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?
Speaking as a “person with obesity” I’m not a fan of this language even with people first. I’m a big person. I’m a large woman. I’m not even sure I like the “fat” descriptor. Mostly I feel muscular and powerful and big, not fat. But there times and I’ve talked about it here when I want to claim the label “fat.”
Thanks for the comments; I don’t like the language either, applied to those terms. It’s clunky and also I hate using those terms as if they’re supposed to be medically useful. I do use “fat” sometimes, but mainly to make a point, as in,”I’m fat, and I do x”. Or “I’m fat, which means I have trouble finding clothing of a certain sort that’s not ugly…” Otherwise, I also like large or big– it feels good to call myself those terms.
I use fat, personally. I love fat. And it’s who/what I am. I get that it’s not for everyone. I used to use lots of ‘person first’ language to describe loads of different folks, and then learned years ago that not everyone fits that model for a variety of ‘labels’. For example, I used to INSIST people use person first language – all the time. Then I learned that most often, autistic folks preferred it the other way around. Person first ideas vary from community to community, but most especially from person to person.
Thanks for the comments. Yes, I’ve read that there’s variation in what different communities prefer, and also variation within those communities. This is all one big non-suprise, when we think of it. It is good to put out there that there’s variation in ways terms can be used, and we need to listen and respond to what people prefer. We do it for names; why not these important descriptors?
agreed with you. I think People-First language is similar to Euphemism. the term Euphemism is largely used in sociolinguistic to express a mild or indirect expression to not sound too harsh. To call a person who is 50kg 150 cm, fat is somehow sounded offensive, especially to a lady. No one would ask a person’s BMI before making a remark. They just use their naked eyes and deliver it “you look fat” without first aware of the receiver’s feeling. Although, it is a fact, use euphemism/people-first language would be better.
Hi– thanks for your comments. I think preferences vary about use of euphemisms. I recall people using the terms “pleasingly plump” and “husky” (this is even a size designation for boys’ clothing), and I happen to dislike them. If I have to give a third-person description of someone, I will use terms like heavy, heavier, broad, large, large-ish, etc. It depends on what they look like to me, and how important the details of the description are to the situation.
Thought-provoking post. Incidentally, I label myself a diabetic, rather than a person with diabetes as I find the latter a mouthful. But then, diabetes is a hidden health condition so I don’t introduce myself to others, “I’m Emma, a diabetic.”
Thanks, Emma, for your comments. My mother also uses this language to refer to herself. I wonder how much variation there is among the group of people with diabetes about this? Interesting project for some grad student… 🙂