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Moralized at Every Size: Weight, Health, and Language

by Sam Swank

It feels like you just can’t win when discussing health and weight. With a documented problem of weight judgment embedded in medicine and other areas of life, how can we determine what language is stigmatizing versus necessary? What responsibility does language have in morphing how we discuss health and morality? And how can we acknowledge the medical implications of weight without shaming people of different sizes? 

We could start by considering patient preferences. Activists often push to reclaim the word “fat” in place of “overweight” or “obese,” which they deem stigmatizing. Yet some research indicates that terms like “overweight” and “unhealthy weight” are preferable to words like “fat” or “obese,”` at least in a healthcare setting. Using “obesity” in place of “fat” also promotes greater feelings of perceived agency over one’s health when presented with the diagnosis of obesity.

In the arena of terminology, we may benefit by comparing English with another language. Consider the sentence, “I am overweight.” Now consider “I am brunette.” Notice how, in English, we refer to someone’s weight—a malleable state that changes throughout life—using the verb “to be.” Yet we also use this verb for permanent, inherent characteristics.

However, in Spanish, there are two forms of the verb “to be”: ser, which refers to enduring attributes, and estar, which indicates changeable or temporary characteristics. Es amable—”They [sg.] are a friendly person”—has different connotations than Está amable—”They [sg.] are being nice (but they aren’t always).”

Interestingly, weight—like thirst, hunger, or temperature—is a characteristic that one has rather than is. I can say Estoy cansada, “I [fem.] am tired,” but it’s generally more natural to say Tengo sueño, directly translated as “I have sleepiness.” So, to say “I am overweight,” I would actually say Tengo sobrepeso, or “I have overweight.”

In English, this “person-first” language is often encouraged for people with disabilities and by style guides like the Associated Press’. It distinguishes one’s identity from one’s corporeal condition—it’s a way to say that who you fundamentally are is not the same as your body. Under this stylistic convention, it’s preferable to use phrases like “patients with obesity” or “patients diagnosed with obesity” instead of “obese patients.”

It’s not just the verbiage that matters. The formal classification of obesity in 2013 as a disease by the American Medical Association was itself controversial. Some believed it would further stigmatize a group that already faces unwarranted social scrutiny. Others, however, perceived it as an excuse for those “undisciplined enough to become fat,” as one reader of a 2013 Boston University article commented. (Yet others were kinder, merely concerned that it would promote powerlessness and demotivate people from pursuing healthy behaviors.)

We shouldn’t have to argue over the complexity of weight—just like the human body itself, it’s exceptionally intricate. Hormone disorders, psychiatric conditions, medications, environmental pollutants, social conditioning, genetics, and eating and exercise habits all contribute to it. There is no “one-size-fits-all”—two people can share the same height, sex, and age yet still be healthy at different weight ranges.

Yet weight’s status as a malleable characteristic opens it up to more socially acceptable moral assessment. And our tendency to assign both temporary and permanent attributes the same verbiage subtly blurs the distinction between the two and forms a more direct structural link between weight and identity.

Researchers Megan Ringel and Peter Ditto explain in their paper on weight stigma, “Attitudes become moralized when they transition from mere preferences to value judgments of a behavior as right or wrong.” Moral beliefs, they elaborate, tend to be accompanied by “intense emotions, such as disgust and anger.” 

We frequently stereotype people’s personalities based on their bodies and the results of presumed actions (overeating, underexercising) and motivations (laziness, discipline), assuming that only one factor (willpower) influences a person’s size. When we blame, shame, and punish individuals for their weight alone, it’s often an expression of moral disgust or anger that erases the nuance of human bodies.

Conversely, some declare that practically every utterance of weight is unacceptable. The Association for Size Diversity and Health (ASDAH), for instance, insists that, even in severe under- and overweight, weight gain or loss should never be a health ambition. They write, “For both the 68-lb and 600-lb persons, using a HAES [Health at Every Size] approach puts the focus on their behaviors, unique sets of abilities, and available resources…. Improving a person’s health is a process that begins by… not by pathologizing any specific weight.”

While it is true that anyone can adopt healthy behaviors regardless of their size—and that an overemphasis on weight ignores other contributors to health—it’s simply unfactual to suggest that certain weight ranges on their own can’t be unhealthy. 

