Flying Words

Only Words? Words Shape Reality for Better or Worse

We have an opportunity before us, say Thiago Gagliano-Jucá and Caroline Apovian. They are writing in Annals of Internal Medicine to reflect on the implications of words we use in healthcare. Specifically, they are talking about the words providers attach to obesity – words like morbid. These are words that leave patients feeling judged. Such words shape the reality of experiences in healthcare that diminishes people living with obesity and harms their health.

These words are rude, disrespectful, and need to go.

Rude Words Fly Farther with OpenNotes

Gagliano-Jucá and Apovian start with the fact that the OpenNote initiative is now a legal requirement in healthcare. That means that the notes and observations that go into patient records are now available to patients. Before this rule took effect, healthcare providers could write whatever they wanted about patients in their records and patients would never see it.

It turns out that when patients see medical notes about them, they too often find offensive and harsh judgments against them. In one study, descriptions of obesity were a most frequent source of offense. It makes it worse that providers often don’t even discuss the subject as a health issue. It’s a silent, unilateral, and personal judgment – especially with terminology like morbid obesity.

The Morbid Label

We do not have morbid cancer or morbid heart disease. But we have morbid obesity because of the suggestion in 1970 that people with severe obesity belong in a freak show:

“When an obese individual attains the Gargantuan level of the fat man or fat woman in the circus and maintains this degree of massive obesity for many years, we believe the adjective morbid should be added to emphasize the serious health implications and severe, life-shortening hazards of such grotesque accumulations of fat.”

Though that description came from a medical journal, it has more in common with a puritanical screed. But it worked. Morbid obesity is language that embedded itself in medical records quite easily.

Word Shape Thoughts, Feelings, and Health

Some people are disdainful about using respectful language – some dismiss it as political correctness. But psychologist Rachel Goldman reminds us how important words can be:

“Even though one specific word, or label, doesn’t define us, the words we use and the words we hear can become internalized. Eventually we believe them. Our thoughts, emotions, and behaviors are all linked, and therefore, one word can impact how we feel about ourselves. It becomes a vicious cycle.”

These harsh words are the seeds for self-stigma. The result of self-stigma is worse health outcomes. So healthcare providers are in the wrong profession if they can live with being the source of this. As Gagliano-Jucá and Apovian rightly suggest, it’s time to take the morbid out of obesity.

Click here for this important commentary in Annals of Internal Medicine.

Flying Words, photograph © Nalo Souleyman / flickr

Subscribe by email to follow the accumulating evidence and observations that shape our view of health, obesity, and policy.


September 22, 2021

2 Responses to “Only Words? Words Shape Reality for Better or Worse”

  1. September 22, 2021 at 1:58 pm, Donna Kasznel said:

    The language in the 1970 article is horrifying! “The basic factor of gluttony…” Unbelievable! When health care professionals/researchers deem that kind of language appropriate in a peer-reviewed journal, I can only imagine how they addressed their ‘gluttonous’ patients!

    • September 22, 2021 at 2:35 pm, Ted said:

      You’re right Donna. Knowing that this is the source of the term, “morbid obesity,” tells us a lot about the bias it conveys.