Both Sides

People-First Language: Preferences and Aversions

Language unites us and divides us. Certainly, this is true for the language of obesity. A new study in JAMA Surgery tells us that patients seeking bariatric surgery don’t like people calling them fat. Nor do they like people calling them obese. Instead, they give higher marks to the language of having a high BMI or obesity or excess weight. In other words, they prefer people-first language. Not language that labels them according to their weight or shape.

A Study

Rebeca Pearl and colleagues surveyed 97 people seeking bariatric surgery at a large university hospital. Most of these people had BMIs in excess of 40. They answered questions about internalized stigma, stigma preferences, and everyday discrimination.

This is a relatively small and targeted sample of people. But they expressed their preferences clearly. Respondents really disliked “fat person” as a label for people with obesity. “Obese person” and “person with excess fat” got low ratings, too. Describing people as having an “elevated BMI” or “obesity” or “excess rate” was more acceptable.

Likewise, respondents disliked the language of “morbid” and “extreme” obesity for people with a BMI above 40. The more objective language of “class III obesity” was the most acceptable.

Other Perspectives

Of course, it’s not hard to find dissenting views. Fat acceptance activists embrace “fat” as an identity and find the language of “obesity” offensive. “My body is not a disease” is a theme that we hear often from folks in this community. Needless to say, these are folks who don’t accept the idea that obesity is a medical condition.

However, those views are not entirely mainstream. We’ve found that only about 15 percent of adults strongly embrace the idea that “fat” is merely an objective description. Most people see it as an insulting label.

From a totally different perspective, we also hear from folks who object to people-first language because they see it as evidence of political correctness. A constraint on speaking plainly. Unfortunately, the line between plain talk and rudeness can be a very thin one.


In the end, this all boils down to respect for individuals. People like to be known, respected, and understood as individuals. Labels, even if chosen carefully, don’t help with this. Caregivers for people seeking help with obesity can’t avoid the subject. But they can listen and care first. They can speak objectively and respectfully about health conditions. They can honor a patient’s preferences and do their best to understand the whole person.

Not just a diagnosis.

Click here for the study by Pearl et al.

Both Sides, photograph © Paul VanDerWerf / flickr

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September 15, 2018

3 Responses to “People-First Language: Preferences and Aversions”

  1. September 16, 2018 at 7:01 am, Angela Meadows said:

    I was interested in that 15% figure – I’m surprised it was that high actually. I clicked the link – looks like you did this work in 2014? I don’t think I’ve seen these data. Where can I find the results? Also, I’d be interested to redo the study 5 years on and see if anything has changed.

    • September 16, 2018 at 7:06 am, Ted said:

      Thanks, Angela. Maybe we should write it up as a brief report for publication. But I haven’t done so yet.

      Interestingly, I tried to get a repeat measure last year and Google refused to field the survey again. Too offensive, they said. Tough to study something you can’t talk about, eh?

  2. September 27, 2018 at 6:15 pm, Valerie said:

    I like Dr. Aria Sharma’s comparison: would you call an oncology patient “cancerous”?

    We see headlines saying “The obese have higher rates of blah blah blah”, but we don’t see headlines saying “The cancerous have higher rates of blah blah blah.”

    If switching “obese” with “cancerous” (or “disabled”, that works too) in your sentence is offensive, then you should probably rephrase.