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Key points
- The language used to describe body size can be stigmatizing, and there is no consensus on how to be more respectful.
- New research suggests that matter-of-fact references to weight and BMI are preferred over terms like "fat" or "obese."
- If body size must be discussed, take your lead from the individual's language preferences and be sensitive to their reactions.
In recent years, medical researchers and practitioners have begun taking the impact of weight stigma more seriously. For example, in 2020, Nature Medicine released a “joint international consensus statement for ending the stigma of obesity,” and the American Academy of Pediatrics has published research on the physical and psychological toll of weight stigma on children and teenagers.
The language used to discuss body size can exacerbate weight stigma or body shame, but there is little consensus on which weight-related terms are the least stigmatizing or most respectful. Recently published research led by the Center for Obesity Research at University College London examined the terms individuals preferred their health care providers to use when discussing body size. The researchers also looked at the emotional reactions people have to different weight-related terms.
What Are the Points of Disagreement About Weight-Related Terminology?
Weight stigma is a serious issue with clear effects on people’s mental and physical health. The growing “fat acceptance movement" has championed an end to the stigma and discrimination that fat people face. This movement deliberately uses the word “fat” to describe larger bodies, in part to reclaim the word as a neutral descriptor of a body type (like "tall" or "short") and strip the word “fat” of its power to hurt.
But many well-meaning people avoid using the term fat to describe bodies. Writer Aubrey Gordon (author of What We Don’t Talk About When We Talk About Fat) has detailed how some people struggle to say the word "fat" in front of her, instead opting for euphemisms like “fluffy” or “full-figured.” Those identified with the fat acceptance movement often shun the words “obese” or “obesity,” while health practitioners and researchers tend to prefer these terms. (The new study that is the subject of this piece uses the word "obesity" in its title and is published in a journal called Clinical Obesity.)
Medical professionals (and others) often assume that because “obese” is a medical term, it is the least stigmatizing way to describe a fat body. But, as Gordon explains, “… it is precisely because these terms are medical that they are so hurtful to so many fat people. Those words echo years of medical judgment failed health care: untreated eating disorders, misdiagnoses, and denied care altogether. Medicine doesn’t feel so neutral when it so frequently turns fat people away just because of the way we look.”
The British Psychological Society has moved toward using the term “individuals living with obesity” to describe people who are fat. This “person-first” language (linguistically akin to saying “person with a disability” instead of “disabled person”) is meant to be more respectful and is the language used in the title of the new research reviewed in this piece. Yet academic Cat Pausé makes the case that this person-first language does little to reduce stigma, instead perpetuating the notion that obesity is a disease and “fat people are not a natural part of the world.”
What Does the Research Say About the Weight-Related Phrases Patients Prefer?
In this new research, around 1,700 people with a body mass index above 25 completed an online survey distributed through social media ads, patient obesity organizations, and weight management providers. Most participants were from the UK, but respondents from several other countries were included as well. Research participants were given a list of 22 words or phrases describing high body weight (e.g., chubby, fat, obese, super obese, fat, plus-size, high BMI) and rated how much they liked vs. disliked each term, as well as the emotional reaction they would have if their medical provider used that term.
Participants preferred the terms “weight” and “overweight.” “Excess weight” and “higher weight” were also considered acceptable, as were references to BMI. The most disliked terms were “super obese,” “chubby,” and “extra-large.” Commonly reported emotional reactions to the use of these disliked terms were contempt, anger, and disgust. The word “fat” also resulted in negative emotional reactions.
In other words, at least when it comes to health care settings and interactions with medical professionals, relatively straightforward references to weight and BMI were preferred over words like “fat” or “obese.” The authors note that these results are inconsistent with preferences by fat acceptance activists to use the term “fat” and to avoid using BMI, with its problematic history and applications.
What Should You Do When Talking About Body Size?
What should we take from this research in terms of how we should describe body size in everyday conversations? First, remember that in most situations, there is simply no good reason to be discussing anyone’s body size—regardless of what language you’re using. But our body size can dictate how we experience much of our lives, and there are certainly contexts in which it is important and relevant to discuss body size.
Given the lack of consensus about which terms for heavier people are least stigmatizing, the best thing you can do is allow people the opportunity to identify and describe their own bodies using the language they prefer. And while language matters, health professionals shouldn’t let disagreements about preferred terminology distract from what many patients really need: an end to weight-based discrimination in health care settings.
