Sticks and stones: why terminology among anti-stigma advocates can be fraught

One of the difficulties of working at the interface of the Social Justice Movement and Everyone Else is the use of language. A little over a week ago, an anti-stigma advocate who is situated within the medical paradigm wrote a blog post that I thought was interesting and I shared it. Because I am known as a size acceptance and HAES® proponent, people who follow what I write expect me to use the language of the SJM and assume that any content that I share does the same. Because of this, I included a content note in my tweet – a heads up – to indicate that the post I was sharing contained language that would not normally be situated within this movement, namely that ‘obesity’ is a disease that requires treatment.

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I often include content notes, even on my own writing. I consider it a service to the reader, signposting, if you will. The original writer, Ted Kyle of ConscienHealth, saw my tweet and wrote another blog post about how progress in the anti-stigma agenda is sometimes hampered by the fact that we do not use the same language, and that the SJM considers the language used by EE as harmful in itself. I commented on the blog post and that would have probably been that, except for a discussion that then ensued on Twitter, and it is this that I want to expand on here.

This row over language use is more than simply semantics. The vast majority of individuals – whether lay people, research scientists, healthcare professions, or policy makers – define ‘obesity’ by the BMI criteria; that is, you are ‘obese’ if your BMI is equal to or greater than 30. The BMI is calculated by dividing your weight in kilograms by your height in metres squared. In other words, it is a measure of body size and shape. It says nothing about health. So when in 2013 the American Medical Association classified ‘obesity’ as a disease, against the recommendation of their own scientific committee who had spent a year considering the issue, they were in effect saying that bodies of a certain size and shape were, essentially, a walking, talking pathological condition.

So you can see why some people might find that offensive. The use of the words ‘obese’, and also ‘overweight’ (and ‘underweight’ for that matter) medicalise body shape. But it is more than that. By calling our body shape a ‘disease’, you are implying that it needs to be treated, until it becomes non-diseased, or ‘not obese/overweight’. In other words, the solution to Us is to make us Not Us. To eliminate us.

In order to make this seem less offensive than it actually is, the medical community has recently shifted toward the use of ‘person-first language‘. This is a phrase lifted from the disability idiom, where it is just as controversial as it has become in the weight arena. Essentially, it is a recommendation to use phrases such as ‘person with obesity’ (putting the person first) rather than ‘obese person’. The idea is that the person is seen as more than their weakness/illness/disability/bad thing and that the weakness/illness/disability/bad thing does not define them. In some circles, it is more than a recommendation. Some journals specialising in research around ‘obesity’ now obligate the use of person-first language in any research papers that they publish.

One objection is that this implies that the word that comes before or after ‘person’ is something bad. This may make sense if you think that ‘obesity’ is a disease to be treated. It certainly doesn’t if you object to this automatic negative evaluation of your body size. It has been argued that person first language adds to the widespread stigmatisation of heavier people (and disabled people/people with disabilities before them*). Additionally, our experiences are embodied. We live our lives and move through the world in our bodies, and how we experience that world is to some extent shaped by those bodies. Perhaps what you consider a disease, we consider something that does define us, at least partially.

We can go backwards and forwards over the pros and cons of using person first language. The point is that it is controversial and not everybody likes it. A group of organisations that advocate for better treatment of higher-weight individuals issued a press release objecting to the adoption of the term by the medical community without any attempts to solicit their input. Ultimately though, there is no consensus within any community as to the single best term to use. Some people prefer person-first language and the use of medicalised adjectives for fat bodies. Others do not. And if you claim to respect us as individuals then you need to respect our own, individual preferences. Ask us, then use the words that we prefer. To insist on a one-size-fits-all acceptable terminology is just as ridiculous as to insist on a one-size-fits-all acceptable body shape.

Having said that, while there may not be consensus among entire populations or groups, there is consensus within specific domains about what is considered normative, and in order to engage with people in those domains, you need to respect their choices. For example, on a size acceptance website, the use of the word ‘obese’ is generally considered offensive. Last week’s debate around terminology was picked up by a couple of other anti-stigma advocates on twitter who fall within the EE camp. They had both had negative experiences within size acceptance sites.  I should point out that they are certainly not alone in this. Their take-away message from their experiences were also not uncommon: that these ‘size acceptance’ folks were not really about ‘acceptance’ and that they are rude, inconsiderate, and unappreciative of other people’s attempts to engage with them. I can’t speak for the particular experiences of the two women on twitter, but I have moderated a Health At Every Size® Facebook group. Like many spaces within the Fatosphere, there were strict rules about what is and is not acceptable behaviour on that page. Trouble tended to arise when people did not read or abide by those rules and were then upset by the treatment they got in return. While I don’t doubt that some sites would delete and block any transgressors on sight, our page did not. We tried to explain, to educate. But rarely was any self-reflexivity involved on the part of the visitors. They were never in the wrong, and it was always us who were considered unreasonable and intractable.  But think for a minute. How would you feel if I came into your house and used language to describe you and yours that you considered to be offensive? Especially if you told me that you found it offensive and I continued to use it and demanded to be heard. Being about ‘size acceptance’ does not mean that we accept anything you throw at us with good grace. We spend a lot of time in the big wide world where we are treated to daily hostilities or the ongoing threat of such. We don’t have to put up with that in our own homes.

Note: Health At Every Size and HAES are registered trademarks of the Association for Size Diversity and Health and used with permission.

*For a recent post on this topic, and some interesting discussion in the comments, see here.

Edit: Myself and activist and psychologist Sigrún Daníelsdóttir have recently written a paper on this topic, reviewing some of the evidence around language use around weight, published in Frontiers in Psychology. You can read the article for free here.

Posted in research, weight stigma

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On Huffington Post UK

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Never Diet Again UK (This one is aimed more at the lay public; may contain ranting and occasional language!)

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