An online survey of nearly 3,000 UK adults suggests that people would prefer health professionals to use the words "weight", "unhealthy weight", and "overweight" when discussing weight status, and reveals parents' desire to avoid their children being referred to as "fat", "extra-large", or "plus size".
The study, being presented at The European and International Congress on Obesity (ECOICO 2020), held online this year from 1-4 September, also explored people's emotional response to the language that healthcare professionals use, with the terms "fat" and "super obese" provoking the strongest feelings of anger and disgust in adults living with obesity, and sadness, anger, and disgust in parents of children living with overweight and obesity.
"Our study demonstrates the importance of the language used by healthcare professionals, and that using terminology that is less preferred may provoke negative emotions including sadness and anger amongst adults living with obesity, and parents of children living with overweight and obesity", says Dr Stuart William Flint from the University of Leeds, UK, who led the research.
"With around two-thirds of the UK population estimated to be living with overweight or obesity (BMI 25 kg/m2 or above), it is vital that healthcare professionals consider and make conscious efforts to use preferred terminology. This may mean asking people to provide their preferred weight-related terminology within consultations where it is necessary to discuss weight."
Co-author Dr Adrian Brown from University College London, UK, added that, "our findings advance current knowledge about weight-related terminology, and should be considered by healthcare professionals working with people living with obesity."
People's perceptions of weight-related terminology remains poorly understood because of limitations of previous studies including small sample sizes and sample makeup (and therefore representativeness), which may result in ongoing uncertainty by healthcare professionals around the most appropriate terms to use.
To provide more evidence, researchers conducted an online study recruiting adults aged 18 years and older via social media adverts, email list distributions, and word of mouth. In total, 2,915 adults (average age 49 years, 96% female, average BMI 31.5 kg/m2) completed the online survey, asking their opinions about 22 terms (e.g., fat, weight problem, higher weight, and obesity) that healthcare professionals may use to describe weight status, on a five-point scale (strongly agree to strongly disagree). The survey also asked participants to rate their emotional response to use of these terms using seven core emotions (i.e., happiness, sadness, anger, contempt, disgust, surprise, and fear). Respondents who were parents (856) were then asked to repeat the same questions to describe their children's weight. Finally, all respondents completed the modified weight bias internalisation (WBIS-M) scale, which measures the extent that people internalise negative weight stereotypes and self-disparagement.
The researchers found that adults perceived the terms "super obese", "chubby", and "extra-large" as the least favourable for health care professionals to use when discussing body weight. In adults, the strongest feelings of disgust, contempt, and anger were associated with healthcare professionals using the terms "super obese", "chubby", and "fat" respectively.
Parents preferred healthcare professionals to use the terms "weight", "unhealthy weight", and "body mass index". Emotions of contempt, anger, and disgust were most frequently reported in response to use of the words "high BMI", "fat", and "super obese" respectively.
Overall, the most commonly reported emotion associated with all weight-related terminology was sadness.
Average WBIS-M score was relatively high among the study sample, and was higher amongst respondents who had a higher BMI. Therefore, people with a higher BMI had internalised negative weight stereotypes and were subsequently self-disparaging.