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Obesity and language: Why the way we talk about obesity matters

The prevalence of weight-stigma around the world has accelerated at pace over the past 70 years. Close to half of adults have experienced weight stigma, and recent studies show this trend continues globally. Perhaps most worryingly of all, weight-stigma manifests in the healthcare setting. A study into trainee doctors found that 65% witness jokes made about obesity by other healthcare professionals.

4 min. read

The image is a model

Fortunately, this trajectory is changing with the adoption of ‘people-first language’, spearheaded by the obesity community.

This article looks to explain the meaning of ‘people-first language’ and how the reduction in weight-stigma can help more people access the support and care they need. 

What do we mean by ‘people-first language’?

Put simply, people-first or person-first language is a way of describing someone (or a diagnosis), that puts the person-first, rather than the disease.

Typically, in English, the most common way to describe someone with a body mass index (BMI) of over 30 is ‘obese’. While most people using this term - doctors included - do not mean any harm, the use of terms such as ‘obese’, ‘morbidly obese’ and ‘fat’ are weight-bias. This is because it reduces a person down to just their disease.  

‘People-first language’ is not a new concept, it just hasn’t yet been adopted widely for obesity. In fact, the person-first movement was introduced back in 1974, and then widely advocated for by the American Psychological Association in the early 1990’s. To give an example, it would be very unusual to hear someone say  ‘the cancerous man' had a hospital appointment when they are diagnosed with cancer, instead they would say 'the man with cancer' had a hospital appointment. More recently, literature and health communications have moved away from using the term ‘diabetic’ when describing someone with diabetes. Instead, you will hear people say ‘they live with diabetes’.

So, what can you say instead of ‘obese'’? The most accepting way to talk about obesity, is to describe someone as ‘living with obesity’. This reinforces that obesity is a disease and drives language away from blame or personal responsibility. Using terms such as ‘severe obesity’ instead of ‘morbidly obese’, and ‘weight/excess weight’ instead of ‘heavy/fat’ also promotes anti-weight-stigma.

The European Coalition of People living with Obesity (ECPO) shares further examples of ‘people-first language’ here.

Why is the adoption of people first-language important?

For some, changing the way we speak can seem trivial. But the truth is, language can have a bigger impact than you may realise. Weight-stigma prevails not only in society, but also in a healthcare setting – a place that should be a safe, inclusive, and most importantly, equal for all. It can be easy to forget that healthcare professionals are members of society too, and constant exposure to stigmatising attitudes is impacting the health of the millions living with obesity.

There has been extensive scientific research into the impact of weight-stigma in a healthcare setting. In fact, a multi-country study of nearly 14,000 people living with obesity, found that two-thirds of people surveyed who experienced weight-stigma experienced it from their doctor. This neglect of care may lead people living with obesity to:

  • Avoid healthcare appointments, even when medical care is needed
  • Feel uncomfortable when their body is examined
  • Feel less likely to be able to talk to their doctor about problems they are experiencing

For people living with obesity, feeling judged or discriminated against in a healthcare setting can lead to an increase in feelings of depression, disordered eating, and increased risk factors associated with heart disease.

Fortunately, this research is making an impact, and in 2020, over 100 scientific and community organisations, scientific and medical journals, academic institutions and hospitals and parliamentary groups signed a petition to eliminate weight-stigma in a healthcare setting.

Why do we still hear the word ‘fat’?

Some people with larger bodies may feel undeterred by historically common language used to describe obesity.

While there is no set rule on how you should feel, it is important to understand the possible impact of self-stigma, an unconscious side-effect of a weight-bias society.

Self-stigma, or internalised weight-stigma, can be described simply as negative feelings about yourself or reinforcing negative weight stereotypes. Unfortunately, the impact of internalised weight-stigma can reinforce the very stereotypes that led to self-stigma in the first place. For example, someone experiencing negative feelings about themselves is less likely to stick to a weight-loss programme. Self-stigma is also associated with greater exposure to the other health comorbidities commonly associated with obesity (heart disease, osteoporosis, diabetes and poor mental health).

So, why does weight-bias language still exist?

You only need to open a newspaper to see the use of stigmatising language, imagery, and negative stereotypes. As the prevalence of obesity increases, the media coverage across the world has increased, with people living with obesity often blamed for the disease. It is difficult to understand why this still happens, but what we do know is that it is time for this to change.

