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Body size

Note: This section uses 鈥渙besity鈥� and 鈥渙verweight鈥� when discussing problematic language, describing some research, and quoting people who use those terms. We do not support the medicalization of higher-weight people. When the word 鈥渇at鈥� is used, it is used as a neutral descriptor.

When to mention body size

Background:

Mentioning body size when it鈥檚 not relevant can contribute to antifat attitudes and behavior and create harm. For example, unnecessarily discussing weight in the context of health may imply that high weight causes poor health; this erroneous belief stigmatizes higher-weight people and can create a fear of becoming fat (see also 鈥淒on鈥檛 conflate weight and health鈥�). Even phrases that may seem like compliments鈥攕uch as telling someone they lost weight and look great鈥攃an reveal antifat bias and a mistaken belief that weight loss is a universal good (see also 鈥淒on鈥檛 glorify dieting, weight loss, or thinness鈥�). Beyond perpetuating stigma for higher-weight people, unnecessary mentions of body size can create real harm by pressuring people to try to change their body through dieting or other means. Studies have shown that weight cycling鈥攑eriods of losing and then regaining weight, which is a common result of dieting鈥攈arms health (for example, see table 5 in SAGE Open 2018, ). And .

In the context of eating disorders, unnecessary mentions of body size can trigger people with those illnesses and impede recovery. In the US National Eating Disorders Association recommends not mentioning a person鈥檚 current or past weight.听

Recommendation:

Mention body size only when it鈥檚 relevant to your content. Discussing someone鈥檚 health does not necessarily mean body size needs to be discussed. Also be cognizant of how discussions of body size and weight can harm people with eating disorders.


How to mention height

Background:

defines 鈥渄warfism鈥� as 鈥渁 medical or genetic condition that usually results in an adult height of 4'10" or shorter.鈥� include 鈥減erson with dwarfism,鈥� 鈥渓ittle person,鈥� 鈥減erson of short stature,鈥� and 鈥渟hort-statured person,鈥� but individuals鈥� preferences are highly variable. While some people use the term 鈥渄warf,鈥� it is not universally accepted, and the National Center on Disability and Journalism鈥檚 recommends using the term only when referring to a medical diagnosis or quoting someone. The word and should not be used. Euphemisms like 鈥渧ertically challenged鈥� can be infantilizing.

Recommendation:

Whenever possible, ask people how they want to be described, and use that language. If it鈥檚 not possible to ask, generally use 鈥渓ittle people,鈥� 鈥減eople of short stature,鈥� or 鈥渟hort-statured people.鈥� Use 鈥渄warf鈥� only in reference to a medical diagnosis. Do not use the term 鈥渕idget鈥� or euphemisms like 鈥渧ertically challenged.鈥�


How to mention weight

Background:

The most appropriate language for weight is highly personal and political. Many fat activists have and believe that a staunch refusal to respectfully maintains its power to harm. Some have created new terms鈥攕uch as 鈥渄eathfat鈥� (coined by author and fat activist Lesley Kinzel) and (coined at Nolose, an organization for fat queer and transgender people)鈥攁s a means of self-empowerment and a way to describe the . The US-based rights organization the , 鈥淲e choose to use the word fat to describe ourselves in order to remove the negative connotations normally associated with larger-than-average body size.鈥� Others find 鈥渇at鈥� stigmatizing and prefer terms that use comparatives, such as 鈥減eople at higher weights鈥� and 鈥減eople at lower weights.鈥�

Some people use euphemisms like 鈥渂ig boned鈥� and 鈥渃hubby鈥� to avoid saying 鈥渇at,鈥� but these words can be condescending and perpetuate the idea that fatness is something to be avoided or ashamed of rather than a natural body size.

