Wrestling with the Delicate Language of Obesity

Maybe it’s progress. Five years ago social media was full of explicitly hateful fat-shaming content. More often than not, complaints fell on deaf ears. But Friday, we learned that Google now considers merely asking about the word fat to be distasteful and offensive. Google Surveys will no longer ask people what they think about the word fat. The language of obesity has become a delicate matter that’s tough to navigate.

Respectful Language

This summer, the American Medical Association resolved to promote the use of respectful patient-first language in caring for people with obesity. The AMA now discourages using words like obese, morbidly obese, and fat.

AMA’s action came just four years after AND, ASMBS, OAC, OMA, and TOS together called for adoption of people-first language by all professionals addressing obesity.

Claiming an Identity

Unfortunately, obesity affects quite a large and diverse population. Most folks don’t give it much thought. The condition is so stigmatized that they assume it has nothing to do with them.

But fat activists have a more adamant view. Fed up with bias and stigma, they claim fat as an identity. Author Roxane Gay explains:

Fat is not an insult. It is a descriptor. And when you interpret it as an insult, you reveal yourself and what you fear most.

Elaborating on this viewpoint, Angela Meadows and Sigrún Daníelsdóttir describe the terminology of obesity as “mired in the medicalization of body state.” So they suggest the word obesity should be discarded. Though fat is the preferred term among fat activists, they concede that it’s insulting to most people. So instead, they suggest using only weight and higher weight in research, publishing, and healthcare.

That line of thinking has just one problem. Weight is not the core issue in obesity. Unhealthy adipose tissue is what’s core. Though that usually comes at a high weight, it can also occur in lower weight individuals.

Word Games

So we are left to wrestle with words that nobody likes. Clearly obese is not a helpful word. It only serves to dehumanize people. Obesity is a disease that no one wants because it comes with lots of stigma and few cures. But it’s tough to solve a problem that people can’t talk about.

Renaming it won’t help, though people have tried. Metabolic syndrome is a term that dates back to the 1950s. It was a way of talking about all the metabolic effects of obesity, without directly talking about obesity. It started gaining popularity in the late 1970s. But by 2005, support for the concept had faded, as summarized in this scientific statement by the ADA and EASD.

Now, clinical endocrinologists are promoting another alternative diagnostic term – ABCD. That’s an acronym for adiposity-based chronic disease. We haven’t seen it catch fire yet.

At the end of the day, we’re probably stuck with the word obesity. Respectful language is important. But some of the energy that goes into playing with words will do more good if it goes toward fighting bias and finding better solutions for the health impact of obesity.

For the AMA position on respectful language for obesity, click here and here. The views of Meadows and Daníelsdóttir can be found here. And finally, if you want to read up on ABCD, click here.

Learning New Language, photograph © Abdillah Wicaksono / flickr

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December 11, 2017