People First: Remove the Word “Obese” from Your Dictionary

Going straight to the conclusion, I want you to remove the word obese from your dictionary. Click here for the directions to do it in Microsoft Office.

Have you ever noticed that when people talk about health conditions or disabilities, they usually talk about the people separate from the condition? Talking about diabetes instead of diabetics is an example of people-first language. For the most part, we avoid labeling people with their condition. It’s a measure of respect. But the situation is very different for obesity.

The word obese feels like a rude label that’s used all too often. Consider, for example, the language that floats around the internet. If you do a Google search for the phrase “people with autism,” you’ll get roughly seven times more mentions for that phrase than you get for “autistic people.” The same is true for asthma and diabetes. It’s the opposite for obesity. References to obese people are twelve times more common than references to people with obesity. The numbers are in the table below.

Condition/Adjective

People First

Condition First

Autism/Autistic

4,030,000

579,000

Asthma/Asthmatic

3,570,000

125,000

Diabetes/Diabetic

4,920,000

230,000

Obesity/Obese

218,000

2,710,000

People with conditions such as autism, diabetes, or asthma prefer to be considered as people first, and not defined by their condition. And research shows that people-first language affects attitudes and behavioral intentions toward persons with disabilities. Because of this, people-first language has become the standard for most chronic diseases and disabilities.

The rules of APA Style (for professionals in psychology) calls for language in all publications to “put people first, not their disability” and to “not label people by their disability.”

Likewise, the American Medical Association (in their Manual of Style) requires authors to:

“Avoid labeling (and thus equating) people with their disabilities or diseases (eg, the blind, schizophrenics, epileptic). Instead put the person first. Avoid describing person as victims or with other emotional terms that suggest helplessness (afflicted with, suffering from, stricken with, maimed). Avoid euphemistic descriptions such as physically challenged or special.

Why is obesity different? Well, there’s no good reason.

Bias and discrimination against people with obesity is well documented. Studies have shown that describing a person as obese is enough to cause discrimination in the absence of any meeting with the person in question. And it’s clear that people don’t like being called obese, whether by family, friends, or healthcare professionals.

Calling someone obese has a bad effect on how individuals feel about their condition and how likely they are to seek medical care. Labeling people like this leaves them feeling stigmatized and discouraged from doing anything about the condition.

So why does it continue? Mainly it continues because, without even thinking about it, many people act as if they have permission to disrespect people with obesity. “Don’t let them off the hook” is an appalling phrase I hear people speak without shame.

What can we do about it? We can wipe the word obese out of our vocabulary. We can press health professionals to apply the same standards for people-first language to obesity as they do to every other chronic condition or disability. And we can stand up for principles of decency and respect in relationships with everyone we encounter.

Thank you,

Ted Kyle, RPh, MBA, OAC Vice-chairman



17 Comments for this Post
  • Dr. John Mitchell
    January 25, 2013 at 4:29 pm

    Recognizing if one has a problem is critical to effecting change. Obese people have a problem…a weight problem. Let’s not ignore that fact. Stop coddling, hiding, renaming a serious health issue that is killing millions of humans every year.
    We have to get very tough on obesity, not simply put our heads subterranean, or be blind to their problem. It’s our problem as well….increased health costs we all pay for with obese people.
    People are fat for a few reasons….some bonafide hormonal (2-3% only)….vast majority is lifestyle (97%). We should not accept obese individual’s “lifestyle choices” in being obese. A concerted “lifestyle intervention” by everyone is required to get them to change their lives. Tough love for obesity.
    Why? Because we need to show them we care, and want them to change….not ignore them by “removing the word obesity from my dictionary.” That would be a mistake and would make the obesity crisis worse.
    Poor advice is the cause of our national obesity crisis. NOT individual weakness. Stop blaming the individual, and blame the “experts” who have given obese people very, very, poor advice over the past 4 decades:
    -eating fat makes you fat
    -eat low-fat foods
    -avoid cholesterol
    -eat grains
    -avoid animal fats
    -exercise more, eat less
    -eat a plant-based diet
    The experts have been wrong for a long time. When does someone finally step out of the line of lemmings, and say “Enough is enough”?
    I refuse to sacrifice more humans to obesity caused by nutritional, or psychological, ignorance. See the problem, don’t ignore it, and cure the obesity problem.
    Dr. Mitchell