In contrast, organizations that promote the medicalization of weight use the terms 鈥渙verweight鈥� and 鈥渙bese.鈥� These terms are problematic because they are defined by body mass index (BMI), a tool based on a mathematician鈥檚 measurements of White European men and originally intended to measure populations, not individuals. These words also treat higher weight as a disease that needs to be prevented and cured鈥攚hat some fat activists frame as eugenic ideology. The term 鈥渙verweight鈥� assumes there is a natural or correct weight and that people above it are aberrations. Nevertheless, because some researchers use these terms in studies, people reporting results may have to use them. To indicate that these terms are problematic, some writers use asterisks in place of the 鈥渆,鈥� place the terms in quotation marks (scare quotes), or include a content warning or note on terminology.

Organizations and some doctors focused on 鈥渙besity鈥� prevention or treatment advocate for people-first (or person-first) language using the word 鈥渙besity鈥� or 鈥渙verweight.鈥� They claim that saying 鈥減eople with obesity鈥� is less stigmatizing than identity-first language, such as 鈥渙bese people.鈥� In a , researchers Angela Meadows and Sigr煤n Dan铆elsd贸ttir note flaws in this approach: 鈥淲hile some obesity organizations that call for the use of person-first language claim to speak for all higher-weight people, this population is far from homogeneous, and individuals who do engage with such organizations will be a self-selecting group who are seeking a medical solution to something they consider inherently problematic.鈥� Similarly, researchers who have surveyed higher-weight people鈥檚 preferences on language often use a questionnaire that 鈥減rompts participants a priori to think of weight as a problem鈥� and use terms that 鈥渨ere chosen after consultation with patients in treatment-seeking settings,鈥� which limits the results鈥� generalizability, Meadows and Dan铆elsd贸ttir say. In their review of multiple studies鈥� results, they found that 鈥渁lthough the medical establishment positions 鈥榦besity鈥� as a neutral term, higher-weight individuals do not seem to like it, and associate it with increased societal disapproval.鈥�

and wording that tries to dissociate fatness from one鈥檚 identity in such phrases as They say separating the person from the weight reinforces the notion that fatness is shameful. In a on inclusive language, health and fitness professional, researcher, and fat activist Ragen Chastain says, 鈥淚n truth, this language actually increases stigma because [people-first language] is not being suggested for other adjectives that describe our bodies. Nobody is advocating that we say 鈥楾he woman was affected by thinness鈥� or 'The man with brunetteness was on the bus.' The use of [people-first language] suggests that accurately describing a higher-weight person鈥檚 body is so awful that we have to find a way to talk around it. It also shifts the blame from weight stigma to larger bodies. When someone says 鈥榯he woman affected by obesity,鈥� it suggests that the problem is her body size, and not the weight-stigma and lack of accommodation that is actually harming her.鈥�

Recommendation:

Whenever possible, ask individuals how they want their weight to be described, and use that language. When it鈥檚 not possible and you need to talk about larger-bodied people, follow the lead of fat activists rather than organizations that pathologize weight, but tailor your language to your audience and content. For most general audiences, use neutral terms. Examples for larger people include 鈥渉igher-weight people,鈥� 鈥減eople with higher weights,鈥� 鈥渓arger-bodied people,鈥� 鈥減eople in larger bodies,鈥� 鈥減eople with more weight,鈥� 鈥渓arger-size people,鈥� and 鈥減eople of size.鈥� Examples for thinner people include 鈥渓ower-weight people,鈥� 鈥減eople with lower weights,鈥� 鈥渟maller-bodied people,鈥� 鈥減eople in smaller bodies,鈥� 鈥減eople with less weight,鈥� and 鈥渟traight-size people.鈥� If you鈥檙e using 鈥渇at鈥� as a neutral descriptor and your audience is receptive to that term, or if you鈥檙e discussing fat activism or fat acceptance, use it as a way of dissociating the word 鈥渇at鈥� from its negative connotations, and explain why you鈥檙e using it. The terms 鈥減lus size鈥� and 鈥渇ull size鈥� are often used in the fashion industry; in other contexts, they may be seen as euphemisms and should be avoided.

