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Today I’m going to offer a sample letter that I have used with success when pushed to use “person-first language” for higher-weight people. First I’ll give a brief introduction into the issue, if you want to skip that, you can scroll down to where it says “Sample Letter.”
Person first language originated in disability community, where there has been and currently is a lot of conversation, transformation, and nuance happening (more on that later.) It has also begun to be more commonly used in other healthcare scenarios. It is the opposite of identity-first language. One example would be a person with Type 2 Diabetes (person-first language) versus a diabetic person (identify-first language.) In people with the same disability or health condition, some will prefer person-first language and others will prefer identity-first language.
This is much more convoluted when it comes to the use of person-first language for higher-weight people.
The weight loss industry (driven by Novo Nordisk and their astroturf “patient advocacy” organizations) seized upon person-first language as a way to forward their profit goal of declaring simply existing in a fat* body to be a disease (“treatable,” of course, with their interventions.)
That is how we got to a place where instead of simply describing higher-weight/fat bodies like we do tall, short, and thin bodies, we instead get the ridiculous “person with ob*sity,” the even more ridiculous “person affected by ob*sity,” and the ridiculous and grammatically criminal “person with overw*ight.”
In order to more effectively market this change, the weight loss industry is marketing the use of person first language as a stigma reduction method. It is not (in fact it creates greater stigma) which I’ve written about in detail previously. That said, they have almost endless money and, I would describe their behavior as displaying low-to-no ethics and so this naked attempt to take advantage of well-intentioned people’s desire to be less stigmatizing - by co-opting and decades of actual weight stigma work and redirect it toward weight loss industry profit - has been very successful as they put massive effort into pushing this into healthcare as quickly and broadly as possible.
I know that we are all tired as the weight loss industry continues its incessant, insatiable campaign for profits, and this might seem like something we can let slide but I think this is, in fact, something that we should go to the mat for or, more appropriately, we should to go to the mat against any time we can.
Again, individuals can choose the language they prefer for themselves (though those choices don’t happen in a vacuum and they can have a negative effect on others,) but when we’re considering general/published language, the use of person-first language for higher-weight people does many harmful things including:
Advancing the weight loss industry goal of diseasifying a body size (regardless of actual health) to increase their market and profits, legitimizing the extremely questionable construct of “ob*sity” and leading to an increased number of people being harmed by their interventions
Separating fat people from our bodies and turning fatness into an undesirable label that we are told everyone should want to get away from/avoid.
Telling higher-weight people that we should be grateful to be less stigmatized because person-first language constructs our existence that is claimed (with plenty of direction from the weight loss industry) to be an epidemic/pandemic/global crisis… at least isn’t our fault because our existence is a “disease” that requires “treatment” and “prevention” so that higher-weight people cease to exist and are prevented from existing in the future. (It’s the old “we don’t want fat people treated badly, but we do want to eradicate them from the earth in a non-stigmatizing way” nonsense.) Of course there is no shame in having a disease of any kind, the issue is that body size simply doesn’t qualify scientifically or logically and the weight loss industry’s attempt to strong-arm this into existence is creating significant harm.
Ignoring/erasing the true method of ending weight stigma which, instead of telling us that our bodies are wrong but it’s not our fault, is affirming and celebrating bodies of all sizes.
I believe it is critical that we not allow the weight loss industry and those (knowingly or unknowingly) working to advance their priorities to speak over and for actual fat positive anti-weight stigma advocates/experts.
All of that to say, I’ve heard from a number of people in healthcare and research who, even though they know better, are being pressured to acquiesce and use this language. It’s not just other people either, in several of my recent academic projects, including research, I’ve received pushback telling me that my use of “higher-weight” is stigmatizing and I must use person-first language to reduce stigma. (While fat is my preferred personal descriptor, it is also a reclaiming term with all of the complexities of a reclaiming term and so in academic work I often use higher-weight and/or use fat with an explanation of the choice of identify-first language generally and the terms I use specifically.)
This is a massive problem because if they can get us to acquiesce in order to be published, then we are giving our tacit approval and who is left to hold the line and demand not just the dignity but the safety of higher-weight people?
Below is the email (with in-text references) that I have created and sent back. I’ve used it three times now and it’s been successful each time though, of course, your mileage (and mine in future uses) may vary.
Finally, I’ll just say that this situation is infuriating because someone (at least in all of the cases it’s happened to me,) who is neither higher-weight nor an expert on weight stigma is telling me what terminology I have to use to avoid creating stigma against myself and people like me. Dude. Still, as I’ve said before, while impact is greater than intent, I think that intent matters (someone accidentally stepping on my foot who immediately moves and apologizes when I point it out is very different than someone who stomps on my foot on purpose who tells me they won’t stop because if they stopped stomping on my foot it would be stigmatizing me.)