If you are interested in finding out more about the fight to end weight-stigma in the media, you can read the full report developed by World Obesity here.

If you feel you may be dealing with feelings of self-stigma, there are many resources and support groups that can help you. Speaking with an experienced obesity management specialist can be a helpful first step. You can find your local healthcare provider below. 

  1. Kirk SFL, et al. Canadian Adult Obesity Clinical Practice Guidelines:  Reducing Weight Bias in Obesity Management, Practice and Policy. Available from: https://obesitycanada.ca/guidelines/weightbias. (Accessed: July 2023)
  2.  Tomiyama, A.J. et al. (2018) ‘How and why weight stigma drives the obesity “epidemic” and harms health’, BMC Medicine, 16(1). doi:10.1186/s12916-018-1116-5
  3.  Brewis, A., SturtzSreetharan, C. and Wutich, A. (2018) ‘Obesity stigma as a Globalizing Health Challenge’, Globalization and Health, 14(1). doi:10.1186/s12992-018-0337-x.
  4. Phelan, S.M. et al. (2015) ‘Impact of weight bias and stigma on quality of care and outcomes for patients with obesity’, Obesity Reviews, 16(4), pp. 319–326. doi:10.1111/obr.12266.
  5. Puhl, R.M., Luedicke, J. and Grilo, C.M. (2013) ‘Obesity bias in training: Attitudes, beliefs, and observations among advanced trainees in professional health disciplines’, Obesity, 22(4), pp. 1008–1015. doi:10.1002/oby.20637.
  6. Weight Bias: People-first language (2021) Obesity Action Coalition. Available at: https://www.obesityaction.org/action-through-advocacy/weight-bias/people-first-language/ (Accessed: July 2023)
  7. Kyle, T.K. and Puhl, R.M. (2014) ‘Putting people first in obesity’, Obesity, 22(5), pp. 1211–1211. doi:10.1002/oby.20727.
  8. Crocker, A.F. and Smith, S.N. (2019) ‘Person-first language: Are we practicing what we preach?’, Journal of Multidisciplinary Healthcare, Volume 12, pp. 125–129.
  9. ECPO (2020) How to support people first, Eurobesity. Available at: https://eurobesity.org/peoplefirst/how-to-support-people-first/ (Accessed: 16 June 2023).
  10. Flint, S.W. (2021) ‘Time to end weight stigma in healthcare’, EClinicalMedicine, 34, p. 100810. doi:10.1016/j.eclinm.2021.100810.
  11. World Obesity Federation (2023) World Obesity Atlas 2023. Available at: https://www.worldobesity.org/resources/resource-library/world-obesity-atlas-2023 (Accessed: June 2023)
  12. Brown, A., Flint, S.W. and Batterham, R.L. (2022) ‘Pervasiveness, impact and implications of weight stigma’, eClinicalMedicine, 47, p. 101408. doi:10.1016/j.eclinm.2022.101408.
  13. Puhl, R.M. et al. (2021) ‘The roles of experienced and internalized weight stigma in healthcare experiences: Perspectives of adults engaged in weight management across six countries’, PLOS ONE, 16(6). doi:10.1371/journal.pone.0251566.
  14. Rueda-Clausen CF, et al. Canadian Adult Obesity Clinical Practice Guidelines: Assessment of People Living with Obesity. Available from: https://obesitycanada.ca/guidelines/assessment. (Accessed: June 2023)
  15. Rubino, F., Puhl, R.M., Cummings, D.E. et al. Joint international consensus statement for ending stigma of obesity. Nat Med 26, 485–497 (2020). https://doi.org/10.1038/s41591-020-0803-x
  16. Rossi, A.A. et al. (2022) ‘Weight stigma in patients with overweight and obesity: Validation of the Italian weight self-stigma questionnaire (WSSQ)’, Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity, 27(7), pp. 2459–2472. doi:10.1007/s40519-022-01385-8.
  17. World Obesity. (2018) Weight stigma in the media: the current use of imagery and language in the media. Available at: https://britishlivertrust.org.uk/wp-content/uploads/WOF-Obesity-and-stigma-report-2018.pdf  (Accessed: June 2023)


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