Castor and Pollution

Words That Betray Implicit Bias About Obesity

“This is a cane that’s going to help you walk. But you’re going to have to do the walk yourself.” This is how Dr. Zhaoping Li explains why she prescribes anti-obesity medicines to patients only after lifestyle changes have failed. But words like failure betray an implicit bias about obesity. They contradict the understanding of obesity as a biological not a moral problem.

Naomi Fearon and colleagues find such words cropping up frequently in the scientific literature about obesity. They published their analysis this week in Obesity, concluding:

“Although most journals object to overtly stigmatizing language, using phrases or words that carry negative connotations is less clearly discouraged. It is important to recognize that language that implies a moral responsibility for weight loss or the development of obesity contradicts the well-established evidence base that obesity results from complex biological processes.”

Quantitative and Qualitative Analyses

Fearon et al conducted a quantitative analysis of pejorative terminology in 3,020 scientific papers dealing with bariatric and metabolic surgery. They found that failure cropped up in 2.4 percent of the papers they screened. Various expressions of morbid obesity and morbidly obese appeared in 17 percent of the papers.

In parallel, qualitative interviews, people seeking care for obesity told investigators that such language conveys a negative judgment of them personally. For example, one respondent explained:

“Because of the way my doctor talked about obesity, I avoided going as much as possible, and as a result, it took nearly 20 years to be diagnosed with endometriosis, in part because I just wouldn’t go.”

Humiliation is a lousy way to promote wellness. More constructive language fosters a starkly different therapeutic setting for care, described by another person in the qualitative research:

“Because of the way they spoke, for the first time, I actually felt respected when I went to the obesity clinic. You actually felt they were there to help you rather than just judging.”

Words Matter When They Reveal Implicit Bias About Obesity

Explicit weight bias won’t fly these days without attracting a rebuke. But implicit bias can fly under the radar, and in fact, it’s becoming more common. It shows up in the words we choose. Words like failure, morbidly obese, and recidivism might not be used expressly to demean a person, but they appear commonly in the literature. And they serve to perpetuate an implication of moral judgment about obesity that harms the field.

The language attached to obesity is sufficiently negative to lead some to even suggest the word obesity itself is nothing but a slur. This is obviously not helpful, but it should make us all stop and think.

Words matter – especially when they reveal our hidden biases.

Click here for the new paper by Fearon et al.

Castor and Pollution, painting by Max Ernst / WikiArt

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June 11, 2022

One Response to “Words That Betray Implicit Bias About Obesity”

  1. June 11, 2022 at 9:28 am, John DiTraglia said:

    Obesity comes from Latin ob edere= from eating. Not true. But what other word should we use?