is predictive of later health issues [27].

Storing Fat when times are tough

Food insecurity and other stressors lead to increased fat storage, as bodies naturally try to insure against future risks [28]. Stress. including facing an uncertain future, makes us attracted to fattening foods [29]. Linked to this, poverty and inequality induce a propensity to seek high calorie foods  [30]. If you subliminally give people messages suggesting that harsh economic times are around the corner and then you offer them both high and low-calorie food, they tend to choose more fattening food than those given more hopeful messages. Indeed, when both groups are offered the same food, but some are told that this food is high calorie, those receiving messages of economic trouble or hard times consume considerably more of the supposedly high rather than food designated low calorie.

Extraordinarily, if we have a stressful or depressing event 6 hours before eating a high fat meal, then our metabolism slows down and we are more likely to put on weight than someone not experiencing stressors. This can translate to around an 11kg weight difference over a year for stressed or depressed people compared to a non-stressed control groups [31]. Stress and anxiety actually alter the bodies inflammatory responses, which in turn effects how we metabolise foods, which is one way in which stress increases the propensity for obesity [32], again presumably for good evolutionary reasons.

Life-history here makes a surprising difference. Extraordinarily the same meal in the same fast-food outlet has a different effect on disadvantaged populations to the affluent [33], allostatic load and its likely effects on the microbiome seeming to be central in this process. The way our bodies respond to a food is in part determined by people’s whole lived experience, including both long-term lifetime and environmental stressors. This is another reason why just legislating about fast or processed food sales is not enough, we must also look at stress and life-history.

Linked to this, parents with an insecure attachment style who struggle to regulate their own emotions are more likely to have kids who indulge in foods that are less healthy, and who are likely to become obese [34]. This is partly due to using food as a comforter to compensate for unhappy feelings, but the stress is likely to drive both children and adults to not only comfort eat but also to store fat.

This all makes sense from an evolutionary perspective. In our hunter-gatherer pasts when the environment and food sources were uncertain and there was little sustenance available, our bodies pushed to stock up on calories and fat. These are not conscious decisions but bodily-led non-conscious instinctual ones.

Benefits of psychological wellbeing

On the other hand, feeling good about our lives will lead to consuming less. In fact people who do the same activity, such as running a race, and find it pleasurable are less likely to eat high calorie foods than those who are dissatisfied or unhappy about the same run [35]. If you get people to do exercise and tell some it is a pleasurable, relaxing activity while others are told it is exercise, the latter afterwards tend to consume more calories and less healthy foods. Feeling good helps you to eat healthily, creating a virtuous cycle for those without stressors. Clinical experience adds plenty of important angles to these issues. The push to eat when stressed and anxious often of course leads to ‘eating down’ feelings, and self-punishment linked to high levels of self-disgust about body-shape in both obese and non-obese people.

Given all this it seems imperative to challenge belief systems replete with blame and factually dubious assumptions. Current discourse has remained primarily at the level of individual responsibility. The British Prime Minister,  Boris Johnson, whose covid-linked scrape with mortality was probably diabetes/obesity linked, has naively exhorted us to, Tebbit-like, get on our bikes to exercise as well as eat better. This is not enough, especially when factors such as early adversity and its relationship to biological mechanisms are not considered, let alone the power of the food industry.

 Addiction and Big-Food

Important here is the ‘addictive’ nature of eating and cravings, powerfully fuelled by the addictive nature of much processed food. Our biological and psychological systems drive us towards pleasurable experiences which aid species reproduction, such as sex and food, such drives being linked to the dopaminergic system,  and centrally involved in all addictive processes. While in some clients we see too low a drive and ‘appetitive’ system, in others we see a very high one, and more often one which has lost touch with ‘real’ needs, such as in drug, alcohol, and other addictions. We can add food addiction to this list, and following high stress, we see worse poor interoceptive abilities, ie less capacity to read bodily signals and know if one is hungry. The propensity for both worse interoception and heightened addictive states is massively increased in trauma, stress and abuse.

 Particularly worrying are the obesogenic effects of easy to access high sugar/fat/salty foods designed to stimulate reward pathways. Food companies invest huge sums into researching exactly what quantities of, especially, sugar, fat and salt, and also which tastes, stimulate addictive food urges and the likelihood of customers returning for more.  Alongside this supermarkets invest vast sums in not only marketing but also product placement, such as where exactly to place, at what height etc , the  high profit, less healthy more addictive processed foods.  Calling for a ‘sin tax’ is a wrong-sighted redirection of responsibilities onto individuals and away from culprits such as poverty, childhood trauma, inequality, stressful environments and of course the powerful food industry.


What are some of the lessons from this kind of research? Firstly, it does not mean that we should not continue to campaign against advertising which suggests that skinny prepubescent looking bodies are what is attractive. Nor should we let up on arguing that companies who basically sell addictive products should be brought to rights. Such practices are as pernicious and dangerous as selling cigarettes and other addictive health damaging substances. Indeed, it might well be the combination of the fairly recent availability of high calorie, high fat foods with the biological predisposition to consume these in times of stress that has given rise to such an obesity epidemic.

