SILVER SPRING, Md.—Researchers are recommending a stronger move towards less stigmatizing, standardized terminology in scientific journals and with patients, which reflects our understanding of obesity as a disease, according to a new study in Obesity, The Obesity Society’s (TOS) flagship journal. The is the first study to determine how wide-spread, stigmatizing language is within scientific publications on obesity and examine its impact on patients.
Researchers explain that although most scientific journals have developed editorial policies that encourage use of first-person language, negative language which perpetuates both overt and implied stigma related to obesity, continues to be used. The mechanisms contributing to the development of obesity are increasingly well-characterized; however deeply ingrained perceptions within the medical community and the public have seen the persistence of negative attitudes towards obesity. This study aimed to access how frequently negative terminology was used to report bariatric surgery studies in peer-reviewed journals. A secondary goal was to evaluate the patient perspective of potentially stigmatizing language and its implications for forming constructive relationships with healthcare providers and engagement with weight-loss interventions.
“All healthcare professionals should be aware of this research and consider their use of language when talking about obesity with colleagues and patients. Non-judgmental, standardized terminology may help patients feel safe to engage in a conversation about weight and potential treatment options,“ said Richard Welbourn, MD, FRCS, Department of Upper Gastrointestinal and Bariatric Surgery, Musgrove Park Hospital, Taunton, United Kingdom. Welbourn is the corresponding author of the study.
Data for the study consisted of a quantitative and qualitative investigation of specific terminology within the scientific literature and from the patient perspective. The words “fail” and “morbid” were identified for the search. For “morbid,” the search was limited to mentions in the title or abstract. However, for the term “fail,” the premise of the paper and the number of times “fail” appeared were recorded. The quality of studies was not relevant in this context and not assessed. For the qualitative portion of the study, 16 patients with obesity involved in a supervised weight-loss program were interviewed. Themes explored with patients during the phone interviews included their perceptions of the importance of language used by healthcare providers in treating patients with obesity, their views of specific phrases including “fail” and “morbid”, and the implications of language on engagement with weight management interventions.
Results revealed that out of 3,020 papers screened, 2.4% included the term “fail” and 16.8% contained “morbid” used in conjunction with obesity. The patients felt that that negative language, particularly the word “failure,” implied a personal responsibility for lack of weight loss.
"Our words truly do matter! The old expression "sticks and stones may break my bones but words will never hurt me" doesn't apply for those living with obesity. As the study’s authors have demonstrated, poor or outdated language hurts the provider/patient relationship and ultimately keeps people with obesity from seeking or receiving care. It's time we prioritize better language around obesity,” said Joe Nadglowski, president and CEO of the Obesity Action Coalition, a nonprofit dedicated to serving the needs of every individual affected by obesity. Nadglowski was not associated with the research.
The study’s authors write that clinicians involved in research on the treatment of obesity are uniquely positioned to take the lead starting with the adoption of non-stigmatizing, clinically-descriptive phrases and the use of first-person language in publications. The researchers add that the adoption of editorial policies discouraging the use of ambiguous, non-scientific phrases such as “fail” or “morbid obesity” would reinforce the need to communicate with clarity and in a way that does not perpetuate the role of the medical professions in stigmatizing obesity.
Other authors of the study include Naomi Fearon, Department of Upper Gastrointestinal and Bariatric Surgery, St. Vincent’s Hospital, Dublin, Ireland; Alexis Sudlow and Dimitri Pournaras, Department of Upper Gastrointestinal and Bariatric Surgery, Southmead Hospital, Bristol, United Kingdom and Carl le Roux, Department of Experimental Pathology, University College Dublin, Ireland.
The study, titled “Say What You Mean, Mean What You Say: The Importance of Language in the Treatment of Obesity,” will be published in the June 2022 print issue.
Roux reports grants from the Irish Research Council, Science Foundation Ireland, Anabio and the Health Research Board. He serves on advisory boards of Novo Nordisk, Herbalife, GI Dynamics, Eli Lilly, Johnson & Johnson, Sanofi Aventis, AstraZeneca, Janssen, Bristol-Myers Squibb, Glia and Boehringer Ingelheim. Roux is a member of the Irish Society for Nutrition and Metabolism outside the area of work commented in the study. He is the chief medical officer and director of the Medical Device Division of Keyron since January 2011.Both of these are unremunerated positions. Roux was gifted stock holdings in September 2021 and divested all stock holdings in Keyron in September 2021. Roux continues to provide scientific advice to Keyron for no remuneration.
Pournaras reports receiving honoraria from Johnson & Johnson and Novo Nordisk. He holds an unremunerated post on the advisory board for Keyron, and on the board of directors for Metadeq and GHP Scientific.
Fearon, Sudlow and Welbourn report no conflicts of interests.
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The Obesity Society (TOS) is the leading organization of scientists and health professionals devoted to understanding and reversing the epidemic of obesity and its adverse health, economic and societal effects. Combining the perspective of researchers, clinicians, policymakers and patients, TOS promotes innovative research, education and evidence-based clinical care to improve the health and well-being of all people with obesity. For more information, visit www.obesity.org.