Language Frames Our Response to Obesity

Recent advances in the scientific understanding of obesity has led to more frequent public rejection of explicit weight bias, but implicit bias and stigma remains a serious impediment to health. Language is a potent tool that frames our understanding of obesity. But too often, even in scientific publications, it reflects bias against people with obesity and may even serve to promote stigma that is a barrier to progress. Examples of stigmatizing language include descriptions of obesity as an identity rather than a disease, suggestions of a cause for panic, and excessive focus on weight rather than health outcomes.

People First

For a decade now, we have been describing the implications of describing a person as obese in comparison to describing obesity as a condition they have. Early on, the pushback was strong. As time has passed, the world has been coming around to understand that when we describe someone as obese, we implicitly assign this as their identity. We put them in a box where obesity is who they are, not a condition they have. Researchers and health professionals who default to describing people as obese, rather than having obesity, are signaling that they regard obesity more as an identity than a disease.

Two recent studies (here and here) tell us that progress toward broad adoption of person-centered language for obesity is happening. But it is painfully slow.

The Language of Panic

One of the stigmatizing beliefs about people living with obesity is that they don’t care enough. Thus for decades now, seemingly well-intentioned health advocates have been injecting the language of moral panic into public discourse about obesity. They describe it as an epidemic, a pandemic, a syndemic, or a crisis. Often, it is the foundation for an urgent call to action.

This is profoundly unhelpful. Centuries of experience with the stigma of cancer tell us that catastrophizing a disease only promotes denial and discourages people from seeking care. We have certainly seen this happen with obesity, if only a bit more subtly.

Weight Loss and Health Gain

With the advent of more effective obesity medicines, the mistake of focusing on weight loss rather than health gain becomes ever more painfully obvious. People are clamoring for a weight loss miracle and expressing profound disappointment when they learn that the chronic disease of obesity requires chronic care. Medicines stop working when a person stops taking them. Language that frames weight loss as the answer for obesity profoundly misleads people. Because it prepares them for a sprint rather than a marathon.

Words Matter

The bottom line here is simple. Words matter. Language frames our beliefs about obesity and our response to it. The language we use betrays the implicit biases we harbor. Even more important, language shapes our thoughts. When we hold onto implicitly stigmatizing language, we reinforce the stigma of obesity.

Let’s stop this right now.

Bird Language, painting by Nicholas Roerich / WikiArt

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June 14, 2023