For instance, obesity remarkably increases the risk of osteoarthritis by stressing the joints, resulting in inflammation, pain, and strained mobility. Higher body fat percentage can reduce the effectiveness of insulin in those with diabetes. And as a significant source of estrogens in humans, body fat may play a substantial role in immune system function and the disproportional development of autoimmune conditions (such as diabetes) in overweight individuals. 

On the opposite weight spectrum, 68 pounds would not contain enough muscle and fat tissue to sustain the body of most adults long-term. In fact, in severe underweight, the body cannibalizes muscles such as the heart, weakening the organ and upping the risk of sudden cardiac death as frequently seen in patients with anorexia nervosa.

ASDAH isn’t the only one pushing the idea that weight is irrelevant to health. Some, like body diversity writer Virginia Sole-Smith, censor the word “obesity” with an asterisk. Others, like famous fat activist Virgie Tovar, make videos documenting “cake-related fatphobic incident[s]” in which someone ruins dessert by asking for a smaller portion, which she interprets as a fatphobic assertion of moral dominance. And in a paper about fat bias in psychiatry, one researcher even writes, “The term ‘obesity’ turns the size of an individual into a disease. Calling fat people ‘obese’ medicalizes human diversity and inspires a search for a cure for something that is a naturally occurring difference.” 

This is not the first time we’ve heard the argument that a diagnosis pathologizes natural human variance. As an example, premenstrual dysphoric disorder (PMDD) is a sex-specific depression that occurs during the premenstrual phase. When the writers of the DSM-IV recognized the diagnosis and later added it formally to the DSM-V, some opposed it on the basis that it could medicalize healthy premenstrual experiences and promote sexism. Tasteless commercials for a repackaged version of Prozac called Sarafem didn’t help. 

But for the 2–5 percent of women of reproductive age who have the disorder, PMDD presents as a severe depressive episode and may come with significantly higher suicide risk. Suicidal ideation, presumably, is not part of the healthy premenstrual experience. Should we have denied those who were suffering so immensely the opportunity to heal because the diagnosis might be ideologically weaponized?

We can change social perspectives of an illness and the institutions that treat it. Denying the existence of obesity, PMDD, and other illnesses is likely far more stigmatizing for those who suffer than giving the symptoms a name and solutions. Accurate diagnoses intended as tools to improve quality of life are worth preserving, even if they don’t feel as politically palatable.

None of this contradicts accounts of awful treatment toward overweight and underweight individuals. Unfortunately, there are vocal groups who take their rhetoric to unacceptable extremes. Yet two things can be true at once: Underweight, overweight, and obesity negatively affect our health, and the people with such conditions experience unfair, unnecessary levels of cruelty.

Linguistically, the problem resides in describing people’s moral character based on their body, over which they have a varying amount of—but not total—control. Of course the diagnosis of obesity, for example, will feel stigmatizing if we collectively associate having overweight or obesity with being morally reprehensible.

 By detaching moral judgments, though, we can open our minds to the nuance of weight variation and its causes both in and out of our hands. We can promote taking care of our bodies while acknowledging the many elements that bar people from doing so, like inaccurate information, a lack of resources, or a pre-existing condition.

Agonizing over whether overweight and obesity diagnoses are fatphobic misses the point: it’s simply incorrect to infer someone’s morality from a health condition that doesn’t reflect morality in the first place. We’re much better off uncoupling morality from weight discussions altogether—whether on the giving or perceiving end of judgment.

For many, it’s simply exceptionally unpleasant to talk about weight, but unpleasant doesn’t mean uncompassionate so long as we distinguish condition from character. How can we do that?

First, we can resist the imperative to discredit long-established research in favor of absolutist views. Instead, consult with medical professionals to ensure that pieces are centered in fact, then have an editor versed in sensitivity review them. Second, we can employ language that humanizes individuals with health conditions whenever possible and structurally differentiates person from identity. Don’t feel compelled to include weight descriptions if they’re irrelevant to the story. Finally, by grounding discourse in medicine over rhetoric, we can accurately frame well-being and discouraging weight-shaming as the mutually inclusive goals they are.

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