Depending on the type of content and audience, consider including a note to explain your reasons for choosing certain terminology. For example, you can note that you鈥檙e using 鈥渇at鈥� as a neutral descriptor in keeping with organizations such as the National Association to Advance Fat Acceptance. Do not use 鈥渇at鈥� as a negative descriptor (see 鈥淎void using 鈥榝at鈥� to mean something negative鈥�).

Avoid the terms 鈥渙besity,鈥� 鈥渙bese,鈥� 鈥渕orbidly obese,鈥� and 鈥渙verweight鈥� unless you鈥檙e reporting on a study that uses those specific categories. And if you do use those terms, define them and explain why they are problematic. Consider using quotation marks or another indication that the terms can be harmful.

Also avoid euphemisms such as 鈥渂ig boned,鈥� 鈥渃urvy,鈥� 鈥渇luffy,鈥� 鈥渉eavy,鈥� 鈥減lump,鈥� and 鈥渇it鈥� unless the person you鈥檙e describing uses those terms. Use caution with the term 鈥攁n average size in the US is a misses 16鈥�18, or a women鈥檚 plus-size 20W, according to a in the International Journal of Fashion Design, Technology and Education. If your intended meaning is 鈥渓ower weight鈥� or 鈥渟traight size,鈥� say that instead. Do not use 鈥渘ormal,鈥� 鈥渁bnormal,鈥� or 鈥渦nhealthy鈥� to describe body size or weight, and do not insist on people-first language. See also 鈥淎sk people how they want to be described, and respect that language".

Examples:

Use:

鈥淭he emergence of Wegovy and a handful of other drugs over the past few years coincides with a shift in the medical complex's and pharmaceutical industry鈥檚 description of people who have obesity, a controversial word that is defined by the US Centers for Disease Control and Prevention as anyone with a body mass index (BMI) of 30 or higher鈥� ().

Avoid:

people who have obesity

Use:

鈥淭he project creators note that while the literature tends to use stigmatizing language鈥攕uch as 鈥榦verweight鈥� and 鈥榦bese鈥欌�we do not endorse this language as it is both oppressive and incorrectly pathologizes and medicalizes bodies based on their size鈥� ( HAES Health Sheets).

Use:

鈥淚n most cases, I use quotation marks or 鈥榮care quotes鈥� around the medicalized terms for large body size including 鈥榦verweight鈥�, 鈥榦bese鈥�, or 鈥榦besity鈥�. This derives from a fat politics lens that questions these terms as medical facts. However, I chose not to use quotation marks when describing public health research on fatness (as they do not use these words critically) or when describing critical obesity studies鈥� ( in The Routledge International Handbook of Fat Studies, 2021).

Use:

Participants who weighed between A and B were more likely to experience this effect than those who weighed between C and D.

Avoid:

Healthy-weight participants were more likely to experience this effect than participants at an unhealthy weight (See also 鈥淒on鈥檛 conflate weight and health.鈥�)


How to describe antifat oppression

Background:

Several terms describe oppression related to body size. as 鈥渄iscrimination or prejudice directed against people because of their size and especially because of their weight.鈥� In a , researchers A. Janet Tomiyama, Deborah Carr, Ellen M. Granberg, Brenda Major, Eric Robinson, Angelina R. Sutin, and Alexandra Brewis define 鈥渨eight stigma鈥� as 鈥渢he social rejection and devaluation that accrues to those who do not comply with prevailing social norms of adequate body weight and shape.鈥� In addition to stigma, people also face weight-based bias, or prejudiced attitudes about weight, and discrimination, which is prejudiced actions based on size.

