What Shall We Do with the O Word?

Obesity – the O word – has an image problem. It’s a condition that nobody wants to have. Nevermind that the best estimates hold that 38% of adults in the U.S. have it. Nevermind that, if ignored, it progresses to cause chronic diseases that harm just about every part of the body.

Doctors don’t write it down. They certainly don’t talk about it. Patients get insulted.

So the disease progresses, untreated, until diabetes, heart disease, cancer, and other diseases result. Avoiding shame and blame is a bit easier with those diseases.

And it’s easy to understand why. Many people born with bodies that resist obesity are certain that their physique is a mark of personal virtue. (It’s not.) “Obese” is an epithet that turns obesity into an identity. Weight bias and stigma are pervasive, destructive, and born out of ignorance about how physiology – not morality – regulates metabolism and adipose tissue.

Playing with Semantics

Metabolic syndrome is a concept with origins dating to the early 20th century.  Herman Haller used the term in 1977 to describe converging diagnoses of obesity, diabetes, lipid disorders, gout, and liver disease. Popularity of the term rose through the 1990s. But then the squabbling began. In 2005, the American Diabetes Association and the European Association for the Study of Diabetes issued a critical appraisal of its clinical value.

Maybe diabetologists were defending their turf. Maybe they had a point about diagnostic precision. Regardless, popularity of the term in medical circles started to wane. FDA declined to approve drugs for a metabolic syndrome indication.

Now the American Association of Clinical Endocrinologists (AACE) has another scientific euphemism for obesity: adiposity-based chronic disease. It has a cute acronym, ABCD. We haven’t seen a lot of traction yet. But maybe it will take off.

Many fat acceptance advocates want to reclaim “fat” as an identity and description for themselves. But most people aren’t ready for that. Our own research says that most people consider the word to be an offensive insult.

Another approach is just to talk about “weight-related concerns.” It certainly helps as a way to avoid the O word. However, weight is just a symptom. Weight management is just one aspect of dealing with obesity. Good obesity care requires attention to holistic metabolic and physical health. Exclusively focusing on weight can take people to bad outcomes.

The Core Issue: Understanding and Respect

The O word is unlikely to go away. Semantics are not going to solve its problems.

The real problem is a misunderstanding of what obesity really is – the failure of the body to regulate healthy adipose tissue. Behavior is a factor. Physiology, genetics, and environmental factors play larger roles.

But the real problem is bias, stigma, and plain old hatefulness. Semantics will not cure that. We must confront it.

“Hatred will always outpace linguistic correctness.” – Christopher Hitchens

Click here for an Hitchens’ essay on linguistic correctness.

O, photograph © Sheila Tostes / flickr

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May 24, 2017

4 Responses to “What Shall We Do with the O Word?”

  1. May 24, 2017 at 7:08 am, Angela Meadows said:

    True, semantics won’t cure stigma, but they can indeed play a role in its maintenance. Words have cultural significance beyond pure descriptive value. Researchers and practitioners working with or in the interests of higher-weight individuals have a duty not to reinforce marginalisation or devaluation.

    There is no simple solution when labelling is, by definition, a process of othering. Also, language is not static. What is appropriate now may not be in ten years’ time. The problems arise with paternalistic top-down dictates of one-size-fits-all labels and a preference within the scientific community for a nice clean answer that negates the need for true reflexivity on the social construction of devalued status. Working at the boundaries of social justice is not easy and never will be.

    • May 24, 2017 at 7:31 am, Ted said:

      Well said, Angela.

  2. May 24, 2017 at 9:33 am, Mary-Jo Overwater said:

    What further obfuscates addressing the realties and truths of obesity is the cultural insistence on attributing thinness, often extreme thinness, with beauty, and even success (not just virtue). We’ve been aware of this for a long time and just as it seemed that the emphasis on holistic metabolic and physical health finally started to seep more into the consciousness of our societies and give a more balanced and honest perspective on obesity, it seems the craze for ‘skinny = beautiful, happier, more successful’ is returning to the airwaves, internet, print with a vengeance. Celebrities (actors, chefs, gurus, etc.) are touting their ‘wisdom’ and ‘advice’ more than ever. Those of us who strive to approach obesity with proper science, dignity, and integrity seem to be always playing ‘catch up’. I hope I’m wrong about that.

    • May 24, 2017 at 1:55 pm, Ted said:

      I fear you are right, Mary-Jo.