Destigmatizing language for weight

The way we portray and discuss obesity and other weight-related topics and treatments shapes attitudes toward these health issues and those affected by them. People with larger bodies, and descriptions of causes and treatments for obesity, are often oversimplified and portrayed negatively. These portrayals help create stereotypes and contribute to weight bias and stigma. Research shows these negative depictions pose significant consequences for emotional and physical health.¹

At VA, we strive to avoid negative portrayals of people affected by obesity. We do this by using language and images that ensure all people, regardless of their body weight and size, are respected and represented equitably.

• We use language that puts the person first. We don’t define people by their problems or conditions. Refer to the Language about weight-related health section for words to use and avoid.
• We understand obesity as a complex chronic disease, not a choice. People with obesity deserve science-based treatment and comprehensive care to improve their quality of life. Negativity, punishing attitudes, and blame are harmful and serve no purpose.
• We carefully consider language that might unintentionally communicate bias, blame, or negative judgment. We show support and understanding for people regardless of body size by using language that is empathic and empowering.

Language about weight-related health

At VA, we communicate about weight-related health with Veterans and medical professional audiences. Studies support using neutral, person-first language applicable for each audience.^2-3

For example, clinical terms to describe degrees of obesity may be appropriate in the scientific and medical community. But our Veteran audiences may experience these terms as belittling or stigmatizing.³

In Veteran-facing content and conversations

To describe people

Use these person-first phrases: Person with higher weight, person with a larger body
Avoid these stigmatizing adjectives: Obese, morbidly obese, overweight, chubby, fat, heavy

To describe conditions

Use these nouns: Weight, higher weight, unhealthy weight
Avoid these nouns: Obesity, morbid obesity, fat

Note: We recognize and respect that some people and communities prefer language that honors the way they interact with the world. For example, some people and groups prefer the terms “fat” and “fat person.” In clinical settings, consider asking Veterans what terms they prefer to use to describe their own bodies and conditions, and follow their preferences.

In medical professional-facing content and conversations

To describe people

Use these person-first phrases: Person with overweight, person with obesity, person with higher weight, person with a larger body
Avoid these stigmatizing adjectives: Obese, morbidly obese, overweight, chubby, fat, heavy

To describe conditions

Use these nouns: Weight, higher weight, unhealthy weight, overweight, obesity
Avoid this noun: Fat

Use this noun: Class 3 obesity
Avoid this noun: Morbid obesity

Examples

Like this: Overweight and obesity affect 80% of Veterans.
Not this: 80% of Veterans are overweight or obese.

Note: Consider the effects of words in the same sentence as “obesity” and “weight,” which some people could perceive as stigmatizing. Avoid words like “burden” and “crisis” when discussing obesity and “motivation” or “effort” when discussing weight or weight loss.

Language about body mass index (BMI)

Best practices for the use of BMI as a standard measure in clinical settings are evolving. Instead of treating BMI as a standalone measure of a person’s health, discuss it as one tool that medical professionals use to understand weight-related health on a population level.

Like this: Body mass index is one tool providers may use to assess risk for certain health conditions.
Not this: If you have higher BMI, you’re at higher risk for health conditions.

Language about behaviors: Language to use and avoid

Communication about eating habits, physical activity, and other behaviors also matters.⁴

Use: Consistent choices that form healthy habits
Avoid: Discipline, self-control, willpower

Use: Challenges that get in the ways of goals
Avoid: Excuses

Use: Slips or situations that make it difficult to stay on track
Avoid: Cheating

Use: Triggers, thoughts, or feelings that may lead to eating when not hungry
Avoid: Temptations

Use: Progress toward goals or achieving goals
Avoid: Success

Use: Desire to eat in response to emotions or feelings
Avoid: Cravings

Use: Eating more than planned
Avoid: Overeating, overindulging

Use: Foods low in nutrients
Avoid: Junk food, bad food, sinful food

Use: Foods high in nutrients
Avoid: Good food, guilt-free food, clean food

Visual communication

Images can contribute to depersonalization and stigmatization of people affected by obesity. Use of non-stigmatizing images can reduce bias and improve public attitudes.^5-7

Avoid images that use these approaches:

• Place unnecessary emphasis on excess weight or isolate body parts (for example, abdomens or buttocks). This includes pictures of people from the neck down (or with face blocked) for anonymity.
• Depict people engaging in stereotypical “unhealthy” eating behaviors or looking disheveled.
• Portray specific foods or food groups in a negative or humorous way.

Choose images that use these approaches:

• Portray people engaging in diverse activities, roles, careers, and lifestyle behaviors.
• Present individuals of diverse backgrounds, including related to gender, ages, appearances, and race and ethnicity.
• Depict individuals in clothes that fit and a well-kept appearance.

When selecting an image, consider the following questions:

• Does the image imply or reinforce negative stereotypes?
• Does the image portray the person in a respectful manner? Does the image maintain the person’s dignity?
• Who might be offended by the image, and why?
• What are the alternatives? Can another image convey the same message and eliminate potential bias? Does it need to be an image of a person?

Conclusion

We all can help reduce negative stereotyping, body shaming, and personal blaming in portrayals of people with higher weight. This will increase respect and representation of people with diverse body sizes.

Resources

1. Puhl RM, Heuer CA. The stigma of obesity: A review and update. Obesity 2009; 17: 941-964.

2. Wadden TA, Didie E. What’s in a name? Patients’ preferred terms for describing obesity. Obesity Research 2003; 11:1140–1146.

3. Puhl R, Peterson JL, Luedicke J. Motivating or stigmatizing? Public perceptions of weight-related language used by health providers. International Journal of Obesity 2013;37(4):612-619.

4. Rudd Center. Guidelines for Media Portrayals of Individuals Affected by Obesity. https://uconnruddcenter.org/wp-content/uploads/sites/2909/2020/07/MediaGuidelines_PortrayalObese.pdf.

5. Heuer, Chelsea & McClure Brenchley, Kimberly & Puhl, Rebecca. (2011). Obesity Stigma in Online News: A Visual Content Analysis. Journal of health communication. 16. 976-87.

6. Pearl RL, Puhl RM, Brownell KD. Positive media portrayals of obese persons: impact on attitudes and image preferences. Health Psychol. 2012 Nov;31(6):821-9.

7. Puhl RM, Peterson JL, DePierre JA, Luedicke J. Headless, hungry, and unhealthy: a video content analysis of obese persons portrayed in online news. J Health Commun. 2013;18(6):686-702.

Additional Resources

6 tips to help journalists improve news coverage of obesity (journalistsresource.org)