The term 鈥渨eight鈥� paired with any form of oppression and the word 鈥渟izeism鈥� can mask the fact that higher-weight people are disproportionately mistreated. Naming the group that faces the most harm鈥攆or example, using terms like 鈥渁ntifat bias鈥� and 鈥渁ntifat discrimination鈥濃攊s clearer. Writer and fat activist Aubrey Gordon explains in a , 鈥淲hen we aren鈥檛 explicit about who pays the price for anti-fat attitudes, it opens the door for those with the greatest privilege (in this case, thin people) to recenter themselves as the primary victims of a system designed to underserve and exclude fat people.鈥� Some people also view the neutral term 鈥渨eight鈥� as irreflective of the seriousness of fat hatred. Researcher and university educator Kristen Hardy asks in a , 鈥淚s it 鈥榳eight stigma鈥�? Or is it eugenic ideology?鈥�

The term 鈥渇atphobia鈥� is often used to describe society鈥檚 fear of fatness, but some activists criticize the term for being ableist鈥攄iscriminatory to people with disabilities. Gordon explains in her article, 鈥淒iscriminatory attitudes aren鈥檛 a mental illness. Mental health advocates and activists in the Mad Pride mental health movement have been clear: Oppressive behavior isn鈥檛 the same as a phobia.鈥� Likening antifat discrimination to a mental disorder may also unintentionally absolve people of blame. In addition, 鈥渇atphobia鈥� may be less effective in engaging people in discourse because it comes across as an attack on character rather than actions, according to Gordon. She says, 鈥淚t invites defensiveness rather than transformation from the very people who most need to change.鈥� A lesser-known term for a hatred of fat is 鈥渇atmisia.鈥�

The term refers to negative comments that thin people receive because of their body size. While this behavior is unacceptable, it isn鈥檛 comparable to antifat hatred because it is not systemic exclusion, which oppression against higher-weight people is. While the term 鈥渇at shaming鈥� centers higher-weight people, it focuses on individual acts rather than 鈥渁 complex oppressive system,鈥� Gordon says in the Self article. She recommends 鈥渁nti-fatness鈥� and 鈥渁nti-fat bias,鈥� which she defines as 鈥渢he attitudes, behaviors, and social systems that specifically marginalize, exclude, underserve, and oppress fat bodies.鈥�

Recommendation:

Generally opt for naming fat people as the oppressed group when discussing weight-based bias, stigma, discrimination, and other forms of oppression. For example, use 鈥渁ntifatness,鈥� 鈥渁ntifat bias,鈥� 鈥渇at stigma,鈥� and 鈥渁ntifat oppression鈥� instead of 鈥渨eight bias鈥� and 鈥渨eight stigma鈥� unless you are reporting the results of studies with those terms or you鈥檙e discussing stigma against both lower-weight and higher-weight people. When using 鈥渟izeism,鈥� terms paired with the word 鈥渨eight,鈥� and 鈥渂ody shaming,鈥� add the context that fat people face the most oppression. Avoid treating negative comments to thin people as comparable to antifat hatred.

Avoid the term 鈥渇atphobia.鈥� See also 鈥淎void metaphorical uses of disability-related terms.鈥�


Body size movements

Background:

There are several names for movements related to fighting antifat oppression. Body positivity鈥攍oving one鈥檚 body, regardless of what it looks like鈥攐riginated from fat activists but has been coopted and diluted by some corporations and mainly White, thin people. Fat activists have and positive body image because it tends to position self-love as a prerequisite for worthiness or an answer to discrimination rather than the answer being dismantling systems of oppression. Similarly, calls to accept 鈥渁ll bodies鈥� tend to ignore the highest-weight people and are reminiscent of 鈥渁ll lives matter鈥� instead of 鈥淏lack lives matter.鈥� is similar to body positivity but does not require self-love; it focuses on just accepting one鈥檚 body.

In contrast, fat activism, fat acceptance, and fat liberation are terms for a civil rights movement that aims to end oppression of fat people. A related term is 鈥渟ize acceptance,鈥� but because its name doesn鈥檛 center fat people, it is less specific. Some people try to compare antifat discrimination to other forms of discrimination by saying, for example, that antifat attitudes are the That reasoning ignores the very real harms still perpetrated against groups including people of color, people with disabilities, immigrants, transgender people, and people with multiple marginalized identities. Similarly, some people try to call attention to antifat oppression鈥檚 seriousness by saying that behavior toward fat people wouldn鈥檛 be tolerated if it were directed at Black people. In therapist, writer, and fat activist Charlotte Cooper explains that these because they imply that anti-Black racism doesn鈥檛 exist and ignore intersectionality.

