The World’s Most (Implicitly) Stigmatized Disease

Justin Ryder is quite plain about obesity and the stigma attached to it. “It’s the most stigmatized disease in the world. In America, we view obesity as a personal behavior problem and not as a disease.” Ryder should know. He is a pediatric obesity scientist and a vice-chair of research at Lurie Children’s Hospital in Chicago. But if you have any doubt, take a moment to consider the human testimony and research on the experience of living with obesity. Melanie Bahlke describes it:

“I am used to being talked about more than having people talk to me. For everyone I am something different and I am rarely what I am: a person who deserves respect.”

The Implicit Assumption

A popular assumption is that “kids today are coddled. They need to exercise more and eat less junk food.” So insurers have an excuse to fight the parents who seek care for their children when they need advanced care for obesity – a disease where a child’s metabolic systems are not working to regulate fat tissue in a healthy way. Aaron Kelly, co-director of the Center for Pediatric Obesity Medicine at the University of Minnesota, describes the battle that ensues:

“It’s a war of attrition. Fight and fight and appeal and appeal,” Kelly said. “Typically, mostly it will be covered, but the insurance companies can make it extremely difficult to where many families and providers will sometimes just give up on trying.”

Plain Stigma in the Words We Use

Even in the scientific literature, the words we use in discussing obesity reflect bias and implicit blame. If a person has cancer, describing them as malignant or cancerous would be absurd. They have cancer. It is not who or what they are.

But a new paper in Diabetic Medicine tells us that 99 percent of the scientific literature about obesity does just the opposite. It describes people as “being obese” rather than having the condition of obesity. Diabetes is a condition that bears some burden of stigma and has an association with obesity. But even so, the use of such stigmatizing language is less common in the diabetes literature. Roughly half of the time, writers describe people as “being diabetics” rather than having diabetes.

Jane Dickinson and colleagues found these characteristics in the language of diabetes and obesity research published between 2011 and 2020. We are fortunate to have participated in this analysis.

Promoting Implicit Bias or Empathy?

Bias about fatness runs deep in our culture. We deceive ourselves by thinking we are masters of the universe and our fates. Eat healthy, live an active life, and we can be exempt from the infirmities that lesser beings suffer.

This is a seductive belief wrapped around a big lie. Of course, we must make our best efforts to care for these bodies we inherit. But that is what our bodies are – an inheritance. We did not earn them. They have their limits and imperfections. To varying degrees they may or may not be susceptible to obesity or many other diseases. We don’t get to choose, we simply deal with it.

If we empathize with the challenges that others face, it will show up in the words we use.

Click here for Politico’s exploration of obesity as the world’s most stigmatized disease and here for our new paper on stigma in the language of scientific literature.

Re-creation of Man at the Crossroads (Controller of the Universe) by Diego Rivera / Wikimedia Commons. Find more about this mural here.

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

February 25, 2023