This kind of research could be used to try to halt the tendency of certain already marginalised sectors of society to be blamed for what are basically the effects of stress, fear, unhappiness, inequality, poverty and bad luck, plus a manipulative food industry. Such issues need addressing on a macro-socio-political level, but also with community interventions, improving neighbourhoods. We also do need interventions to help individuals feel better about their lives through wellbeing enhancing help, whether therapy, mindfulness, yoga, exercise, dietary advice and the like. These can make a huge difference but will be but a drop in the ocean if we don’t address the wider, macro socio-political issues such as poverty, inequality, poor economic prospects for so many, degraded neighbourhoods, the lack of hope for increasing numbers of our population and the power of Big Food.

We know that the current climate is particularly dangerous given  how economic downturns gives rise to a reduction of food spending,  buying foods higher in calories and fats [36], and our bodies retaining more fat when stressed. In the face of what is being described as an obesity epidemic we must avoid simplistic and judgmental solutions, many of which blame sufferers. Instead we badly need scientifically valid yet potentially liberating understandings, with the blame, guilt and judgement stripped out, allowing for macro-social, community, family and individual level responses that might lead to better overall mental and physical health, including the reduction in obesity.​  

This is truly deadly serious. Obesity has been shown to increase death by covid-19 by nearly 50%, hospital admissions by 113% and ICU admission by 74%  [37]. Incredibly a recent government report  [38] suggested that obesity costs the NHS more than the police, fire-services and judicial systems combined.  Given the clear link between obesity, covid mortality and a range of health issues, we cannot afford not to act.


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[24]      C. Evers, A. Dingemans, A. F. Junghans, and A. Boevé, “Feeling bad or feeling good, does emotion affect your consumption of food? A meta-analysis of the experimental evidence,” Neurosci. Biobehav. Rev., vol. 92, pp. 195–208, 2018.

[25]      G. Music, Nurturing Natures: Attachment and Children’s Emotional, Social and Brain Development. London: Psychology Press, 2016.

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[27]      S. Kumar and A. S. Kelly, “Review of Childhood Obesity: From Epidemiology, Etiology, and Comorbidities to Clinical Assessment and Treatment,” Mayo Clin. Proc., vol. 92, no. 2, pp. 251–265, Feb. 2017, doi: 10.1016/j.mayocp.2016.09.017.

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Covid-19, Disproportionate BAME deaths, inequality and adverse childhood experience. A serious plague


As too often, the poorest and most discriminated against are suffering most, and bearing the brunt of an unequal neoliberal agenda.  This is a serious political issue, literally deadly serious


One of the extremely shocking features of the current epidemic is the disproportionate number of people from Black, Asian and Minority Ethnic Groups who have become ill and died. For example, many US cities report that 70% of the deaths have been from minority groups, even when these groups make up only 30% of the population. In the UK it looks like about 35%  are from non-white populations who in fact make up only 13% of the population, although, possibly as a cover-up, the government seems to not even be recording race and ethnicity formally.

There is a lot to unpick here, some speculative. The disproportionate illness levels are linked clearly to who is bearing the brunt on the front-line. Those designated as keyworkers, such as nurses, doctors, and equally those who work on public transport, in supermarkets, in refuse collection and many other ‘essential’ services, are at most risk of exposure to the virus. Many also have zero-hours contracts, work in poor conditions and are struggling to keep bread on the table and pay bills. A disproportionate number of people from BAME groups work in poorly paid insecure roles such as those above.  Similarly nursing in this country is shockingly under paid and a disproportionate proportion of nurses come from BAME backgrounds, and indeed vast numbers are imported from abroad due to worrying staff shortages.

Viral load, the sheer amount of exposure to the virus, is obviously an important causative factor, and explains some of the deaths of front-line health workers, but it is hard to square the pictures of the first 10 doctors who died in the UK all being from BAME groups. While some have hypothesised genetic predispositions, other research has talked about certain blood-types conferring resistance, and others talked of vitamin D deficiency, the jury is still out on these factors. Dietary factors linked to culture and social class/poverty might also be an issue (e.g. high fat, salty, sugary and especially processed foods). In addition, there likely is also unconscious racism, with certain groups possibly prodded to take on the riskier tasks, but we do not know for sure.

 However, what is incontrovertible is that a disproportionate number of people dying and having serious symptoms have what has euphemistically been called underlying health conditions. Those who seem particularly at risk are people who have well above average obesity levels, diabetes, heart and lung conditions and a range of metabolic syndrome disorders, as well as those who are immuno-suppressed. For the under 60’s for example, being obese seems to at least double the risk of hospital admission and indeed, mortality, and this has been seen in many countries, including the USA, UK and France.

This is by no means just bad luck and needs urgently to be linked to other findings out there about the effects of inequality, discrimination and particularly the long-term lifetime effects of Adverse Childhood Experiences (ACE’s). The data we have seen linking obesity and Covid-19 illness severity is crude, based primarily on Body Mass Index (BMI) measures, but we know that BMI is just one of many biomarkers linked with ACE’s .

What we know for certain is that, generally, more adverse life experiences, especially earlier on, are linked with worse health outcomes later, and to earlier death, and Covid-19 is not about to make an exception to this.

