Apr 1, 2024 - Health

Don't say "obese": America's changing language around weight

Illustration of a traditional weight scale in the shape of a speech bubble

Illustration: Sarah Grillo/Axios

There's been a major shift in what Americans say — or won't say — about our weight.

Why it matters: The blockbuster success of anti-obesity drugs is driving efforts to frame obesity as a chronic disease with clear and urgent health impacts rather than a cosmetic condition.

  • To change how people think about and ultimately address obesity — including who's seen as "deserving" pricey drugs like Ozempic — the language we use to talk about it needs to evolve as well, advocates argue.
  • That means using what's known as person-first language, a subtle rhetorical pivot that's been adopted in other patient communities.
  • For instance, a person isn't "overweight," they "have overweight." A person isn't "obese," they "have obesity."

What they're saying: "We don't want to be describing people by their illness or defining somebody by their illness. We are so much more than an illness," said Rachel Goldman, a psychologist who consulted on the the film "The Whale" who has also appeared on an Oprah Winfrey special about obesity.

The big picture: In the medical community, there's a greater awareness of how language clinicians use to describe patients can seem judgmental and lead to poorer health.

  • Even a few years before Ozempic exploded, the vocabulary around obesity started to change with the body acceptance movement and as medical societies began recognizing obesity as a chronic disease.
  • These professional groups have also started to require researchers to use person-first language in their studies.
  • Experts also say it's better to call the GLP-1s "anti-obesity medications" rather than "weight-loss drugs" to indicate they're not a vanity product.

Between the lines: The person-first language can sound a bit grammatically awkward, and some may think it's just splitting hairs.

  • But experts say the relatively small linguistic change can make an outsized impact on how people think about obesity, including whether they blame someone who has it.
  • "By eliminating the term 'obesity' in favor of person-centric language, we pave the way for a more equitable healthcare system that prioritizes the well-being of all individuals, regardless of their size or shape," Transcarent CEO Glen Tullman recently wrote in MedCity News.
  • In the same way it would sound pretty insensitive to call someone "cancerous" rather than say they have cancer, it also dehumanizes someone to call them obese, said Joe Nadglowski, CEO of the Obesity Action Coalition.

Yes, but: Not all patients adopt person-first language because they say they embrace their condition as a part of their identity. For instance, many prefer being called autistic over "a person with autism."

  • In the same way, some in the body acceptance movement prefer using the word "fat" when they refer to themselves.

What to watch: Even "obesity" may be falling out of favor in medical circles for more precise language, such as "clinical obesity" or "metabolic syndrome."

  • A Lancet commission is working to better define and clearly diagnose when someone has clinical obesity, meaning a person is already experiencing health concerns connected to excess body fat.

My thought bubble: This shift first caught my attention when I was gently chided for using "obese" during a conference panel discussion.

  • At another event, Weight Watchers CEO Sima Sistani also implored me to talk about "weight health" rather than "weight loss."
  • While even advocates acknowledge it can take a while to adopt more compassionate terminology, language is always evolving as our understanding changes.
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