    • Pam Davis
      January 25, 2013 at 5:07 pm

      “Dr.” Mitchell,

      I would love to know what type of “doctor” you are, obviously not one used to interacting with humans or one who has any empathy for patients. Please explain to me how it is that we as a society of healthcare professionals continue to treat other chronic disease states such as diabetes, hypertension, heart disease, COPD and lung cancer without playing the “blame and shame” game for the role lifestyle choices play in those conditions? Would you monitor the grocery checkout aisle and if A PERSON AFFECTED BY DIABETES purchased an item with more than 30 grams of carbs per serving cancel their access to their prescriptions? Would you camp out in the soup aisle and measure the blood pressure of THOSE AFFECTED BY HYPERTENSION and refuse to let them purchase items containing over 500 mg of sodium per serving and if they do so, notify the pharmacy not to refill their medications unless they pay for them themselves?

      You have literally missed the point of the original blog post which is we are not treating a diseased individual, WE ARE TREATING INDIVIDUALS AFFECTED BY A DISEASE. Additionally, please, please show me your reference illustrating the CHRONIC DISEASE OF OBESITY is 97% related to lifestyle choices. There are hormonal factors, environmental factors, genetic factors as well as lifestyle factors to consider.

      Diet and exercise alone do not work long term for someone AFFECTED BY SEVERE OBESITY; however, access to appropriate treatment options are often limited by employers and insurers. To successfully treat THOSE AFFECTED BY OBESITY, we have to begin with educating our healthcare professionals on the following:
      1. THOSE AFFECTED BY OBESITY AND SEVERE OBESITY have a chronic multi-factorial illness that requires multi-factorial treatment. Eat less, exercise more as a “counseling” session does not work.
      2. You have to engage your patient in a conversation about their weight. A conversation that is not blaming and shaming, not condescending and one both the healthcare provider and the patient are ready to have.
      3. TOGETHER, the individual affected and their healthcare provider need to develop a plan they both agree is the best option for the patient. Those options MAY include: referral to a Registered Dietitian for education and nutritional counseling; referral to a Physical Therapist or Exercise Physiologist to develop an activity plan appropriate for the individual; referral to a psychologist or behavioral health provider to address stress, coping mechanisms, and other factors affecting the individual. Additionally, we now have new medication therapies for those AFFECTED BY OBESITY. For those AFFECTED BY SEVERE OBESITY, bariatric surgery is both a safe and effective treatment option.

      STOP BLAMING AND SHAMING-IT DOESN’T WORK.
      START TREATING PEOPLE LIKE HUMANS AFFECTED BY A DISEASE, NOT AS A DISEASED INDIVIDUAL.
      EDUCATE YOURSELF
      EDUCATE OTHERS
      HAVE SOME EMPATHY

      Pam Davis, RN, BSN
      Certified Bariatric Nurse
      Chairman of the Board of the Obesity Action Coalition
      AND SOMEONE AFFECTED BY OBESITY SINCE AGE 5


      • Dr. John Mitchell
        January 31, 2013 at 7:03 pm

        Nurse Davis,
        Attacking my education or salutation, does not assist your critique, nor does yelling your point (CAPS ON). Please demonstrate respect and better demeanor in a public forum. Your quotations around my salutation insinuates envy. Let’s hope not.

        Not calling someone obese, who is by medical standards (BMI), a drastic departure from all medical training. Bariatric surgery cannot be performed without the diagnosis of obesity. Drugs can’t be dispensed without a diagnosis of obesity. There are ways to play with words, and semantics won’t change the issue of obesity.