Multiple detailed studies show how, using basic measures of ACE’s, the more ACE’s someone has experienced, the worse the physical as well as mental health outcomes. While obesity is one marker, we see the same link and trajectory with, for example,  hypertension, heart disease, strokes, cancer, diabetes, arthritis,  lung disease, insulin resistance, inflammatory disorders, to name a few, and that is without mentioning the host of psychological effects, from depression,  anxiety disorders, eating disorders, a list too long to write. Typical, and hugely relevant for Covid-19,  is the clear link between ACE’s and COPD, Chronic Obstructive Pulmonary Disease, a huge cause of death anyway in the western world, and about 2.6% higher in those with 5 or more ACE’s.

It is important to note a few things here. While adverse experiences might increase the likelihood of behaviours which are risky, including smoking, poor diet, addictive behaviours, still, the pathways to such ill-health and the links between psychological and physiological states are multi-layered and overdetermined. Yet, seems clear that important genetic pathways are turned on or off by adverse experiences, one example being the glucocorticoid receptor, very linked to many serious psychiatric disorders. Being under stress and thereat lowers our immune responses, and anyone’s immediate survival needs in the face of danger will trump the body’s desire to look after long-term immunity. Indeed cortisol, often seen as the ‘stress hormone’, is a steroid with immune dampening effects.

Similarly, more Adverse Childhood Experiences equates with a range of effects on the nervous system, and the brain (eg on the hippocampus, amygdala, PFC and so much more). Constantly being on ‘red-alert’ for danger or stress has powerful effects on immune functioning and the ability of the body to relax and recover, the healthy parasympathetic ‘rest-and-digest system barely getting a look-in while we are under threat.

How does this link to BAME morbidity and risk in the current crisis? People from minority ethnic groups are grossly over-represented in the population struggling with poverty, economic stressors, scary neighbourhoods, psychiatric problems and so much more.  We are seeing the effects of structural inequality at a society-wide level. Of course, as scholars such as Wilkinson and Marmot have shown unequivocally, inequality itself in a society has profound health effects. The more unequal societies have much worse health outcomes than more egalitarian ones.,

This is without taking account of the effects of, for example racism. Racial discrimination alone has an effect at a biological and cellular level. Those from minority groups in areas of the US with more discrimination have been found  to have higher levels of the stress hormone, cortisol, and also show faster biological ageing, as measured by telomere length. This is mediated by oxidative stress and is linked, for example with type-2 diabetes and obesity.  The over-determining factors pile up. More stress increases the propensity for addictive behaviours, for having raised blood sugars (needed in fight/flight responses), for eating the /sugar/salt infused food peddled by fast food companies, to conserve fat more, to affect sleep, needed for immune responses, and so it goes, on and on and on. This is the tip of the iceberg.

We might add to this the effects of lockdown. While the privileged, like myself, can manage to pay bills and buy food and have a home with internal and external space, many families lack this pressure valve, and were already experiencing huge emotional challenges pre-Covid. As children’s charities are warning, such serious chronic stressors are being exacerbated in the current crisis. We have seen an increase in domestic violence reported and we might surmise that there is also likely to be an increase in child maltreatment.  People in such families are already suffering, especially the children perhaps, but the chickens will certainly come home to roost in terms of poor health outcomes later in life, and indeed intergenerationally.

We need to begin to take this research very seriously. As Marmot’s recent report showed, health inequalities, even pre-covid, had worsened in the last decade, Life expectancy has stalled in the UK, inequality has widened, and more people are predicted to be in worse health as they get older.  Perhaps most worrying of all, wealth inequalities have grown hugely, and of course on average those from BAME groups tend to suffer the worst effects of this.

Thus while it is true that there are links, for example, between obesity and COVID morbidity, the obesity factor is just one piece of the puzzle. Without doubt, racism and discrimination needs to be taken very seriously, and fought against, but it also needs to be linked to structural inequalities. Obesity is just one of multiple biomarkers that we might use and there is host of other measurable markers one could point to.

This is a serious political issue, literally deadly serious, and as often the poorest and most discriminated against are suffering most and bearing the brunt of an unequal neoliberal agenda. This is not just about the level of NHS resources, and who has access to them, although it is as well. This issue of who is ill and dying and why, goes to the root of how we have organised society, and the effects of this are showing up at a biological and cellular level as well as psychologically. While we all applaud the amazing courage and generosity of our NHS frontline workers, this might also be a moment to stand up and be heard campaigning about racial and other inequalities.


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Recent Comments
Guest — Melinda Elson
Thank you for this Graham, a very important piece. Perhaps you can get this into one of the national papers? It needs to be read, ... Read More
Monday, 20 April 2020 19:13
Guest — Emily
I agree, I’d like to see this information being distributed more widely as the ramifications of this crisis are going to be far re... Read More
Tuesday, 21 April 2020 20:19
Guest — Deirdre Fay
This is an important link you're making, Graham. As you say, "literally deadly serious" ...."goes to the root of how we have org... Read More
Saturday, 25 April 2020 15:08
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