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This is a question that is asked in an article in Medscape by Becky McCall (as per my policy against giving traffic to weight stigma, I’m not linking to it.) It begins:
Public perception of disease is everything. "Diabetics" are now referred to as "people living with diabetes"; an "ob*se person" is now an "individual living with ob*sity."
This tells us immediately that the author is fully bought into a narrative created by the weight loss industry both in the indefensible concept of “ob*sity” as a disease (which we’ll get to in a moment) and in the inappropriate use of “person-first” language for higher-weight people (which is not about weight stigma but about a diet industry goal of having simply existing in a higher-weight body considered a “chronic lifelong disease?”
The article also mentions that the AMA declared “ob*sity” to be a disease, but fails to report that, in doing so, they over-rode the recommendation of their own Committee on Science and Public Health and succumbed to intense lobbying from the weight-loss industry.
So why rename “ob*sity”? This is a question being undertaken by a Lancet Diabetes & Endocrinology Commission on the Definition and Diagnosis of Clinical Obesity. They are scheduled to publish their opinion this fall. It’s important to be clear that this international task force is comprised of 60 people, most of whom have based their careers on the “treatment” and/or prevention of “ob*sity” and none of whom come from a weight-neutral or fat liberation perspective. The person leading the project is Francesco Rubino, MD, chair of metabolic and bariatric surgery at King's College London who has received research grants from Novo Nordisk, Medtronic, and Johnson & Johnson. He has undertaken paid consultancy work for GI Dynamics and received honoraria for lectures from Medtronic, Novo Nordisk, and Johnson & Johnson.
So this is a group of people who believe that it is worth risking higher-weight people’s lives and quality of life in attempts to make them thin and whose leader (and an unknown number of members) are taking payments from the companies that stand to benefit financially from their work. To be clear, I don’t think that everyone involved is actively making the decision to harm higher-weight people for money – for many this failed paradigm is a sincerely held belief upon which they’ve built a career. But the outcome is harm and a failure of ethical, evidence-based medicine all the same, and the harm they will do has to be my primary concern.
As always, anyone who, for any reason, is committed to the eradication and prevention of fatness is not in a position to address weight stigma in any way, since the idea that the world would be better without fat people and that it’s worth risking fat people’s lives and quality of life to create that world is a position built on a foundation of weight stigma.
Further, when it comes to looking critically at the concept of “ob*sity” and question if it makes sense to pathologize bodies based on shared size, rather than shared symptomology or cardiometabolic profile or if we should simply abandon a failed paradigm, this group of people has no motivation to do so, and has plenty of financial and personal incentive not to.
Rubino demonstrates that in the article where he says:
"Renaming 'obesity' is very important," states Rubino. "The word is so stigmatized, with so much misunderstanding and misperception, some might say the only solution is to change the name."
Sure, some might say that, and a whole bunch of those people have careers and finances that depend on not dismantling a failed paradigm, but simply giving it another name.
Some ideas they have for a new name for this failed concept are:
ABCD, for Adiposity-Based Chronic Disease
The problem with this is the same as with “ob*sity” it’s about calling body size a “disease.” While there is absolutely no shame in having a disease, simply existing in a larger body doesn’t qualify. The only reason to classify it as such is to prop up a failed paradigm of treating body size in fat people with diseases while treating the diseases themselves in thin people. This is not scientific, but it is incredibly profitable.
“Clinical Ob*sity”
Rubino tries to sell this by claiming that “It is similar to the difference in meaning between depression and clinical depression, which communicate two different things."
First, I want to be clear that the way that the healthcare system fails people with depression (clinical or otherwise) and other mental health issues is real and using this comparison without that nuance suggests a lack of critical understanding not just of weight and health but also of mental healthcare. Even if we take his quote without that nuance, it’s still not an apt comparison. What Rubino is suggesting is more like saying that fat people who experience depression should have a separate diagnosis than thin people with depression.
