Weight Stigma: Mark, Label, Threat, and Blame

How do people with obesity – or any other health condition – become stigmatized? It turns out that words are very important for weight stigma. In Communication Theory, Professor Rachel Smith offers us powerful insight with a classic paper. Four elements are critical. Thus, we should be careful about letting those elements creep into the words we use in obesity. Because words matter.

The Mark

The first element that serves to stigmatize a health condition is a mark. It’s a visual cue. It serves to single out a person with the disease. We stigmatize criminals with an orange jumpsuit. And thus, when we define obesity as a condition of size, the mark is simple. It’s largeness. People feel free to assess someone’s health based upon their size. Even if they know nothing whatsoever about their health. That’s the first mistake.

The Label

This is where we define someone purely by their condition. Put a label on them. At one time, medical practitioners labeled people with intellectual disabilities as imbeciles. Obese is a label that serves to dehumanize a person. It reduces that person’s identity to a disease. We would never refer to a patient as cancerous. But medical literature about the obese abounds. Discard that word – because it serves only to dehumanize and stigmatize. It adds nothing good to your writing or your spoken words.

If you want to talk about the subject, obesity is the right word. Not obese.

The Threat

We get it. Danger a tool for grabbing attention. Obesity is not just an epidemic. It’s a pandemic! It’s costing us millions … no, billions … no, trillions of dollars. How many ways to we need to scream that obesity is a terrible, awful, no good threat to wealth, health, and happiness? Simply put, fear mongering is overused. Hyping a problem without offering real solutions only makes the problem more daunting.

What’s more, it’s the third key building block for stigmatizing people with obesity. Our communication labels them as a threat.

The Blame

To complete the picture, blame is the perfect bookend. They did this to themselves. The conviction that obesity is a behavioral problem of choice, rather than a metabolic disease of physiology is factually wrong. But it’s key for keeping stigma strong.

Smart people – health professionals who should know better – often push back when we tell them a basic fact. Obesity is a highly heritable disease. People don’t choose it. They inherit it. And then the environment activates it. Denying this fact keeps weight stigma alive.

So What?

We hope the implications are obvious. We need to stop defining obesity based solely on BMI and thus size. It’s a metabolic problem. Size is secondary. Next, we need to strike obese from the lexicon. It’s always offensive, as well as stigmatizing. Also, we need to lay off the fear mongering about obesity. Enough. Most people know it’s a bad thing. So much so that they run from discussing it.

And then finally, we must stop with the blame game. It’s a lie that puts people in a box they cannot escape. Genes set the table for obesity. The environment serves it up. The only choices are what to do about it. And when health systems restrict access to care, they leave patients with no good choices to make.

Want to wipe out weight stigma? Pay attention to these four building blocks and wipe them away.

Click here for Smith’s classic paper on conveying stigma. For more on the subject, click here and here.

Marking the Landscape, photograph © Gord McKenna / flickr

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December 3, 2019