Thus, while I think pushing back is completely essential (to the point that I would absolutely withdraw a publication before I would agree to use person-first language with “o-words” for higher-weight people,) I try to keep in mind that this person is likely well-meaning and has simply been reached by the deep pockets of the weight loss industry and address them accordingly.
Sample Letter
(As always, please feel free to modify this to work for you.)
Thank you so much for your communication and for your interest in ensuring that de-stigmatizing language is used. It is definitely an interest that I share and an area that I’ve studied, so I would like to provide some context.
Person first language emerged in disability community where there has been, and is, significant and nuanced conversation around the use of person-first versus identify-first language.
Janeszewski et al, 2025 discussed this in more detail (https://doi.org/10.1037/rep0000631)
As an example of transformation, The Association on Higher-Education and Disability has shifted to identify-first language and offers an explanation as to why in their statement on language
This issue is even more complex for higher-weight people as the co-option of person-first language for use on higher-weight people was constructed primarily by the weight loss industry and pushed into healthcare and research primarily though weight loss industry funded organizations like the Obesity Action Coalition, The Obesity Society, EASO etc. This is part of the weight loss industry’s primary goal of pathologizing existence in a higher-weight body (regardless of health status) in order to increase their market. This is made plain in the 10-year plan by Novo Nordisk (manufacturers of the Wegovy weight loss medication) ilaid out in their 2015 annual report under the section “Obesity Care: Creating the Market from Scratch” (https://www.annualreports.com/HostedData/AnnualReportArchive/n/NYSE_NVO_2015.PDF)
Fat studies scholars, weight-inclusive health community, and fat liberation community reject the idea that higher-weight bodies are a condition and/or label that person-first language should be used to avoid, instead conceptualizing accurate descriptions of higher-weight bodies as simply neutral/positive attributes like tall, short, and thin.Rather than reducing stigma, the use of person first language for higher-weight people can be more stigmatizing as it treats higher-weight bodies differently than other bodies (for example, we do not typically insist upon the use of “person with thinness,” or “person with tallness.”) The claim that accurately describing higher-weight bodies in a non-stigmatizing way requires a semantic work around that is not utilized in other size-based body descriptions is, in and of itself, a form of weight stigma and adds to the pathologization of higher-weight bodies which further adds to weight stigma.
Robins et al., 2025 (https://doi.org/10.1016/j.bodyim.2025.101860) sought to fill a gap in the literature around terminology. This gap has been created by the common research practice of asking people who aren’t higher-weight, and who often have a financial interest in pathologizing higher-weight bodies, what terms should be used to describe higher-weight bodies. This study asked higher-weight people their preferences and then made recommendations for clinicians and researchers:
“Prior research excludes those most affected by the terms used to describe them.
Weight-related term preferences are linked to beliefs about health and weight.
Preferring “fat” and nonmedicalized terms is associated with favorable outcomes.
Person first language, such as “person with overweight/obesity,” is not preferred.
Clinicians and researchers should utilize terms that don’t pathologize larger bodies.”The APA’s Inclusive Language Guides recommends (https://www.apa.org/about/apa/equity-diversity-inclusion/language-guidelines)
“To avoid perpetuating weight stigma, use neutral terms that affirm and respect the dignity of all individuals regardless of their body size, such as “weight,” “lower weight,” and “higher weight” but does not take a position on general use of person or identify first language. That said, weight is not included in their specific discussion of person- vs identity-first language.
I believe there is a strong lived-experience and evidence basis to support the use of identity-first language (in this case higher-weight) as de-stigmatizing language in [this work] and I am asking to use that language as originally submitted.
Again, I truly appreciate your commitment to inclusive language and your willingness to engage in dialog on this subject.
Best,
~Ragen
So, are you dealing with this? If you have other ideas/options/references I would love to hear about them in the comments and if you use this I’d love to know how it goes!
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More research
The Research Post
More resources
The Resource Post
*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’s Belly of the Beast: The Politics of Anti-Fatness as Anti-Blackness for more on this.
Ragen you are the best. Thank you for sharing this, and for all that you do.
It feels a little similar to how you have that explanation at the bottom of your posts, Ragen:
"*Note on language: I use “fat” as a neutral descriptor as used by the fat activist community...."
If we're taught that it's rude to say "fat", we may assume that someone using the phrase "fat person" is being unkind. I'd hope they'd look it up when the phrase comes from someone like you, but the fact that you include that explanation right there could make a big difference!
You also *could* choose to briefly discuss identity-first and person-first language in that note, but I realize you have to balance length with thoroughness. At some point, if they're interested in fat-positive language, they just need to go study it, instead of arguing with a well-respected fat-positive advocate!