Language matters. What words people use for us have lots of effects– they contribute to the way we see ourselves and also how others see us. In school, I was known as “that smart girl” in a way that was definitely not complimentary. It was as if that was the box I had to occupy, never to stray into other territory. Luckily, I got over this once I arrived at university, where being hailed as “smart” was definitely considered praise.
For people who are living with illness or disability, language does additional harm by burdening them with labels that identify them with the illness or disability they are dealing with in their lives. Calling someone sick, disabled, or other terms simplifies them by identifying them with one feature of their lives to the exclusion of all the complexity and richness of personhood.
Luckily, there’s a solution to this problem: we can use what’s called people-first language (see here for a good handout on how to shift from harmful to more accurate language). Here’s what the organization The Arc has to say about it:
People-First Language emphasizes the person, not the disability. By placing the person first, the disability is no longer the primary, defining characteristic of an individual, but one of several aspects of the whole person. People-First Language is an objective way of acknowledging, communicating, and reporting on disabilities. It eliminates generalizations and stereotypes, by focusing on the person rather than the disability.
Disability is not the “problem.” For example, a person who wears glasses doesn’t say, “I have a problem seeing,” they say, “I wear/need glasses.” Similarly, a person who uses a wheelchair doesn’t say, “I have a problem walking,” they say, “I use/need a wheelchair.”
So what does this have to do with obesity? In a blogpost this week, James Fell reported that Obesity 2018 Canada has shifted to using people-first language when talking about people’s weight. He says:
From a post by endocrinologist Dr. Sue Pedersen: “Obesity is a diagnosis, and not a way to describe a person. Thus, instead of the terminology ‘overweight or obese people’, the correct terminology is ‘people with overweight or obesity’. This is a critical step in breaking down the stigma against obesity!”
I thought “people with overweight” sounded a bit weird, but Yoni [Freedhof, obesity medicine physician and writer of this blog ]told me, “people with excess weight” could be an easier way to address that.
I have a bunch of responses to these developments. First, let me say that people-first language strikes me as respectful and indeed a necessary step in the direction of destigmatizing lots of diseases, conditions and modes in which people make their way through their lives.
That said, let me turn to its application to the terms “overweight” and “obese”. It’s true that both the Canadian Medical Association and the American Medical Association having a BMI >30 as a disease (even though scientific and other subcommittees of the AMA recommended against this classification; see here for one such report). However, announcing that people with BMI >30 (the standard medical definition for obesity) have a disease is both massively stigmatizing and arguably incorrect. Announcing that people with BMI >25 (the standard medical definition for overweight) have a disease is arguably absurd and definitely flies in the face of loads of evidence to the contrary.
I’m aware that what I’m saying is controversial. I’m questioning whether all or most people with BMI>30 have a disease/are unhealthy. I think I’m on safer ground questioning whether all or most people with BMI>25 have a disease/are unhealthy.
So, if I’m right (which of course I think I am, and I have a gigantic bibliography of evidence available), then maybe the language we need is not people-first, but people-only. Do we need these terms “overweight” and “obesity” at all? If medicine needs precision, there are actual body weights and dimensions available for help in assessing someone’s health. And BMI can be calculated easily from those measurements using tables (I’m not linking to one, but you can find them anywhere). I don’t think these terms are helpful in medical contexts (I’m working on an article with a colleague– Hi Dan!– on this now), and as general descriptors they are stigmatizing and shaming (and often an inaccurate way to convey information about a person).
If we want to describe someone’s dimensions, there are lots of words to use, including large, big, fat, heavy, etc. These are descriptive words, and many people in fat acceptance movements embrace them. I just happen to think that obese and overweight aren’t helpful as descriptors. And I think that using the terms “people with obesity” or people with excess/over weight” is terrible– its strangeness calls attention to the person’s size, maybe also invites stigma, and presupposes something that I argue elsewhere is false. For more on this, you can look at this blog post. And when the article comes out, I’ll blog about it too.
So what do y’all think? Do you prefer “obese people”? “People with obesity”? Or maybe just using their names?