Words Matter to People Who Are Overweight
— New policy statement pushes « people-first » language rather than disease-first
by Ed Susman, Contributing Writer, MedPage Today November 3, 2021
How a physician refers to a patient can influence how they are treated and how they feel about themselves and their doctors, which is why The Obesity Society (TOS) and four other organizations chose to kick off the annual ObesityWeek meeting with a policy statement promoting the idea that people come first, not diseases.
« People-first language emphasizes that individuals are not defined by their weight, » TOS spokesperson Rebecca Pearl, PhD, of the University of Florida in Gainesville, told MedPage Today.
« Its use can be a subtle yet powerful way to communicate that patients are seen as human beings who deserve to be treated with respect and dignity. »
The statement, which was co-endorsed by the Academy of Nutrition and Dietetics, the Obesity Action Coalition, the American Society for Metabolic & Bariatric Surgery, and the American Society of Bariatric Physicians, noted that in terms of language, people who have weight problems should be treated in a way similar to people with chronic diseases — for example, saying « people with diabetes » rather than « diabetics. »
The statement noted that a Google search conducted at the time the statement was prepared showed 4,030,000 references for people-first expressions for autism compared with 579,000 for disease-first language (« autistics, » « autistic people »).
Similarly, for diabetes, the number of people-first references was much higher than for disease-first mentions (4,920,000 compared with 230,000).
And the situation was the same for asthma: 3,570,000 hits for people-first mentions compared with 125,000 for « asthmatics. »
But when it came to obesity, the people-first reference hits totaled only 218,000 compared with 2,710,000 for condition-first mentions.
« Bias and discrimination against people with obesity is well documented, » the policy statement noted. « Research has demonstrated substantial impact on personal relationships, educational attainment, professional achievement, and healthcare delivery.
Further, studies have shown that a description of a person as ‘obese’ is sufficient to cause discrimination in the absence of any meeting with the person in question.
Describing individuals as obese as opposed to having obesity could have negative impact on how people view them. »
« People‐first language has been widely adopted for most chronic diseases and disabilities, but not obesity, » the statement continued.
« It has become the accepted norm in addressing people with mental and physical disabilities.
The rules of APA [American Psychological Association] Style call for language in all publications to ‘put people first, not their disability’ and to ‘not label people by their disability.' »
The AMA Manual of Style has similar recommendations, the statement noted, adding that research has shown that people‐first language affects attitudes and behavioral intentions toward persons with disabilities.
For example, referring to individuals as « obese » has been shown to influence how people feel about their condition and how likely they are to seek medical care.
In one study, people reported that they preferred that health providers use the terms « weight, » « unhealthy weight, » or « weight problem, » saying that those terms were more motivating for weight loss and less stigmatizing than being referred to as « fat, » « obese, » or « extremely obese. »
When the survey respondents were asked how they would react if they felt a doctor had stigmatized them about their weight, 19% said they would avoid future medical appointments, and 21% said they would seek a new doctor.
« Labeling individuals as obese creates negative feelings toward individuals with obesity, perpetuates weight bias, and must be avoided, » the statement noted.
« Healthcare providers who use respectful communication with their patients, such as people‐first language, create positive, productive discussions about weight and health.
We call upon authors and editors of scholarly research, scientific writing, and publications about obesity to use the same rules that are the norm for referring to individuals with other disabilities, diseases, and health conditions: The use of people‐first language. »
Asked for his perspective, Mitchell Roslin, MD, chief of Bariatric Surgery at Lenox Hill Hospital in New York City, told MedPage Today: « I think this is an excellent point, especially for me, as I have practiced in the field for 27 years and primarily have treated individuals who were labeled and referred to as morbidly obese — that is an awful term and may be part of the reason we treat such a small proportion of the people who could potentially benefit. »
« Any improvement in communication that allows us to confront these issues is paramount for improved population health, » he added.
Ed Susman is a freelance medical writer based in Fort Pierce, Florida, USA.
Pearl disclosed no relationships with industry.
Roslin disclosed relationships with Medtronics and Johnson & Johnson.
The Obesity Society