        We use to do this to patients diagnosed with cancer. Should we return to archaic methods? Hide our diagnosis? And not treat the patient? I do treat my patients by not hiding a diagnosis, telling them they have had poor past lifestyle choices. I do tell them they are obese, they have an obesity problem, and they need to loose weight. I provide lifestyle changes to save their lives. Drugs and surgery do not change lifestyles.

        Sir Osler, one of the greatest psychosomatic physicians, clearly pointed this out.

        Should we now change all disease nomenclature to “persons with_____”? A mere herculean effort on our part.

        Dr. Mitchell


        • Pam Davis
          February 1, 2013 at 8:17 pm

          Dr. Mitchell,

          Thank you for the response and the complimentary analysis. I can assure you there is definitely no envy here.

          I believe you continue to confuse the difference between assigning an ICD-9 diagnosis of obesity and referring to an individual as obese. Please refer back to Ted’s original post including the rules of APA style.

          Regarding treatment options: I agree medications and surgery alone do not work in the long term. The key to long-term surgical success is not merely the surgery, it is the multi-disciplinary approach which frequently includes physicians, surgeons, registered dietitians, exercise physiologists, psychologists and nurses.

          Thank you for caring enough about the topic and the discussion to access the OAC website and post on the blog. Hopefully we will meet at a conference at some point and can continue our lively debate in person.

          Pam Davis, RN, BSN
          Certified Bariatric Nurse
          Chairman of the Board of the Obesity Action Coalition


    • Ted Kyle
      January 26, 2013 at 1:48 am

      Dear Dr. Mitchell,

      Your intense feelings about people with obesity make quite an impression. It helps me understand the research that shows how many people with obesity encounter such hostility from physicians that it leads them to avoid medical care. Needless to say, I’m not a fan of the tough love you’re advocating.

      I think that it’s best to stick with the facts and follow the evidence for what works in obesity.

      Along those lines, you offered a couple of observations that are correct. I agree with you completely when you say we need to stop blaming people with obesity and show them we care.

      But some of your facts are completely wrong. I’ll keep it brief and just list the things that need correction.

      1. Lifestyle choices contribute to obesity, but genetic, epigenetic, environmental, and other factors play a very large role that’s been documented and replicated in countless research studies over many years. That’s not to say that people are powerless to do anything about their condition. But it’s not helpful to lie and tell people that a difficult task is easy.

      2. People with obesity already get plenty of the tough treatment you’re suggesting and it’s not helpful. Al Roker said it well in his new book. “Guess what? We already know we’re fat. We live in homes with mirrors.”

      3. You missed the whole point of my post when you misquote me as asking you to remove “obesity” from your dictionary. The word you can live without is “obese.” It’s every bit as insulting as using the word “crippled” to describe someone with a disability. But obesity is indeed the word for the disease that we need to confront and defeat.

      4. I’m pretty certain that you don’t have a “cure” for obesity as you suggest in your closing sentence. But if you do, please publish your data in a medical journal and people will be very interested.

      Ted Kyle


      • Dr. John Mitchell
        January 31, 2013 at 7:15 pm

        Mr. Kyle,
        Thanks for your reply. Treating the patient is more important that simply treating the disease. We’ve learned from that mistake. I agree with you on those salient points.
        But what I don’t agree with is taking a word out of our vocabulary. I’m not advocating calling people names, to illicit insult; nor would I advocate hurtful behavior to actually shame someone. That never works.
        What I do advocate is clarity, accuracy, and proper nomenclature of diseases so the patient is fully aware of their condition. Recognition is the first problem-solving step. That we agree upon I’m sure.

        I do challenge my patients to stop their deleterious behaviors. And these behaviors/poor lifestyles are the result of very poor recommendations from dietary organizations; ADA, AHA, RDs, and as well as MDs. Who tend to blame the individual for “lack of discipline or motivation”.

        That is shameful.

