Obese, Demented, and Eaten Up with Cancer
Respectful language is quite a challenge these days. Especially when language touches on issues of stigma and identity, it’s easy to offend people. So it’s no surprise that the language attached to obesity is a sensitive subject. And one thing is certain. “Obese” is a label that nobody likes.
“Demented” or “eaten up with cancer” is language that no health provider would use in reference to a patient these days. But for some reason, many providers still feel free to label a patient as obese.
A Disease or an Identity?
Obesity is a diagnosis. It’s a complex, chronic disease driven by physiology and shaped by our environment. But “obese” is a dismissive label. It’s a tool for erasing a person’s identity and replacing it with a single physiologic trait.
“Who is more clueless about obesity,” asked one physician recently. “The obese? Or the non-obese?” This physician was asking an honest question. But he was looking for a generalization that simply doesn’t exist in reality. Obesity has many different causes and it affects many different people. Every person has their own story.
Stereotypes just don’t work, except for offending people.
Rejecting Obesity, Embracing Fatness
Among fat acceptance activists, obesity is an unwelcome word in any form. Activists host an annual conference on weight stigma where participants are cautioned not to use that word. Weight stigma and anti-fat bias are okay. Obesity stigma? Not so much.
In fact, the Health At Every Size® movement tells its followers that “‘obesity’ is not the health risk it has been reported to be.” Note that quotation marks surround the O-word on the HAES Fact Sheet.
Some in that community want to reclaim the word fat. Take away its power as an insult. It’s a passionate group. But clearly, not everyone is ready for that. It’s complicated.
Language and Empathy
Language can convey empathy and respect. Or it can convey disrespect. We can’t agree with people who want to discard the word obesity. But language that puts people first, rather than labeling them as “obese,” tends to be more respectful.
Even so, it’s no substitute for genuine respect and empathy. A good place to start is to listen to the language that a person prefers – and respect their preferences.
For research on how adolescents with obesity respond to the language their parents use, click here. Click here for a perspective that rejects the use of references to obesity.
Choosing Words: Emile Verhaeren Writing, painting by Theo van Rysselberghe / WikiArt
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August 29, 2018
August 30, 2018 at 3:58 am, Angela Meadows said:
Hi Ted,
One point and one clarification:
There is some evidence that the use of person-first language is more common with characteristics or conditions that are considered negative than in those that are considered positive, thus, using it is still a form of transmitting that view. For example: doi:10.1111/jcpp.12706 (and the extensive systematic review that underpinned that paper – which the author will be happy to send you).
As for the clafirication, at the Weight Stigma Conference, we do not ban the use of the word ‘obesity’ although we prefer people don’t use it, and the same with person-first language, and we link to mine and Sigrun Danielsdottir’s paper in Frontiers in Psychology explaining why. Ultimately though, it is the presenters’ decision. We do make an announcement at the start of every conference that delegates should not get hung up on the terminology people use as they are coming from different paradigms and to try and listen to what else is being said.
BUT, “obesity stigma” is always challenged at the abstract stage, because not only does it offend some people, it is factually inaccurate. However you choose to define ‘obesity’, stigma does not only attach at that level of adiposity. It occurs at lower weights (BMI definition) and in the absence of comorbidity (your definition – a level of adiposity associated with ill health). Weight stigma, or anti-fat stigma, has been demonstrated even at the upper ends of the ‘normal weight’ (by BMI) range, particularly in women. I will also bring this up in peer review, for the same reason.
With respect to the conference, we do not insist that people use specific language and we make that clear when making suggestions, but nobody, to date, has had a problem with changing “obesity stigma.” There is no sound reason to use it.
August 30, 2018 at 5:16 am, Ted said:
Thanks, Angela. In what I have read from your conference and the experiences of colleagues who have attended, it seems to me that attendees must conform to a particular way of thinking or find themselves to be most unwelcome.
August 30, 2018 at 9:01 am, Angela Meadows said:
I’m very sorry to hear that. There are always some tensions when paradigms collide, and it is very personal to some people, but we, as organisers, always try and make people feel welcome. There were some more unpleasant incidents in the first year, but we hope we have a better handle on things now.
August 30, 2018 at 9:33 am, Ted said:
I respect and appreciate your efforts to do this Angela. I’m not sure why paradigms must collide in rhetorical violence, but I see and feel a lot of that. We have some bad role models.