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Fat, obese and other dirty words for weight problems
Sarah Boesveld Jan 14, 2012 – 7:00 AM ET | Last Updated: Jan 15, 2012 1:32 PM ET
Childrens’ Healthcare of Atlanta
Childrens’ Healthcare of Atlanta
The Children’s Healthcare of Atlanta has issued a series of posters for a campaign to fight obesity in children.
Go ahead and say that Adrianna O’Regan is obese. She knows it. Her doctor knows it. They’re dealing with it. It’s fine.
“To me, it’s a clinical term,” the 28-year-old Edmonton woman said of the “o” word, one so commonly used by physicians and in public health campaigns. “It’s a matter of fact. That person is obese, that is true.”
But not everyone sees the term as so benign. An overweight friend of hers, she said, loathes the word obese and prefers to be called “fat,” plain and simple. He doesn’t view it through the same lens as Ms. O’Regan, who sees it as condescending and hurtful.
Now, as doctors try to help nearly a quarter of the Canadian population medically classified as obese, they’re tasked with being a lot more careful with their words. The Canadian Obesity Network, our nation’s globally recognized professional body devoted to helping overweight Canadians, is crafting guidelines to help doctors broach the subject of too much weight with more grace. The news comes as a study in the journal Obesity found that, along with “fat,” the now-ubiquitous word “obese” is one patients hate hearing come off the lips of doctors. The University of Pennsylvania study’s 390 participants rated “fatness” as the most undesirable word to describe their situation, with “excess fat,” “large size,” “obesity” and “heaviness” also ranking among the worst.
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The study’s findings, and the growing body of research into weight bias, has stoked a new debate about the way we discuss obesity in a Western world that sees its residents wrestle with expanding waistlines.
While more and more physicians, researchers and fat acceptance advocates say callous language is demotivating people who are obese, keeping them away from the doctor’s office and perpetuating the stigma against them, public health authorities and some obese people themselves say frank discussions in the doctor’s office and elsewhere are needed to draw attention to a problem that isn’t anywhere near solved.
“We have some people saying we need to soften our language — and not use the ‘o’ word — and others who say we are being too soft now and that we need to toughen our language,” said Michael Gard, the Australian author of The End of the Obesity Epidemic, published in 2010.
While it comes down to worldview, cultural norms and history with the words (for example, Ms. O’Regan has a good relationship with her doctors who have used the word obese in a non-judgmental, medical context), Mr. Gard said there is a lot of politics tied up in the language of fat these days.
The Canadian Obesity Network
A new childhood obesity campaign in Atlanta, Ga., a state with the second-highest childhood obesity rate in the nation, next to Mississippi, is the very embodiment of this tough love point of view.
The US$25-million public health crusade, which involves billboards and YouTube videos with the slogan “Stop Sugarcoating It, Georgia,” is meant to raise awareness in a state where 75% of parents with overweight children haven’t acknowledged the problem, according to the campaign. It’s run by an Atlanta hospital that hopes to eventually spread it state-wide, at double the cost.
The straight-talking ads, one of which shows overweight Bobby sitting before his similarly heavy mother and asking, “Mom, why am I fat?” have been met with fury — the campaign’s Facebook wall is dominated by outraged comments and criticism — with many observers, including physicians and parents, saying the campaign shames overweight children instead of educating them and their families on how to improve their health. The masterminds behind the campaign say they plan to move on to the educational phase soon — after the fallout of its bombshell message settles.
“This awareness approach was chosen to directly address the factors that keep parents, caregivers and families from taking action,” Children’s Healthcare of Atlanta said in an emailed statement to the National Post. “We are not suggesting these ads will fix the childhood obesity crisis, or that we alone can do it. This is intended to spark everyone who has an impact on the life of a child to pay attention to the crisis and take steps to make change.”
But the prevailing research suggests that shock tactics don’t work when it comes to dealing with obesity, said Neil Seeman, co-author of XXL: Obesity and the Limits of Shame, published last spring.
