What’s in A Word – Especially A Word Like ‘Fat’


Researchers at the University of Pennsylvania focused on the terminology used by doctors when discussing weight problems with overweight patients. Anyone discussing weight or size with an overweight person, as a patient, an employee, a customer, or a loved one, already knows the useful lesson reinforced by this research: Don’t let your message get lost in your words.

People are very sensitive about their weight. Negativity has long been associated with overweight. Think back to your youth, and the schoolyard. “You big, fat” is prepended 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 recipient of the abuse really is overweight, then “fat” is an epithet on its own.

Discrimination and prejudice against overweight people is well-documented. This attitude can be seen from children all the way through to adults.

Overweight and obesity are generally associated with gluttony. That makes it a moral argument as well. Gluttony is one of the seven deadly sins of biblical society. We now know that the many different causes of overweight today are much more complex than in biblical times.

Just over two thousand years ago, the physical requirements of everyday life were much more difficult, and most people probably achieved energy balance just getting by, day to day. There was no need to count calories or watch carbs or worry about dietary fats.

Starvation and malnourishment were much bigger risks than obesity. That is why an overweight person would be suspected of overindulgence.

Our world is much different to those times. In just the most recent few generations, industrialization, mechanization, transportation, and marketing, have changed everything.

“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?”

Obesity is a huge epidemic. According to recent statistics, two-thirds of Americans are overweight, and one third are clinically obese. That is not just a moral failing, and not just over-indulgence. A lot more than that is going on. We know that many children are overweight, and their parents were overweight as children too.

It is a both a health and a medical problem. Of course, there are behavioral aspects, but as research is carried out, we see it is a multifaceted and complex issue. There is no one thing that can be pointed to as the root cause.

One female participant in the University of Pennsylvania’s study who had a BMI of 38 had an interesting take on herself. She said, “I’m not obese, that’s for people who are really fat. It’s gross.”

Here she is mixing two subjectively different terms. “Gross” is a value judgment, while “Obese” is medical definition. She, and many Americans see it differently. They see their size as being normal.

Doctors need to know what their patients hear and feel when these words are spoken. On hearing the words obese, big, fat or others, an emotional trigger may cause them to tune out. That is a problem, because they probably disregard the complete health message.

In the study’s conclusion, a number of terms were suggested for doctors to consider using. For example, if speaking with a patient 50 pounds overweight, they could use “obesity,“weight problem,” “excess weight,” “large size,” “heaviness,” or simply “weight.” Asked to score these words as desirable or undesirable, study participants gave them a score within a set range.

The result was that the simple term “weight,” on its own without any adjectives attached, was most preferred. The next favored terms, “excess weight” and “BMI,” weren’t even close, but still scored as the next most desirable. They considered all of the other words undesirable. As expected, “obesity” was bottom of the list, as most undersirable.

The aim of the researchers was to help doctors improve their own “bedside manner,” when working with overweight patients. Now doctors can moderate their wors to best get the important medical information across, without patients tuning out.

This is very useful research, helping doctor-patient communication to be both considerate and effective.