(content warning: weight stigma, ableism, insulting medical terms in linked content)
Reading anything to do with weight and health is similar to reading twentieth-century articles about intellectual and developmental disabilities. Idiot. High-grade moron. Intellectually subnormal. Low-grade imbecile. Mental defectives. Feeble-minded. R*tarded, r*tardates. As a disability activist who focuses on intellectual and developmental disabilities, I find the parallels disturbing.
Why? One word keeps coming up, and it starts with an O and rhymes with fleece.
What’s the matter with the O-word?
It engenders disgust, loathing and judgement that even overweight does not. It comes from a Latin term meaning “having eaten to the point of fatness”—a behavioural judgement, not a neutral clinical term. Before it was a diagnostic term, it was an ordinary insult. It’s as neutral as gluttony. Even corpulence would be an improvement, since it focuses on someone’s size, rather than how they got there. (It’s still insulting, so I’m not advocating its use.)
In the medical literature, the O-word is used as blithely as feebleminded, mental defective and high-grade moron were. People use it ad nauseam without a thought—or if they do think about it, they double down, saying “doctors use it,” as though that absolves them of their responsibility to acknowledge others’ dignity. After all, they once referred to female hysteria and drapetomania.
I am focusing solely on abandoning the O-word in clinical practice, as well as health and wellness websites that refer to the clinical literature. Metabolic science is still in the idiot and mental defective era. We categorise people by their size in ways that are uncomfortably parallel to high-grade moron, use disparaging diagnostic terms, and use “the science” to justify what would be called bullying outside a doctor’s office. Research has shown that higher-weight people object to the O-word—especially Black people—even though clinicians continue to use it repeatedly in their articles. Although clinicians publishing scholarly articles may be following standard practice in their field, it still makes for painful reading.
Weight researchers have started moving toward person-first language, but this is only a Band-aid, just as person with mental r*tardation was back in the 1990s.
I don’t know the right approach to improving people’s metabolic health. But I do know that a field that continues to use pejoratives as diagnoses for the people it claims to support, even if they are shifting toward person-first language, has probably not advanced enough to find the right answers. That was the case with developmental disabilities in the twentieth century, and it’s the case now with weight and metabolism.
Even for those who think that high weight is caused solely by unhealthy behaviour, this is no excuse. Medical history is littered with moral judgement disguised as concern for people’s health, moral defective chief among them. Also, there’s precedent in medicine for developing more sensitive terms in behavioural health: people with substance-use disorder, rather than drunks or junkies. Most practitioners would blanch at applying a term like drunk or junkie in a clinical setting—so why persist in using its modern-day equivalent in metabolic science or endocrinology? Instead of supporting people, we are diagnosing them as food junkies.
What other names should we use?
Radicals in the body-positive and fat-acceptance movements prefer fat, but most higher-weight people continue to avoid it. Fat is analogous to crip: widespread in radical activist circles, but rejected by people outside the movement. For that reason, I don’t advocate the use of fat in clinical settings. Instead, I recommend using an expression like higher-weight.
Even if you consider a high Body Mass Index a medical condition, then you are saying that someone has a disability or chronic illness. By that measure, the continued use of the O-word is a kind of ableism, just as the R-word, moron and mental defective were before it. If you want to use a clinical term to describe high weight and medical conditions that are often correlated with it, why not use metabolic syndrome? At the very least, it focuses on bodily processes (like diabetes or lower-back pain) and doesn’t have the whiff of a playground taunt.
How can we move forward?
The problems with the O-word go beyond the label itself. Social justice isn’t reducible to words—after all, there are people who use all the right nomenclature and still manage to be jerks. For example, I’ve seen a lot of pro-Russian or anti-Ukraine commentators using Kyiv, preferred by many Ukrainians, rather than the Russian-derived Kiev (CW: war coverage).
The O-word is harmful because it is an insult repurposed to be a medical term. It is more like junkies or gluttons than diabetics or people with cerebral palsy. It is used to justify “care” that fails to acknowledge people’s human dignity. It is used to blame and shame. Even as people come to understand the complexities of metabolic health, they continue to use a term that places all the blame on the individual rather than the psychological, social, material, cultural and interpersonal factors that affect their health. It is particularly jarring to see the O-word used in articles that decry weight stigma: it is similar to a substance-use specialist saying that “we should fight stigma against junkies,” or a clinical psychologist saying that “we must acknowledge the dignity of mental defectives.” If you want to avoid stigmatising people with substance-use disorders, you don’t call them junkies. If you want to acknowledge the dignity of people with intellectual and developmental disabilities, you don’t call them mental defectives. And if you want to end weight stigma, you shouldn’t use the O-word.
Weight stigma is detrimental to people’s mental health—and that stress can lead to adverse health outcomes. Ironically, stress can lead to the very thing that many clinicians want to avoid: weight gain. Because they’ve come to acknowledge the harmful effects of weight stigma, practitioners are starting to recommend health-promoting habits, like exercise and eating nutritious foods, rather than focusing on weight loss.
Clinicians are starting to make steps toward more compassionate ways to understand weight and metabolic health, and it’s time to take another step. Medicine abandoned mental defective, r*tarded, and feebleminded and relegated them to the terms of abuse that they always were. It’s time to do the same with the O-word.