“What I’ve been surprised to learn is, across the political spectrum, the vitriol that people use to describe people who are overweight and obese is extraordinary,” he said. “In fact, our data suggests that in countries where there’s a greater incidence of obesity there is, paradoxically, a greater willingness to shame the obese [and] be supportive of heavy taxation on the obese themselves.”
But it’s no surprise to him that biases exist in the doctor’s office, simply because physicians and other health-care professionals are part of broader society too.
Rebecca Puhl, the director of research at Yale University’s Rudd Center for Food Policy and Obesity, said the loaded term obesity, and the brusque way the topic of weight is often raised by doctors, can have a surprisingly strong effect. In September she and her colleagues published a study in the journal Pediatrics that asked parents of obese children what they thought of words that physicians use in conversations about weight and whether they thought the terms were stigmatizing or motivational (like the recent adult study, “fat” and “obese” were considered the most stigmatizing and least motivating). They also asked what a parent would do if their child’s doctor referred to the child’s weight in a way they felt was stigmatizing.
“It was actually concerning because we found quite a sizeable percentage [35%] would actually avoid taking their children to future medical appointments,” she said.
“One of the things we recommend to providers is to use neutral terminology and say things like ‘Could we talk about your weight today?’ and ask ‘Are there particular words you’d like me to use when we have this conversation?’” Many patients are fine with the word obesity and many are not … so it can be a really positive step.”
Dr. Tom Warshawski, chairman of the Childhood Obesity Foundation and a pediatrician in Kelowna, always uses the term “unhealthy weight” when speaking to patients and their parents. He believes he’s actually being more direct by using that term, as opposed to others.
“What these words almost hide is the fact that this is unhealthy. The more extra weight you carry, the more unhealthy your weight is,” he said. “So when we start to say ‘obese’ and ‘overweight,’ it almost obscures the fact that what we’re talking about here is unhealthy weights.”
People tend to have trouble with the word obesity, if they’re diagnosed that way by their doctors, because they envision someone who is morbidly obese — a more severe clinical category — said Dr. Arya Sharma, the chairman of the Canadian Obesity Network.
“What I always tell people is ‘obesity is not a four-letter word,’” said Dr. Sharma, who is also professor of medicine and chairman in obesity research and management at the University of Alberta. “They don’t look at it as a medical definition, which of course it is [since it’s a] BMI-based definition. They look at it as a stereotype. And because of the negative imagery that is very commonly used when talking about obesity … when you see those images [of morbidly obese people] you think ‘that’s not me.’”
Children's Healthcare of Atlanta
He believes the obesity dialogue playing out in the public “promotes weight bias, which makes the problem worse.”
“When I have somebody telling me, ‘If you just watch your diet and you exercise a little bit and follow Canada’s Food Guide, then you wouldn’t be obese,’ then really what you’re telling me is ‘Obese guys are obese because they eat too much and don’t move around enough’ … Anybody who works in this area knows that’s complete nonsense.”
The network’s forthcoming guidelines, crafted in partnership with the Public Health Agency of Canada and expected to be released this spring, will encourage doctors to ask about the patient’s exercise and eating habits and whether they’ve lost weight recently, before suggesting they shed pounds prior to their other medical problems being addressed.
The guidelines may partially emulate those released last October by the National Association to Advance Fat Acceptance (NAAFA) in the U.S., which recommend everything from doctors avoiding offering patients unsolicited weight-loss information to providing sturdy armless chairs in their waiting rooms. The association, which has been fighting for the rights of fat people since 1969, said the word obese is problematic.
“It is a medical term and being used by one’s physician is appropriate,” said NAAFA spokeswoman Peggy Howell. “However it has been so used and abused by just about everyone, and we would really prefer the term no longer be used.”
To Ms. O’Regan, it’s less about the words themselves than the way in which they’re dispatched. If you walk down the street and someone yells “wide load” and the next person says “Oh, that woman is so obese,” it can sting in the same way, she said.
But when the words are used in a completely judgment-free discussion, she said, straight talk can be welcome.
“I think there totally is room for frank chats, but I think it also depends on the relationship you have with that person,” she said. “You’re not going to walk up to somebody who you don’t know and say ‘You’re fat’ or ‘You need to do something about this.’ That puts the person you’re telling that to completely on guard.”
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