Related movements to fat liberation are weight-neutral, or weight-inclusive, health, which is an approach to health that does not focus on manipulating body size. This movement can benefit people of all sizes but is not the same as fighting for fat people鈥檚 rights. Receiving full civil rights should not be contingent on improving one鈥檚 health. See also 鈥淎void healthism.鈥�

Recommendation:

Recognize that body positivity and body neutrality can be useful personal mindsets but are not tools to counter antifat discrimination. When discussing the civil rights movements for fat people, use 鈥渇at activism,鈥� 鈥渇at acceptance,鈥� or 鈥渇at liberation.鈥� Avoid conflating with the civil rights movements. Avoid implying that antifat discrimination is the . See also 鈥淎void healthism鈥� and 鈥淩ecognize intersectionality in body size.鈥�


Recognize intersectionality in body size

Background:

Intersectionality, a to explain the compounded oppressions on Black women, applies to content on body size because . As sociology professor Sabrina Strings writes in a , 鈥淢y research showed that anti-fat attitudes originated not with medical findings, but with Enlightenment-era belief that overfeeding and fatness were evidence of 鈥榮avagery鈥� and racial inferiority.鈥� Strings鈥檚 book Fearing the Black Body: The Racial Origins of Fat Phobia and Da鈥橲haun L. Harrison鈥檚 Belly of the Beast: The Politics of Anti-Fatness as Anti-Blackness are leading works connecting anti-Black racism to antifat discrimination. Harrison explains in the book, 鈥淭he world鈥檚 obsession with obesity and being overweight is less about health and is more about the cultural and systemic anti-Blackness as anti-fatness that diet, medical, and media industries profit from.鈥�

Intersecting identities of race, gender, sexuality, disability, transgender identity, and socioeconomic status can exacerbate oppression for higher-weight people. Language can recognize the intersectionality of and other oppressions by naming them. In addition, language can ensure that when groups of people are compared, they are not framed as discrete groups but ones that can overlap. For example, in The Routledge International Handbook of Fat Studies, describes work by Dean Vade and Sandra Solovay on fat and trans experiences: 鈥淚n their opening sentence, they refer to 鈥榩eople who are transgender, fat, or both鈥� (p. 167), but in what follows, the 鈥榦r both鈥� option disappears and discussion is confined to people who are fat (and implicitly cisgender) or trans (and implicitly thin).听 .听 .听 . The tendency to compare and contrast fat and trans experiences in approaches such as Vade and Solovay鈥檚 has the effect of erasing the experience of those who are both fat and trans.鈥�

Recommendation:

When discussing body size, be aware of how intersectional identities can compound marginalization. Aim to contextualize antifat discrimination in racism, especially anti-Black racism. When comparing groups of people, ensure that your language makes room for people who are part of multiple groups.

Examples:

Use:

鈥淥ne could argue that it鈥檚 imperative to discard of those who are least likely to survive due to a shortage in medical supplies, but my counter-argument would be that not only are fat and disabled people deemed 鈥榣east likely to survive鈥� just because they are fat and/or disabled, but a shortage in medical supplies is a byproduct of capitalism, profit-driven healthcare, and a commitment by the World to killing the Black/fat鈥� (). (Writer Da鈥橲haun Harrison uses 鈥渁nd/or鈥� and the slash in 鈥淏lack/fat鈥� to show people who hold more than one marginalized identity.)

Avoid:

just because they are fat or disabled

Use:

鈥淲hile everyone feels the effects of anti-fat bigotry, larger-bodied women, people of color, and poor people particularly bear the brunt of its negative consequences, which work in tandem with many other forms of oppression鈥� (鈥淎nti-fat Bigotry,鈥� in , May 2022).


