What words should we use to talk about weight? A systematic review of quantitative and qualitative studies examining preferences for weight‐related terminology

Abstract

Evidence of weight stigma and its harmful consequences have led to increased attention to the words that are used to talk about obesity and body weight, including calls for efforts to carefully consider weight-related terminology and promote respectful language in the obesity and medical fields. Despite increased research studies examining people's preferences for specific words that describe body weight, there has been no systematic review to synthesize existing evidence on perceptions of and preferences for weight-related terminology. To address this gap, the current systematic review identified 33 studies (23 quantitative, 10 qualitative) that examined people's preferences for weight-related terminology in the current research literature (from 1999 to 2019). Across studies, findings generally suggest that neutral terminology (eg, "weight" or "unhealthy weight") is preferred and that words like "obese" and "fat" are least acceptable, particularly in provider-patient conversations about weight.However, individual variation in language preferences is evident across demographic characteristics like race/ethnicity, gender, and weight status. Of priority is future research that can improve upon the limited diversity of the existing literature, both with respect to sample diversity and the use of culturally relevant weight-related terminology, which is currently lacking in measurement. Implications for patientprovider communication and public health communication are discussed. K E Y W O R D S language, obesity, terminology, weight stigma 1 | INTRODUCTION Discourse about obesity and weight control remains prominent in public health initiatives, medical care and health-related media campaigns. As body weight is entangled with societal and cultural meanings that infer evaluative dimensions of one's identity, 1,2 it can be a complex and emotionally charged topic to communicate about. The words used to refer to people's body weight can affect their self-perceptions, attitudes and behaviours. Experimental research shows that even a brief exposure to body-related words can induce automatic evaluations and judgements of body shape and weight, and trigger negative affective responses. 3 These negative, and often implicit, associations 4,5 are a symptom of broader societal weight stigma, so pervasive that recent evidence points to the globalization and presence of weight stigma in both developed and developing countries around the world. 6Because obesity is such a highly stigmatized condition, people with higher weight are vulnerable to weight-based prejudice, victimization and discrimination. 7,8 These experiences contribute to harmful health consequences for targets of weight stigma and can impair both psychological wellbeing and physical health. 9-11 Studies further indicate that healthcare providers' use of stigmatizing communication in consultation with a science literature librarian at the author's institution. Data extraction and synthesis were conducted in accordance with Preferred Reporting Items for Systematic Revie...

What’s the name? Weight stigma and the battle against obesity

“…There are numerous similar studies in literature from 2003 with questionnaires offered to adults with and without obesity, adolescents, parents of children with obesity, healthcare workers: physicians and dieticians, have tested words in English and, more recently, also in other languages. However, we were not able to find any in Italian [8,9].…”

At multiple fronts: Diabetes stigma and weight stigma in adults with type 2 diabetes

“…'weight') rather than terms like 'obese' or 'fat' in conversations with their providers. 24 Providers can also reduce stigma by ensuring that health communication and images on signage in medical offices about obesity and diabetes use non-stigmatizing language and images rather than dehumanizing images of headless bodies with obesity consuming fast food. 25 Several sociodemographic markers were associated with both diabetes and weight stigma; younger individuals, individuals with higher income, and individuals with lower educational status reported high rates of both weight and diabetes stigma, suggesting higher socio-economic status may not act as a buffer in experiences of weight and diabetes stigma.…”

Language Matters: Patients’ Preferred Terms for Discussing Obesity and Disordered Eating with Health Care Providers After Bariatric Surgery

“…Consistent with previous research, variants of “fatness” are considered the least desirable when discussing weight after bariatric surgery; however, our findings broadly support the use of terms such as “weight” and “BMI” after bariatric surgery. Furthermore, our findings support the use of several LOC‐eating terms, with the following terms rated as the most desirable on average: ”ate until uncomfortably full,” “kept eating even though not physically hungry,” “ate more rapidly than normal,” “driven or compelled to eat,” “not in control,” and “loss of control.” Importantly, however, there is heterogeneity in patient preferences (20). For instance, although individuals in our study were significantly more likely to rate “addicted to food” as “very undesirable,” some individuals considered this terminology as “very desirable,” suggesting individual variations in preferences.…”

“…To date, researchers have asked individuals with overweight/obesity to identify appropriate or acceptable terminology for discussing weight and obesity. Available data based on survey and qualitative methods, although relatively limited (10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20), has suggested common themes. Terms such as "fat/fatness" and "obesity/obese" have been rated as undesirable, while "weight" has been rated as the most preferable term.…”