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What's in A Word - Especially A Word Like "Fat"

By Caroline J. Cederquist, MD

There's an old proverb that counsels, "Make your words soft and tender, lest you should later be obliged to eat them."

So it's not what you say, but how you say it, and when it comes to weight issues, there's some good hard data now that shows the truth of that conventional wisdom.

The research, conducted at the University of Pennsylvania, focused specifically on the terminology used by doctors when discussing weight problems with overweight patients. But for anyone who has occasion to discuss weight or size with an overweight person, whether as a patient, an employee, a customer, or a loved one, there's a useful lesson in the research: Don't let your message get lost in your words.

It's a sensitive issue. Terms for overweight have long been used in very negative ways, against almost anyone. "You big, fat " is appended to the beginning of almost any schoolyard epithet: liar, bully, coward, braggart, etc., regardless of whether the subject is overweight or not. And if the subject is overweight, then "fat" serves as an epithet all by itself.

Discriminatory treatment and pervasive prejudice against the overweight are well-documented among both children and adults, and negative attitudes about them are almost as universal as they are undeserved.

The truth is that overweight and obesity have long been seen as a moral or aesthetic failing. Gluttony, after all, is one of the seven deadly sins of biblical notoriety. But the causes of overweight in today's society are a lot more complex than they were in biblical times.

Think about it. Back then, the physical requirements of everyday life - including just getting a meal together - were such that most people achieved an appropriate energy balance just getting by, day to day. That is, they burned about what they took in, and didn't need to count calories or watch their carbs or worry about dietary fats.

In fact, it probably took some special indulgences to eat enough to get overweight. In a world where starvation or malnourishment was a far bigger risk than obesity, an overweight person might well be suspected of undue indulgence.

But we are not living in that world.

The world has changed much, and so much in just the last few generations - with industrialization, mechanization, transportation, and marketing - that our progress has outpaced our ability to even recognize all its ramifications.

When Ray Kroc applied assembly line principles to burgers and fries at McDonald's in the 1950s, who imagined that this convenient new dining would be, in just a couple of generations, directly linked to an epidemic of obesity in America?

And it is an epidemic. Two-thirds of Americans are now overweight, one third are clinically obese. How can such numbers be attributed to a moral failing, to mere over-indulgence? Particularly when so many among that number have been overweight since childhood, and so many children are among that number now?

Obesity is a medical problem, a public health problem. It does have behavioral aspects, but as more attention and resources are devoted to considering all its aspects, we learn every day how multifaceted and complex it really is.

Yet studies show that even medical professionals, who really should know better, are subject to the same negative stereotypes society in general assigns to overweight people: that they're lazy, sloppy or undisciplined.

So is it any wonder that overweight people are sensitive about how their weight is characterized and referred to?

For instance, the word "obese," is really just a medical term, and a doctor might reasonably use it when talking to a patient about a weight problem. It defines a person who is 20 percent or more above the expected weight for their height. Typically, people with a body mass index of 30 or more are considered obese. And that's all it means, nothing more.

But the negative connotations the word carries are so entrenched in the public psyche that the simple medical meaning is lost.

The Pennsylvania study on weight terminology quoted one female participant who had a BMI of 38. "I'm not obese," she said. "That's for people who are really fat. It's gross."

"Gross" is a value judgment. "Obese" is medical definition. But try telling that to her, or to any of the other overweight Americans whose body size is so often regarded-even by them - as a reflection of their character.

Doctors need to know how patients hear these words, because if some emotional trigger causes the patient to tune out, the rest of a critical health message could be missed.

So the study set out a number of terms, many very similar, that a doctor might use in a discussion with a patient who was 50 pounds overweight, including "obesity," "weight problem," "excess weight," "large size," "heaviness," and simply "weight." Subjects in the study were asked to score them as desirable or undesirable along a range.

The simple term "weight," without any adjectives attached, was far and away the most preferred of those offered. The next favored terms, "excess weight" and "BMI," weren't even close, but still scored as desirable terms. Everything else was considered undesirable, with "obesity" among the worst.

The research aimed at educating doctors to help improve "bedside manner." When getting heard can be a life or death matter, good doctors learn to tailor the message. They can't afford to be offensive, even unintentionally, because critical medical guidance could get lost in a tangle of hurt feelings.

But there are important things that other people may need to say, too, and no one wants their words to obscure their message. Research like this helps us all communicate not just more considerately, but more effectively.

Through Thick & Thin

While some size-acceptance activists are calling themselves fat and large-sized to try to remove the stigma by embracing these terms, most people aren't yet going along. Research shows that if what you want is not to hurt, but to be heard, non-offensive, non-confrontational terminology is best.

Caroline J. Cederquist, M.D. is a board certified Family Physician and a board certified Bariatric Physician (the medical specialty of weight management). She specializes in lifetime weight management at the Cederquist Medical Wellness Center, her Naples, FL private practice.

She is the author of Helping Your Overweight Child - A Family Guide, which is available at,, or by calling toll-free 1-800-431-1579.

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