Avoid using 鈥渇at鈥� to mean something negative

Background:

When people use 鈥渇at鈥� as a stand-in for an uncomfortable feeling of fullness or group it with other negative adjectives, they perpetuate antifat bias. Being higher weight is not a personal or moral failing, and no one deserves to be discriminated against or hated for their size.

In addition, contrasting fatness with positive attributes, as in 鈥淵ou鈥檙e not fat; you鈥檙e beautiful,鈥� sets up fatness in opposition to positive things. 听

Recommendation:

Use a specific adjective that describes a feeling instead of using the phrase 鈥渇eel fat.鈥� Do not use 鈥渇at鈥� to disparage other people. Avoid grouping it with other negative adjectives, and avoid setting it in opposition to positive things.

Examples:

Use:

I feel uncomfortable in my skin.

Avoid:

feel fat

Use:

He鈥檚 a sloppy, uninformed politician.

Avoid:

a fat, sloppy, uninformed politician

Use:

They鈥檙e a great athlete. (It鈥檚 not necessary to mention someone鈥檚 size in the context of athleticism. See 鈥淲hen to mention body size.鈥�)

Avoid:

fat but a great athlete


Don鈥檛 conflate weight and health

Background:

In 2013, the American Medical Association declared 鈥渙besity鈥� a disease despite a recommendation from its Council on Science and Public Health to not do so. The International Classification of Diseases also considers 鈥渙besity鈥� a disease. As part of this medicalization of higher weight, organizations and doctors categorize people according to body mass index (BMI), a that is (for example, Sage Open 2018, ).

Studies have failed to find a causal link between high weight and poor health (for example, J. Obes. 2014, ; Nutr. J. 2011, ). People at all weights can be healthy or unhealthy. And in fact, some studies have shown a protective effect of higher weight鈥攚hat some call the a problematic phrase because it pits higher weight against health. Organizations and doctors claiming that high weight causes poor health often rely on 鈥攆or example, and that does not control for confounding factors such as exercise, diet, (repeated loss and regain of weight), , or medications (for example, Nutr. J. 2010, ). See also 鈥淐ritically examine the evidence and sources on body size, and provide context.鈥�

People linking high weight and poor health also often fail to acknowledge the effects of 鈥攊ncluding doctors鈥� spending less time with higher-weight patients, not performing appropriate procedures, , and providing less health education than for lower-weight patients (BMC Med. 2018, ). and a lack of accessibility, such as too-small , also create , which may result in . Furthermore, health practitioners and insurance companies often until they lose weight. These delays in care could contribute to poor health outcomes.

Part of dissociating weight and health involves recognizing that people at all body sizes can get eating disorders. The US-based recommends, 鈥淒on鈥檛 fall in to the trap of referring to all people with Anorexia Nervosa as 鈥榰nderweight鈥� and people with Binge Eating Disorder as 鈥榦verweight or obese.鈥� 鈥�

Language that conflates higher weight with disease is inappropriate because it does not accurately reflect the science; it , which is itself linked to bad health outcomes; and it stokes a fear of becoming fat. This language can also lead to the promulgation of weight-loss interventions, which can put people鈥檚 lives at risk through the , weight-loss medications, weight-loss surgery, and dieting. , they often cause weight cycling, and they are a . And often called 鈥渂ariatric surgery鈥� by anti-鈥渙besity鈥� doctors and sometimes 鈥渟tomach amputation鈥� or 鈥渟tomach modification surgery鈥� by fat activists鈥攈as serious adverse health outcomes, including death.

While the conflation of high weight and disease harms higher-weight people the most, equating thinness with health also harms lower-weight people because it can cause them to overlook health problems.

Organizations and people that defend the description of higher weight as a disease say that the classification is meant to reduce stigma. Fat activists say this medicalization does the opposite. Some organizations have shifted to calling higher weight a , which is still stigmatizing and problematic because it treats higher-weight people as in need of a 鈥渃ure.鈥� As Marilyn Wann explains in the , framing interventions for higher weight as 鈥渃ures鈥� implies that weight is under personal control, and people who fail to control their weight are failures. Language that recognizes how antifat discrimination and inequity affect health is more accurate and inclusive than language that labels groups of people as diseased without basis.