        I do appreciate your efforts in this epidemic.

        Dr. Mitchell


    • Nanette
      January 27, 2013 at 4:38 am

      Dr. Mitchell, I worry about your patients. Your attitude here represents an attitude of arrogance and an ignorance of the genetic, hormonal and bio-chemical factors that are often unknown to or out of a patient’s control. Unfortunately, your lack of empathic understanding is common, even in the medical community. We have to educate society that obesity is a symptom of many other factors, not just lifestyle. We can not shame patients and expect it to cure anything; it won’t be effective in motivating them to change those lifestyle factors within their control either. Obesity is a complex disease where each patient needs to be treated as individual, educated on their own complex symptomology with compassion and loving kindness. Not everyone who retains excess body weight retains it for the same reasons. The cure for obesity is to change the way society thinks about it, stop the bullying or the better than thou attitude, and treat people as individuals, not as victims of an ailment.


      • Dr. John Mitchell
        January 31, 2013 at 9:49 pm

        Nanette,
        Thanks for your concern. I worry about them too!

        I have never had a patient fail to loose weight on my program I spelled out in my first post. They start out at about 2 lbs/week for the first couple of months, then taper off to about 1 lb/week.
        Everyone seems to stabilize at their weight when they were 25 yrs old; little bit more for post gravid females.
        Blood biomarkers for disease are excellent as well.
        Lots of energy, better sleep, less stress, more strength.

        It’s not too good to be true. All you have to do is try it for a few weeks. Doesn’t cost anything….except in alterations!

        Dr. Mitchell


  • Cari De La Cruz
    February 1, 2013 at 7:09 pm

    Ultimately, when patients feel they are participating in a joint effort with a knowledgable and supportive physician, they do better. Note that I am not referring specifically to obesity in this statement, as this same dynamic spans the spectrum of diseases/syndromes/afflictions.

    Case in point: The average patient diagnosed with breast cancer feels helpless, undereducated, fearful and convinced that death is imminent. What changes the patient’s attitude? I believe it is the commitment by the treating physician AND team of health professionals who say, “You’re not in this alone; we’ll fight it together. You can beat this thing and live a long and healthy life!” It is the support of family and friends, cheering them on and encouraging them NOT to quit. In other words, it is the belief by OTHERS that the condition can be treated.

    Now, let’s say that patient is diagnosed with lung cancer, and they have a history of smoking. Is it harder to treat them? Initially, I believe there is a normal bias (based upon experience and familiarity with common contributors to lung cancer) BUT, that stops when the doctors and health care professionals commit themselves to working with the patient to “beat” the disease. In other words, they overcome their own objections to join the fight with the patient. They don’t blame the patient; they treat the cancer.

    Can the same be said for obesity? I believe we have a way to go before we witness this same level of commitment from the average physician and team of healthcare professionals who treat people battling obesity. I believe conditioned prejudice clouds the otherwise intuitive desire to help another human being.

    Not convinced by the comparison to cancer? Let me discuss it from a different perspective: In the early days of cancer treatment, more people died and there was less hope for remission — yet, patients and doctors still joined forces and fought it. Why? Because they believed there was hope for a cure. These days, thanks to extraordinary advances in the treatment and eradication of cancer, we have a bold history of success, meaning the belief in a cure and willingness to fight cancer are stronger than ever. This proves that with success comes strength.

    As wonderful as that is for cancer patients, the same cannot be said for the average person struggling with obesity. They have a history of failure…failed diets and exercise programs, failed attempts to keep weight off once they lose it; failed attempts to succeed. Repeated failure leads to poor self-efficacy thus, I believe we need to focus on the SUCCESSFUL treatment of obesity to create the opportunity for “skill mastery.” I believe we need doctors to say, “Let’s fight this thing together and beat it!” Not, “Eat more, move less, and change your ways or you’ll be a diabetic before the year is over.” As a rule, people don’t typically respond well if they believe their case is hopeless and failure is a foregone conclusion I mean, how many obese people believe they can actually beat a disease that has beaten them time, and time again?