Rubino is quoted throughout the article:
“So, what defines it? Is it diabetes? No, because that is another disease. You don't define a disease by another. It has to stand on its own… If we use BMI, or even waist circumference, these might diagnose the disease; but if the person lives to 90 years, what's the point of labeling somebody as having an illness?...As doctors, we have to be cautious. We say this is a disease, but you must think about the implications for the person on the receiving end of that diagnosis of a chronic disease that is substantially incurable. When we say it, we need to be certain."
Reading these quotes is like watching a putt in golf when the ball is headed straight for the hole and then, at the last second it veers right and misses. He is so close to being clear that simply pathologizing bodies based on size isn’t justifiable but then just…veers off.
The article doesn’t quote anyone who is coming from a weight-neutral perspective. The closest it gets is Margaret Steel, Ph.D. From the School of Public Health at the University College Cork, Ireland. The university website says her main research interest is in “fatness as a cultural, social and political phenomenon, as well as a lived experience.” (I have to mention that the Medscape article also quotes this bio but, apropos of nothing, it puts fatness in quotation marks.)
Dr. Steele gets points for using the word fatness but then immediately veers into the idea of environmental causes of “ob*sity” and stereotypes about how fat people eat. She is quoted in the article as saying "Medicalizing ob*sity can be discouraging rather than empowering, but by specifying more clearly that we're talking about a specific set of interrelated metabolic conditions, it would make it much clearer, and that …this isn't about making people skinny, it isn't about an aesthetic thing,"
Except we aren’t talking about a specific set of interrelated metabolic conditions, and the focus is still about making people thinner and I know that because she also says:
“This new knowledge has led to better treatments, including drugs like semaglutide and tirzepatide. These drugs, like bariatric surgery, typically lead to significant weight loss and to improvements in overall metabolic health."
This is the kind of thing that happens when a writer who is fully bought into the failed weight-centric paradigm only interviews people who have also bought into the same paradigm. You get things stated as fact that are, in truth, unsubstantiated claims, exaggerated claims, and/or claims that fail to talk about things like high rates of weight regain or side effects that can deeply impact quality of life or, in fact, end people’s lives, while actively ignoring the fact that weight-neutral options can create the same or greater benefits with far less risk. In fact, many of the studies of both surgeries and pharmacotherapies are short-term and only study weight loss, assuming that it will improve overall metabolic health while often failing to adequately capture adverse events.
The bottom line is that, just like we don’t need more articles that are indistinguishable from diet industry propaganda masquerading as medical education, we also don’t need a new name for a failed paradigm masquerading as ethical, evidence-based medicine.
“Ob*sity” by any other name would still be a (highly profitable) failed concept.
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More research and resources:
https://haeshealthsheets.com/resources/
*Note on language: I use “fat” as a neutral descriptor as used by the fat activist community, I use “ob*se” and “overw*ight” to acknowledge that these are terms that were created to medicalize and pathologize fat bodies, with roots in racism and specifically anti-Blackness. Please read Sabrina Strings Fearing the Black Body – the Racial Origins of Fat Phobia and Da’Shaun Harrison Belly of the Beast: The Politics of Anti-Fatness as Anti-Blackness for more on this.
Note I don’t link to everything I discuss in this post because I don’t want to give traffic and clicks to dangerous media.
That quote from Rubino is almost hilarious. "How can we call it a disease if it doesn't fit any of the criteria for how we define disease?" And instead of going "wow - when I think about it like that, maybe it's not a disease?" his takeaway is "Clearly we just need a different name to call it. Problem solved!"
It would be laughable if that kind of thinking weren't so harmful to so many people.
I don't think it matters what name they decide on. So long as the group being labeled is stigmatized, the term will become a slur. See: retarded, queer, and autistic. And apparently diabetic.
Terms matter, but attitudes matter more. It's telling that people are looking for an even-more-gross word or acronym to replace one corrupted by stigma.
I'm fat. Call me fat.