Importantly, recognizing that weight doesn鈥檛 drive health does not mean that health is a requirement for people to deserve respect, dignity, and full human rights. Higher-weight people do not need to be 鈥渉ealthy鈥� (an amorphous concept itself) to earn a lack of discrimination. , and irrelevant to the importance of showing "," as stated by Tigress Osborn, former chair of the U.S.-based National Association to Advance Fat Acceptance (NAAFA). See also 鈥淎void healthism.鈥�

Recommendation:

Avoid equating higher weight with disease, and thinness with good health. Don鈥檛 imply that higher weight causes poor health, that everyone who is higher weight is unhealthy, that lower weight causes good health, or that all lower-weight people are healthy. Avoid comparing being higher weight with risky . Also, recognize that people at all body sizes can have eating disorders. Avoid equating anorexia with being underweight and binge eating disorder with being higher weight.

At the same time, avoid using the fact that higher-weight people can be healthy as the only rebuttal to antifat discrimination, as this can lead people to think that only those performing 鈥渉ealthy鈥� behaviors are worthy of being free from discrimination and hate. See also 鈥淎void healthism.鈥�

Use caution when discussing body mass index (BMI) categories, as they poorly predict health, have roots in racism, and contribute to fat stigma. If you need to mention BMI, provide context about what it is (weight in kilograms divided by height in meters squared) and why it鈥檚 problematic. Also use care with the words 鈥渢reatment,鈥� 鈥減revention,鈥� and 鈥渃ure,鈥� which frame higher-weight people as problems that need to be eradicated. See also 鈥淎void problematic frames of weight.鈥�

Examples:

Use:

鈥淚n 2014, over 70 percent of Americans were considered to be 鈥榦verweight鈥� or 鈥榦bese.鈥� This does not account for the anti-Blackness and racism inherent to the Body Mass Index (BMI) scale鈥� (). (Author Da鈥橲haun Harrison specifically calls out the problematic nature of BMI to give readers context behind the numbers.)

Use:

鈥淪maller-bodied H1N1 patients were more likely to get early antiviral treatment. It turned out that lower-quality health care, not high BMI, was responsible for the increased risk seen in people with BMIs in the 鈥榦bese鈥� category鈥� ().

Avoid:

Obesity is an independent risk factor for swine flu. (The phrase may imply causation, and when used alone, it doesn鈥檛 take into account other factors that are often inextricably linked to higher weight, including fat stigma and inequitable health care. Similarly, researchers have pointed out . See also 鈥淐ritically examine the evidence and sources on body size, and provide context.鈥�)


Avoid healthism

Background:

, the belief that health is a moral imperative and within personal control, contributes to antifat attitudes because it treats higher-weight people as acceptable only when they are 鈥渉ealthy鈥� or perform health-promoting behaviors. It 鈥攄iscrimination against people with disabilities鈥攂ecause society often views disabled people as not 鈥渉ealthy.鈥� It also involves classism because it assumes that everyone has access to health-promoting resources. In addition, the definition of 鈥渉ealth鈥� is not fixed or clearly defined. In a 2021 talk hosted by Community Leaders in Health Equity and Transformative Alliances, poet, activist, and author why healthist rejoinders of are problematic when directed toward higher-weight people: 鈥淲hen we start asking these questions about health, we have to say, 鈥榃hat do we really mean when we say healthy? .听 .听 . Whose definition of health are we applying in this conversation?鈥� Right? Because we're obviously not talking about mental health. Right? We couldn't be talking about mental health, while continuing to systemically and economically disenfranchise an entire group of people based off of their bodies.鈥�

