Words Matter: Addressing Weight Stigma in Healthcare and Society

Weight stigma has been defined as “negative beliefs, attitudes and stereotypes towards higher-weight individuals”. Terms used to refer to individuals with large bodies may reinforce weight stigma. “Negative comments and demoralizing terminology can be especially harmful in healthcare. Patient experiences of patronizing and/or disrespectful treatment by healthcare professionals due to weight results in low trust in providers, lower perceived respect, doctor shopping and delaying or avoiding future healthcare.”

In a recent publication, IALH Research Fellow Sarah Nutter (Educational Psychology and Leadership Studies) and colleagues at the University of Wellington, University of Calgary, Concordia University and Acadia University explored terminology used by the general public, family physicians, and obesity specialists regarding weight. (The latter group included dieticians, kinesiologists, psychologists, researchers and educators.) Members of the general public were asked about words they commonly use to refer to people with large bodies, while physicians and obesity specialists were asked about words they heard in professional contexts. All participants were asked to identify words they perceived to be socially and professionally acceptable. Data were collected as part of several studies examining perceptions of obesity as a chronic condition.

Responses were coded into seven categories. Weight-related clinical terms included: elevated BMI (body mass index), overweight, and obese. Terms in this category were considered the most socially and professionally acceptable. The fat category exclusively included the word fat. Although approximately 9% of the general public sample viewed fat as a socially acceptable word, almost all of the physicians and obesity specialists viewed it as unacceptable. Words in the negative health category were commonly reported as professionally acceptable among physicians. They included words such as chronic disease, metabolic syndrome and unhealthy. Words in the size category included heavy, big-boned and plus-sized. Size-based words were common among the general public and were viewed as professionally acceptable by obesity specialists. Words in the behavioural stereotypes category (e.g, lazy, over-eater, inactive) were heard by physicians and obesity specialists, but were generally not considered acceptable. The insults category included words such as ugly, fatso, and pig. Insults were used frequently by the general public and a small proportion (10%) of this group considered them acceptable. Words in the positive/humanizing category were reported by the general public and obesity specialists (but not the physicians). Examples included words describing higher weight individuals as kind, friendly, and “an individual with obesity”.

The researchers noted that one of the implications of the findings is the need for education related to health and weight in professional training programs as well as efforts with the general public. They noted that “a weight-inclusive approach to health literacy may include addressing incorrect assumptions about weight and health, the difficulty of sustaining weight loss, and the benefits of engaging in health-promoting behaviours regardless of weight.”

To read the full article, go to https://www.tandfonline.com/doi/full/10.1080/17538068.2023.2297122