The Problem With People-First Language for Higher-Weight People

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I received the following question from reader Alina:

I’m a family med doctor and I’ve started seeing lots of publications, even research, using the terms “person with ob*sity” and “person with overw*ight.” I took some CME [Continuing Medical Education] where they said that it was for weight stigma reduction. I’m not sure why, but it just doesn’t feel right at all (Does person with overw*ight even make sense?) I would love to see a newsletter about this.

Thanks for asking Alina, your feeling that something’s not right here is spot on. That’s because the idea of person-first language for higher-weight people didn’t come from weight-neutral health community or fat activism community, it came from the weight loss industry and is being disseminated by the “patient advocacy” groups they fund. I’ll get to that in a minute. 

There is some important background to understand here, in that People/Person First Language (PFL) began in disability community, based on the concept of putting the person before their illness or disability to reduce stigma. There has been, and continues to be, a lot of conversation and transformation around this and I absolutely recommend that you read and listen to folks from disability community to understand the nuances here. 

Absent any of those nuances, the weight loss industry took this idea and plopped it onto higher-weight people as part of their goal of having simply existing in a higher-weight body, regardless of health status. be considered a “chronic lifelong disease” (crucially) requiring chronic lifelong treatment from them. 

This PFL initiative for higher-weight people was launched by the Ob*sity Action Coalition (OAC) which is almost entirely funded by the weight loss industry, with it’s two biggest current sponsors being Novo Nordisk and Eli Lilly who make the new GLP-1 weight loss drugs.

Per the OAC website - “for years, other chronic disease, such as those in the mental health and disabilities community, have adopted People-First Language and encouraged its usage in all reporting.”

This isn’t entirely true because, again, there is a lot of pushback to the idea of People-First Language from members of these communities and it’s obviously not cool for the OAC to erase that in order to promote the weight loss industry’s priorities.

Still the stated goal of the language by the OAC was to try to treat existing in a higher-weight body (aka “ob*sity”) as a disease. This doesn’t actually make sense based on logic or the way that diseases are defined but it does make sense in terms of profitability for the weight loss industry (I wrote about all of this in detail here).

Thus, they are heavily marketing this as “anti-stigma language” inside and outside of the healthcare industry. When they launched the campaign, they targeted organization stating “The OAC is also asking organizations to sign-on to the People-First initiative and enforce this style of writing within their organization.”

Besides being grammatically problematic (person with overweight? Really??) and making us unwitting marketers for the weight loss industry, using people-first language for higher-weight people actually increases stigma. 

Now, there is no shame in having a disease, the issue is that simply existing in a higher-weight body doesn’t qualify.

So, the problem with using people-first language for “ob*sity” is that we are applying it to body size, meaning that we talk about higher-weight bodies differently than we talk about bodies in general.

We don’t say “Oh good, my friend with tallness is coming over, now I can finally change that lightbulb” or “This seat isn’t available, my friend with blondness is going to sit there” or “That man affected by thinness getting on the bus - I think I know him!”

When it is suggested that simply accurately describing higher-weight bodies is such a terrible thing that the it requires a semantic workaround, that actually CREATES and INCREASES stigma, it does not reduce it.

This also has the impact of suggesting that the “problem” is higher-weight people existing and so we don’t need to solve the actual stigma that higher-weight people experience and that harms them, we just need to “treat” higher-weight people out of existence and then the “problem” is “solved.”  

In truth what we need is a world that affirms, includes, and accommodates higher-weight people, not a world that wants to use marketing spin to sell the eradication of higher-weight people as weight stigma reduction.

So what words should we use?

“Ob*se” and “Overw*ight” are terms that were literally made up for the purpose of pathologizing higher-weight bodies based on shared size, rather than shared cardiometabolic profile or symptomatology like we would see in a real disease diagnosis. In addition to the issues with pathologizing body size, they are body shaming - overw*ight inherently so (it states that there is a correct weight and this person is not at it) and ob*se comes from a latin root that just means to eat oneself fat - a lot more stereotype than science there. Again, these are terms that suggest that higher-weight people, and not a world that is hostile to them, are the “problem” to be “solved.” They aren’t suitable.  

We can use neutral language (language that accurately describes bodies without medicalizing or pathologizing them, and that was not used as a taunt or slur that might be triggering.) This can include terms like higher-weight, larger bodied, people of size etc.

We can use reclaiming language. Fat is my personal preferred descriptor. It is also a reclaiming term, with all of the complexities that come with reclaiming terms. There are people who could be labeled as fat who do not align with that term and that’s completely valid. What is incredibly important is that if someone does describe themselves as fat in a neutral or positive way, is that we do not correct them, do not say something like “you’re not fat” or “don’t call yourself that” as that increases stigma around existing in a higher-weight body. 

Finally, do not use person/people-first language for higher weight people and, if you have an opportunity, push back against the use of person/people-first language, especially as “anti-stigma” language when talking about higher-weight people.

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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.