![\"A](\"http:\/\/expectedly.org\/blog\/wp-content\/uploads\/2023\/06\/kenny-eliason-5ddH9Y2accI-unsplash-scaled.jpg\")
Reading anything to do with weight and health is similar to reading twentieth-century articles about intellectual and developmental disabilities. Idiot<\/a>.<\/em> High-grade moron<\/a>.<\/em> Intellectually subnormal<\/a>.<\/em> Low-grade imbecile<\/a>.<\/em> Mental defectives<\/a>.<\/em> Feeble-minded<\/a><\/em>. R*tarded<\/a><\/em>, r*tardates<\/a><\/em>. As a disability activist who focuses on intellectual and developmental disabilities, I find the parallels disturbing. <\/p>\n\n\n\n Why? One word keeps coming up, and it starts with an O and rhymes with fleece.<\/p>\n\n\n\n It engenders disgust, loathing and judgement that even overweight<\/em> does not. It comes from a Latin term meaning \u201chaving eaten to the point of fatness\u201d\u2014a behavioural judgement, not a neutral clinical term. Before it was a diagnostic term, it was an ordinary insult. It\u2019s as neutral as gluttony<\/em>. Even corpulence<\/em> would be an improvement, since it focuses on someone\u2019s size, rather than how they got there. (It\u2019s still insulting, so I\u2019m not advocating its use.) <\/p>\n\n\n\n In the medical literature, the O-word is used as blithely as feebleminded<\/em>, mental defective<\/em> and high-grade moron<\/em> were. People use it ad nauseam without a thought\u2014or if they do think about it, they double down, saying \u201cdoctors use it,\u201d as though that absolves them of their responsibility to acknowledge others\u2019 dignity. After all, they once referred to female hysteria<\/em> and drapetomania<\/em>. <\/p>\n\n\n\n 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<\/em> and mental defective<\/em> era. We categorise people by their size in ways that are uncomfortably parallel to high-grade moron<\/em>, use disparaging diagnostic terms, and use \u201cthe science\u201d to justify what would be called bullying outside a doctor\u2019s office. Research has shown that higher-weight people<\/a> object to the O-word<\/a>\u2014especially Black people\u2014even 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. <\/p>\n\n\n\n Weight researchers have started moving toward person-first language, but this is only a Band-aid, just as person with mental r*tardation<\/em> was back in the 1990s. <\/p>\n\n\n\n I don\u2019t know the right approach to improving people\u2019s 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\u2019s the case now with weight and metabolism.<\/p>\n\n\n\n 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\u2019s health, moral defective<\/a><\/em> chief among them. Also, there\u2019s precedent in medicine for developing more sensitive terms in behavioural health: people with substance-use disorder<\/em>, rather than drunks<\/em> or junkies<\/em>. Most practitioners would blanch at applying a term like drunk<\/em> or junkie<\/em> in a clinical setting\u2014so why persist in using its modern-day equivalent in metabolic science or endocrinology? Instead of supporting people, we are diagnosing them as food junkies. <\/p>\n\n\n\n Radicals in the body-positive and fat-acceptance movements prefer fat<\/em>, but most higher-weight people continue to avoid it<\/a>. Fat<\/em> is analogous to crip<\/em>: widespread in radical activist circles, but rejected by people outside the movement. For that reason, I don\u2019t advocate the use of fat<\/em> in clinical settings. Instead, I recommend using an expression like higher-weight<\/a><\/em>. <\/p>\n\n\n\n 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<\/em> and mental defective<\/em> 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<\/em>? At the very least, it focuses on bodily processes (like diabetes<\/em> or lower-back pain<\/em>) and doesn\u2019t have the whiff of a playground taunt. <\/p>\n\n\n\n The problems with the O-word go beyond the label itself. Social justice isn\u2019t reducible to words\u2014after all, there are people who use all the right nomenclature and still manage to be jerks. For example, I\u2019ve seen a lot of pro-Russian or anti-Ukraine commentators using Kyiv<\/a><\/em>, preferred by many Ukrainians, rather than the Russian-derived Kiev<\/em> (CW: war coverage). <\/p>\n\n\n\n The O-word is harmful because it is an insult repurposed to be a medical term. It is more like junkies<\/em> or gluttons<\/em> than diabetics<\/em> or people with cerebral palsy<\/em>. It is used to justify \u201ccare\u201d that fails to acknowledge people\u2019s 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 \u201cwe should fight stigma against junkies<\/em>,\u201d or a clinical psychologist saying that \u201cwe must acknowledge the dignity of mental defectives<\/em>.\u201d If you want to avoid stigmatising people with substance-use disorders, you don\u2019t call them junkies. If you want to acknowledge the dignity of people with intellectual and developmental disabilities, you don\u2019t call them mental defectives. And if you want to end weight stigma, you shouldn\u2019t use the O-word. <\/p>\n\n\n\n Weight stigma is detrimental to people\u2019s mental health<\/a>\u2014and that stress can lead to adverse health outcomes<\/a>. Ironically<\/a>, stress can lead to the very thing that many clinicians want to avoid: weight gain<\/a>. Because they\u2019ve come to acknowledge the harmful effects of weight stigma, practitioners are starting to recommend health-promoting habits<\/a>, like exercise and eating nutritious foods, rather than focusing on weight loss. <\/p>\n\n\n\n Clinicians are starting to make steps toward more compassionate ways to understand weight and metabolic health, and it\u2019s time to take another step. Medicine abandoned mental defective<\/em>, r*tarded<\/em>, and feebleminded<\/em> and relegated them to the terms of abuse that they always were. It\u2019s time to do the same with the O-word. <\/p>\nWhat\u2019s the matter with the O-word? <\/h2>\n\n\n\n
What other names should we use? <\/h2>\n\n\n\n
How can we move forward? <\/h2>\n\n\n\n