Inclusive Language For Higher-Weight People

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A frequent question I get when I give talks to healthcare providers about best practices for caring for higher-weight patients is about language. Today I thought I would break down some common terms.

Before we get into this it’s important to understand that, as many others have said before me, no community is a monolith and higher-weight people are no exception. My explanations are based on a combination of research and the views espoused by Size Acceptance community and fat activists. There will no doubt be people who feel differently about various terms, my suggestions err on the side of doing the least harm.

Obese and Overweight

These are the terms most frequently used within healthcare. They are widely considered to be medical and scientific in nature which lends them credibility. However, when we scratch the surface we learn that these terms were literally created to pathologize higher-weight bodies, and that they have a deeply racist history. (I strongly recommend reading Sabrina Strings’ Fearing the Black Body – the Racial Origins of Fat Phobia and Da’Shaun Harrison’s Belly of the Beast: The Politics of Anti-Fatness as Anti-Blackness to learn more,)

They are also not particularly scientific in nature. The term “overw*ight” simply implies that there is some “correct” weight and that this person weighs more than that. The term “ob*se” comes from a Latin root that just means “to eat until fat.” Not very scientific. (I notate them with the asterisks as a way to acknowledge that these are terms that were created to medicalize and pathologize fat bodies, with roots in racism and specifically anti-Blackness.)

It’s also important to understand that these concepts have been malleable over time. In 1998, a committee convinced the NIH to lower the BMI categories, shaving 15-20 pounds off the definition of “healthy/normal weight.” Seven of the nine committee members had direct ties to the weight loss industry.  The committee chairman was a former Executive Director and current board member of the Weight Watchers Foundation. Their recommendations gave the weight loss industry about 29 million new customers, literally overnight.

Terms like overw*ight and ob*se pathologize a body size in a way that does extensive harm, which I wrote about in-depth here. These are terms that should be retired.

Person First Language

First a bit of background, Person/People First Language (PFL) started as a tool in disability community – the idea being that putting the “person” before their “illness or disability” helps to decrease stigma.  For example “A person with a disability” rather than “A disabled person.” There is a lot of controversy within that community around this and I recommend reading work from people in that community to gain a better understanding.

This became pertinent to higher-weight people because organizations that claim to advocate against weight stigma, but are in fact fully funded by those who sell dangerous and expensive weight loss drugs and surgeries, began pushing it as part of a larger campaign to pathologize higher weight bodies.

They began suggesting that, rather than “overweight” or “obese,” it is less stigmatizing to use language like:

“The woman was affected by obesity” instead of “The woman was obese.”

“The man with obesity was on the bus“ instead of “The man on the bus was very obese.”

They then used this concept to bolster their case for insurance coverage of their “treatments.” I discuss this more in-depth in a piece for The Mighty.

In truth, this language actually increases stigma because PFL is not being suggested for other adjectives that describe our bodies. Nobody is advocating that we say “The woman was affected by thinness” or “The man with brunetteness was on the bus.” The use of PFL suggests that accurately describing a higher-weight person’s body is so awful that we have to find a way to talk around it. It also shifts the blame from weight stigma to larger bodies. When someone says “the woman affected by obesity,” it suggests that the problem is her body size, and not the weight-stigma and lack of accommodation that is actually harming her.

This also goes for the concept that “you’re not fat, you have fat, like you’re not fingernails, you have fingernails.” Again, notice how this isn’t applied to other body descriptors - nobody says “your not tall, you just have height” or “don’t call yourself brunette, you just have brown hair” The suggestion that we need to “talk around” body size in higher-weight people (in a way that we don’t in thinner people) is, in and of itself, stigmatizing.

Euphemisms (curvy, fluffy, plus-size etc.)

Like PFL, euphemisms can create stigma by suggesting that being fat is something that can’t be discussed directly. (Plus-size is an interesting case in that it tends to be even less exact - what is considered plus size can change from brand to brand - and it tends to be gendered.) One way that we can better understand the stigma of euphemisms is by noticing how much more rare it is for someone to suggest that we need a euphemism for “thin.” That said, when working with individuals we should respect and use their preferred terms, including euphemisms.  

Fat

This is the term that tends to be preferred by Size Acceptance and fat activists, including me. It’s right in the name of the National Association to Advance Fat Acceptance (NAAFA) the world’s first documented fat rights organization that is doing amazing work today. For me, it is a perfectly good adjective that accurately describes my body that others have been allowed to heap negative connotations upon. It’s also a reclaiming term for me and many fat people, a way to take our power back and tell our bullies that they can’t hurt us by simply accurately describing our bodies.

This is not the preferred term of all people who fall under its description, and some find it stigmatizing, often because of the ways that it has been used as a taunt or negative concept. While this may not be a term that is comfortable for you, it’s important to respect the choice of those who prefer it, as respecting people’s right to choose their labels/descriptors is a root of anti-stigma work. Also, remember that there is no way to say “don’t call people fat” without stigmatizing higher-weight people since we are, in fact, fat whether we call ourselves that or not.

Higher-weight, larger-bodied

For neutral, non-stigmatizing terms when “fat” may not be appropriate, these are the terms I recommend and use. They accurately describe this population but don’t pathologize them like “ob*se” and “overw*ight” do, they don’t increase stigma like PFL and euphemisms, and they aren’t triggering for the victims of weight stigma like “fat” can sometimes be.

We have to be careful not to fall into the trap of creating stigma in our attempts to decrease it. We should follow the lead of Size Acceptance community and fat activists and utilize descriptors that don’t medicalize, pathologize, or euphemize the body size of higher-weight people.

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More research and resources:

https://haeshealthsheets.com/resources/