Poster presented at the 9th annual Weight Stigma Conference
Words are Heavy: A Scoping Literature Review and Discussion of
Size Related Terminology Preference
Molly Robbins; Katerina Rinaldi; Paula M. Brochu, PhD Janell Mensinger, PhD, FAED
Nova Southeastern University
Introduction
“Obesity” is often used in scientific and popular discourse to refer to body size as a disease that has reached epidemic levels, though such a description has several empirical flaws. The size acceptance movement does not use this term because of its unclear evidence base and its close ties to weight stigma. A recent systematic review of studies focused on people’s preferred words for their body weight showed that people found terminology like “unhealthy weight” most acceptable and “fat” or “obese” to be least acceptable (Puhl, 2020). However, most of the included studies focused on participants’ preferences specifically in the doctor’s office and within the context of weight management. In response to growing awareness that the term “obesity” does carry stigma, researchers have adopted an interesting trend when focusing on higher weight individuals, which is using person-first language such as “person with obesity,” or “person with overweight” (Kyle & Puhl, 2014). While person-first language can be an attempt to separate the individual from what is deemed a negative attribute, fat activists have expressed that they prefer to be called “fat,” in part because they do not see fatness as a negative quality in the first place, and due to the negative connotations with the term “obesity” or “overweight” (Meadows & Danielsdottir, 2016; Saguy & Ward, 2011). Using “fat” as a descriptor is also a rejection of the idea of size as a temporary defect or illness that will be removed on the way to becoming thin and a “whole person.” Existing literature on weight terminology preference, as shown by Puhl (2020), primarily uses Likert scales. In these studies, ratings of words tend to cluster closely together, with differences often not statistically significant. These results can be somewhat ambiguous and may contribute to the continued use of “obesity” in the same research that consistently finds it to be one of the least preferred terms for weight . The ways in which people describe their own body weight and the specific words they would prefer others to use are variable and exist within a greater societal context.
Methods
A scoping literature review was conducted utilizing EBSCO and APA PsychArticles databases. Additionally, reference lists were examined to find relevant sources not discovered in the database search. In total, 38 articles were located and analyzed for common themes prevalent within the existing literature. Included studies examined weight-related terminology preference in a variety of settings and samples. 13 of the most recent aforementioned studies are described in the table (see poster image).
Themes Observed
The (Mis)Attribution of Neutrality
Many studies make assumptions about the neutrality of words such as “obese” or “BMI.” However, there is a dearth of literature indicating that this is the case. The neutrality of these terms is called into question when considering the ways they are connected to the weight-normative paradigm, the pathologization of fat bodies, and weight stigma.
Focus on Medical Settings and Healthcare Providers
The current literature about weight-based terminology focuses almost entirely on medical settings and healthcare related communication. Individuals are rarely asked what terms they use to refer to themselves, or what terms they prefer non-medical providers to use.
The Assumed Communication Goal
The aim of most of the existing research is to improve communication about weight loss recommendations to patients or their parents, or to increase patients’ self efficacy and motivation related to weight loss.
Lack of Inclusivity of the Larger Fat Bodies
Many studies on weight-based communication and terminology focus on either ”normal weight” participants, asking them to imagine being “overweight.” Other studies include ”obese” participants, but do not adequately cover the diverse range of body sizes in that category. It is unclear how those with BMIs above 45 feel and given the increased weight stigma that those in the largest bodies face, their voices and opinions are of great importance.
Focus on Weight Loss Seeking Participants
Almost all studies that included higher-weight participants focused on weight loss seeking participant samples. One study that asked the preferences of higher weight individuals who were not weight loss seeking found that, on average, participants preferred to be called “fat” or “overweight,” and had the lowest preference for “obese” (Thomas et al., 2008).