A World without Words

Three Dimensions of the Word Obesity

The word obesity draws strong reactions that depend entirely upon context. Who’s saying it, who’s hearing it, and how it’s being used has a big effect on what’s heard when the word is spoken. Three different meanings for the word obesity stand out.

  1. Metabolic Disease. At its root, obesity is an objective medical term that describes a metabolic disease caused by excess adipose (fat) tissue.
  2. Weight. The most common screening criteria for obesity is body mass index (BMI), which is based on weight and height. Too much weight for a given height yields a BMI in the range of obesity (≥30). So, many people think — incorrectly — that obesity is just a matter of someone weighing too much.
  3. Body Image. For many people, obesity carries a disparaging meaning related to negative views of a large body. Weight bias and discrimination can lead to a poor self image of one’s body.

When one person is talking about a metabolic disease and others hear a reference to body weight or body image, confusion ensues. This is why it’s pretty clear from multiple studies that patients prefer more neutral terms when a doctor discusses obesity with them. “Unhealthy weight” and “high BMI” are terms that are less threatening to patients.

But the underlying problem is not the words. It is weight bias that makes obesity such a misunderstood word. Weight bias stems from a misunderstanding of the metabolic disease of obesity and it allows people to assume that obesity is a choice, rather than a disease. Pervasive weight bias means that people with obesity encounter disrespect on a daily basis.

Choosing words to convey respect is helpful in the short term. But the only real solution is a better understanding of obesity itself, respect for the people affected, and an outright rejection of fat shaming in all forms — both subtle and overt.

Click here for a study of patient-preferred language and here for a study of public perceptions about weight-related language used by healthcare providers.

A World without Words, photograph © Cristian V. / flickr

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