    Not many, hence the “results not typical” disclaimer on every diet and exercise program out there.
    The bottom line is: If treating obesity were easy, everyone would be doing it. So there must be more to the equation.

    Cancer patients really don’t have to “fight” the active disease over and over and over, because if they lose the battle, they die. Do you think they would feel like fighting the same fight over and over again if all they ever experienced was failure that didn’t kill them? I think their confidence would be eroded and their belief in themselves virtually non-existent. Such is the case for the average obese person. Their history of failure precludes them from fighting the disease.

    As physicians, I believe you can find common ground where there are no excuses for obesity, patients are held accountable for their role in the problem, but they are not BLAMED for their condition. I believe you can encourage the patient to join the fight WITH YOU.

    Physicians are on the front lines of this battle, and can lead the charge — but they will first have to bridge the enthusiasm gap that hampers their ability to place themselves in the line of fire (both by patients AND the medical community at large.) I understand how easy it is to write people off if your only experience is one of continuous and willful avoidance of treatment, excuse-making, non-compliance and a bad attitude. But I ask you to consider that behind the obesity is a person who is afraid to believe they can get better. What you interpret as denial, they see as protection. What you hold to be non-compliance, they see as an inability to comply. What you view as avoidance, they see as fear of failure.

    I understand the reason behind the attitude, but encourage doctors to treat the patient first.

    There is so much more to obesity than physiology…so much more to it than a number on scale or BMI chart. There is often a history of trauma, fear, abuse and addiction. Obesity is actually influenced – often CAUSED – by emotional contributors beyond the control of the obese person. This is not to say that the obese person plays no part in their condition, but I am hard-pressed to think of another disease that can actually be caused by the actions of another (second-hand smoking and fetal alcohol syndrome notwithstanding.)

    Think about it: Can you develop diabetes because you were abused as a child? Someone could probably find a correlation somewhere, but I contend it would be the rarest of circumstances.

    Let’s fight this together and treat obesity as the cancer it really is.

    Thank you for writing this article and offering me the opportunity to comment.


    • Nanette
      February 1, 2013 at 8:05 pm

      Kudos, Cari! You are always right on!!!


      • Cari De La Cruz
        February 1, 2013 at 8:12 pm

        Thanks, Nanette. Except for one, teeny little thing (which was very kindly pointed out to me). Eat less, move more. LOL. Got those backward. Gee…does that mean I’ve successfully made the shift in my brain? One can only hope ;-)


    • Yvonne McCarthy
      February 1, 2013 at 5:16 pm

      So agree Cari! I was about to say the same things that Ted said about obesity not being caused by lifestyle only and I’ve said the same thing as Al Roker for years. No one had to tell me I was obese…I owned a mirror. Before anyone could ever discuss my weight with me I had already beaten myself up a thousand times over.

      I actually don’t have a problem with the words obese or obesity. I have a problem with the shame and the power attached to them. If obese meant that our BMI was at a certain level and that’s all, there would be no shame. Labels are part of life. My labels could be “woman, American, Caucasian, blonde (well sorta), tall, tan etc. None of those particular labels imply shame. I do believe we cannot fix what we don’t acknowledge but it’s how we go about it and whether we are even being taught the proper way to go about it. It was also very difficult to learn anything from someone who obviously treated me differently because of my weight.

      After being obese for 30 years and having weight loss surgery almost 12 years ago I learned that a lifestyle change was necessary but it could not possibly be continued until I faced the reasons I ate in the first place. I have maintained my weight since surgery and it is a battle every day. When I don’t deal with why I want to numb the feelings I have, I regain weight and it is obvious to the world. More shame! When someone who quit smoking or drinking slips, they go about basically undetected unless it gets out of control. Shame sucks the life out of us.

