The Washington PostDemocracy Dies in Darkness

What we mean when we talk about obesity, why it matters and what we can do about it

Positive images of people with larger bodies are rare in today’s media.
Positive images of people with larger bodies are rare in today’s media. (iStock)

Research has shown that weight bias can threaten people’s physical and mental health, which makes it vital for the medical community to take special care when discussing obesity. Unfortunately, a recent report in the prestigious British medical journal the Lancet falls short. The report, which highlights the connections between obesity, malnutrition and climate change, is the result of a three-year effort involving 26 authors from 14 countries. While the authors criticize discrimination against individuals who have a body mass index (BMI) in the obese range, they do so in a way that reflects and perpetuates bias. That is troubling.

The good, sort of

The authors point out that, “in most western cultures, obesity is seen as a personal failing rather than a predictable consequence of normal people interacting with obesogenic environments.” Seeing obesity as a personal failing leads to weight bias, which manifests in numerous ways. Consider the dehumanizing, headless “butts and guts” images of larger bodies used in the media and the stereotype that people in larger bodies are stupid, lazy, sloppy, unhappy and incompetent.

This bias not only creates barriers to higher education, jobs and promotions, studies show it leads heavier people to avoid seeking medical care. In one study, signs of cancer were written off as part of patients’ obesity. When people in larger bodies — especially women — experience bias from their health-care providers, they are less likely to return to get regular preventive health care. That’s a big problem.

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The bad

The report then goes on to state that society should not discriminate against people with obesity because it is a “predictable consequence of normal people interacting with obesogenic environments.” In other words: Don’t discriminate against people with obesity, because they can’t help it. They’re diseased.

However, the reason society should not discriminate against people with obesity is because discriminating against people based on their appearance is wrong. People of all shapes, sizes, shades and abilities are worthy of respect and fair treatment.

It doesn’t help that the authors blame obesity on poor diet quality, albeit because of the modern food environment. This perpetuates the myth that fat people are fat because they eat a lot of fast food and other ultra-processed foods. This is far from a universal truth.

The ugly

Additionally, the report, “

The Global Syndemic of Obesity, Undernutrition and Climate Change” is awash in the same gloom-and-doom language used in almost every paper on obesity. In the first place, it refers to obesity as an epidemic (along with undernutrition and climate change, to be fair; a syndemic is a synergistic epidemic) invoking the “health and economic burdens caused by obesity.” It even equates the economic costs of obesity to the costs incurred by smoking or armed violence and war.

The report’s discussion of undernutrition doesn’t elicit those same negative analogies, even though its estimated costs are far greater, which raises a question: Why don’t we constantly hear about “the undernutrition epidemic” or “the war on undernutrition”?

'Person-first' language is not a solution

As with most health professionals who seek to avoid contributing to weight stigma, the authors use — and encourage — person-first language, pointing out that “an obese person” is an identity that suggests personal responsibility (again, unfairly, because many factors determine body weight), whereas “a person with obesity” is a person with a disease.

Trouble is, person-first language ignores that the word “obesity” is loaded with stigma no matter how you use it in a sentence. This is despite — or perhaps because of — the American Medical Association’s 2013 decision to classify obesity as a disease, going against the recommendations of its own Council on Science and Public Health. Today, to be a “person with obesity” is to be seen as diseased, regardless of overall health status and health-related behaviors. The word “obese” is wielded as both an amateur diagnosis and a weapon, designed to shame, silence and dehumanize. Check out the comments on any Instagram photo of a so-called woman with obesity, even if she’s exercising.

It's time for change

We need a new approach. This new strategy, however, should not involve just trying to come up with other, less-stigmatizing ways to say “person with obesity” or “obesity epidemic” (in the case of the latter, we should just stop saying it at all). Instead we should focus on public policies that make it easier for everyone to find and afford nutritional foods, live in a safe and healthy environment, eat well-balanced meals and be physically active. This will promote well-being for all people, regardless of their weight — especially if we are also willing to examine and challenge our own stereotypes and biases. Then, maybe we can leave the obsessive fixation on weight — which is not a behavior — in the rearview mirror.

Dennett is a registered dietitian nutritionist and owner of Nutrition by Carrie.

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