Self-Portrait in Front of a Mirror

Regarding a Person as More Than a Diagnosis

Just about any medical diagnosis can be a bit dehumanizing. Even more so when a medical professional takes it a step further and explicitly labels a person with their diagnosis. For most diseases, health professionals have long understood that labeling people in this way – as an “epileptic,” for example – is bad form. But a decade ago, it struck us that health professionals were not so thoughtful in language about obesity. It was more common to call people “obese” than to use person-first language (PFL) and describe them as having obesity.

So we started calling it out.

A decade later, has the situation changed? New research presented at the ADA Scientific Sessions this week tells us that it’s changing, but ever so slowly.

An Analysis of Scientific Literature

Damian Bialonczyk and colleagues (including ConscienHealth’s Ted Kyle) did an exhaustive review of scientific literature on obesity and diabetes from 2011 through 2020. Their analysis identified 56,048 papers on diabetes and 45,584 on obesity.

They also examined the policies of journals with regard to person-first language.

Slow Change, Possibly Accelerating

The analysis is striking. Person-first language is far more common in papers about diabetes than in those for obesity. In fact, 43 percent of the diabetes literature used it, compared to 0.5 percent of the obesity literature. Starting from such a small base, the rate of adoption for PFL in obesity papers was much faster, 117 percent annually, compared to three percent annually in the diabetes literature.

Diabetes-focused journals were more likely to use PFL for diabetes papers. But the same was not true for obesity papers in obesity journals. The critical factor in obesity journals seemed to be the adoption of a policy for using PFL.

We do note, however, that change seems to be in the works. In 2020, we observed a sharp uptick in the use of PFL for both obesity and diabetes, as you can see in the graphic above.

Implicit Bias About the Disease

The language we use about obesity and diabetes tells us a lot about how we think about these diseases. When we write about diabetes or obesity, we are writing about a medical condition. But when we write about diabetic and obese persons, we mix the diseases with the identity of the persons who have it.

Diabetes researchers seem more likely than obesity researchers to focus upon the disease they’re studying. Perhaps this reflects a subtle bias that obesity is more of a reflection on the person who has it.

We’re glad to see a shift toward more objective language about obesity. But sad to see that it is so slow.

Click here for the abstract of this research and here for the full details in the poster.

Self-Portrait in Front of a Mirror, painting by Henri de Toulouse-Lautrec / WikiArt

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June 7, 2022