      I lost a hundred pounds a hundred times and each time the weight returned I failed yet again. I finally quit going to the doctor because the shame was too great. No amount of tough love could possibly make me feel worse than I already did. There is no greater feeling than to offer a hand of help, treat a person with dignity and respect and see the light come on that I am not looking at them like they are some kind of monster. Inside every large body is a person dying to get out…just wanting the inside to match the outside. I volunteer every day in this community and there is a great need to help people understand why they are obese when the next person isn’t. It’s certainly not about a new diet.


      • Cari De La Cruz
        February 1, 2013 at 7:19 pm

        I’m doing a personal wave for you, Yvonne! I don’t have a problem with the words, either – as you said so eloquently — it’s the SHAME behind the labels that keeps many of us sick. I realize we can’t help everyone, but I do believe we’ll help a lot more by simply changing the tone of the discussion in that examination room…by treating the person first and working to understand what they need in order to believe they can succeed. Wouldn’t it be amazing if patients could receive dual-pronged treatment, where both a physician AND a psychologist form a team to treat the person and manage the condition? Dare to dream…


  • Robert McCann
    February 1, 2013 at 7:11 pm

    Dr Mitchel and Dr Kyle,
    I am also a certified bariatric nurse, I am certified by the Board of Bariatric Meicine, and the American Society of Bariatric Medicine (as a Nurse Practitioner). I was also tormented as an obese teenager.
    Thank you both for your honesty and bravery in dealing with this difficult topic.
    Bob


  • Sandi Henderson
    February 1, 2013 at 8:01 pm

    Thanks Ted for bringing an issue to all of our attention that particularly needs to be addresses in our schools, as well as in our medical offices. I was the FAT child or the OBESE child from the time I was 4 years old. I was bullied and ridiculed by schoolmates, teachers and medical professionals along the way. I resisted any “treatment” for my disease until I was 55 years old and faced with my own impending mortality. Before that time I would try to “diet” fr a while and then give up. It is a known fact that “diets” work only as long as one follows them.
    Perhaps a caring physician, or a schoolteacher who said something besides, “dear, just ignore them and go play somewhere else” would have assisted me in making choices that would have had positive results in treating the disease of obesity much earlier in my life instead of me hiding in shame from those who either pitied or bullied me. I NEVER learned how to manage my disease long term until I was 55 years old and 424 pounds.
    I have obesity, much as my nephew has type I diabetes. It is a disease. I must do as much as I can on a daily basis to keep this disease form rearing its ugly “co-morbidities”. In order to do that please don’t put a “Scarlet O” across my forehead for all to point and stare at.
    Changes in acceptable language can have long term positive results in the world we live in. After all, there are many other unacceptable words in the English language.


  • Susan
    February 1, 2013 at 8:35 pm

    Whew! I am exhausted reading all this back-and-forth…….. Thank you, Dr. Mitchell, for your insight. I am a RN CBN who is a coordinator for a COE Bariatric Surgery Program. I have also worked with other physicians to try to help them work with their obese (yes, I said the appropriate word, not slur) patients and their families to help them resolve their “weight problems” in a kind and caring manner. While it is true,they all “live in homes with mirrors” and they know they are obese, the mirrors are not magical and have not been able to wish away their weight, nor their pain. That is where we come in as medical professionals, with dignity and compassion and good answers. But with good answers also comes honesty and appropriate terms for their condition. So many of my hundreds and hundreds of patients are like family now and they share with me, their successes and their failures…because they know that although I use appropriate teminology, I am their resource for anything I can help them with in their battle with obesity and the changes and struggles that accompany their battles. I have been a nurse for decades and have watched our society’s waistbands growing at an alarming rate, especially over the last 20 or so years, to this epidemic stage… It is too late to coddle, and hide behind softer words; we need to face what has happened to too many wonderful people and to help turn this around for them and for the generations to come,
    I am sorry if someone has a different opinion than mine and may feel inclined to attack me as some did, the doctor, earlier…. that is just ignorant… and I will not banter back and forth with you… Thank you.



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