Healthism creates a 鈥攁 term coined by author Kate Harding to describe a hierarchy in which higher-weight people pursuing exercise or other healthy behaviors are seen as morally superior to other higher-weight people. It can appear in language when rebuttals to antifat discrimination rely only on the 鈥渉ealthy鈥� behaviors of higher-weight people without explaining that health isn鈥檛 necessary for people to deserve nondiscrimination. English professor April Herndon, who studies representations of fatness, explains in The Routledge International Handbook of Fat Studies, 鈥淎rguments that attempt to position fat people as always healthy people who are never affected by their fatness run the risk of creating a category of fatness that is also exclusionary and setting up 鈥榟ealth鈥� as another moral standard by which people are judged worthy of protections (or not).鈥�

Recommendation:

Use language that does not frame health as a prerequisite for receiving respect, dignity, and full civil rights. For example, if discussing the benefits of weight-neutral health care鈥攃are that does not manipulate weight to advance health鈥攐r the lack of causality between high weight and adverse health outcomes, clarify that health is not required for higher-weight people to demand a life free from oppression. Also, use care to not imply that health is always within personal control. Being free from oppression should be a right for everyone, regardless of what their health status is or what behaviors they engage in.

Examples:

Use:

鈥淔at people are worthy of respect, safety, and dignity no matter how fat they are. Fat people are worthy of respect, safety, and dignity no matter how sick they are, no matter how much they eat, no matter how much they move, no matter how far they are from any notion of health, however defined鈥� ().

Avoid:

are worthy of respect because they are just as healthy as lower-weight people

Use:

鈥淔irst, as always, remember that health is an amorphous, multifactorial concept and is not an obligation, barometer of worthiness, or entirely within our control鈥� ().


Critically examine the evidence and sources on body size, and provide context

Background:

In content on body size, the decision about , how to tell them, whom to treat as experts, and even what websites to link to affects how inclusive the content is. Many organizations and doctors consider higher weight a disease and are focused on promoting weight loss instead of ending antifat discrimination and oppression. Treating these people or organizations as experts and linking to them lends legitimacy to their biases. These organizations may oppose weight stigma and may , but if their solution to that stigma is eliminating higher-weight people (for example, by pushing people to lose weight), then they . Furthermore, the media often accept as truth long-held beliefs that aren鈥檛 backed by sound science. In a , sociology professor Natalie Boero says, 鈥淚n the media, pre-existing, yet largely unexamined cultural understandings of fatness form the plinth of representations of scientific debate or agreement about weight.鈥�

Health and fitness professional, researcher, and fat activist Ragen Chastain offers several guides on and spot organizations that . are uncritically using the terms 鈥渙bese鈥� and 鈥渙verweight鈥澨�(medicalized terms for higher weight), calling higher weight a disease or chronic health issue, promoting weight loss as a 鈥渟olution鈥� to higher weight, saying that the primary reason weight stigma or diets are harmful is because they cause weight gain, being funded by diet companies, and linking higher weight to health issues without mentioning that fat stigma, weight cycling, and health-care inequity could instead be the causes. Chastain explains in a , 鈥淲hen we talk about weight gain as a side effect of dieting or weight stigma, it鈥檚 important that we are clear that there is nothing wrong with being fat or becoming fatter, but there is a problem with something foisted on us by the healthcare industry as a healthcare intervention that has the opposite of the intended effect. On the other hand, fear-mongering language, stating that being fat or getting fatter is a negative outcome of weight stigma is, in fact, a stigmatizing point of view.鈥�

In addition, fat studies scholars, activists, and critical obesity studies researchers have pointed out , including , , a , a lack of controlling for confounding factors, high , and poor citation practices, such as citing research that doesn鈥檛 support statements and failing to cite statements at all (for a review of problematic studies, see Nutr. J. 2010, ). If content creators of people focused on higher weight as a disease, they can perpetuate inaccurate beliefs that lead to harm and contribute to (for example, Soc. Sci. Med. 2014, ).

For example, in , theorist, abolitionist, and writer Da鈥橲haun L. Harrison explains how bias, poor research, and unethical publishing practices led to the US Centers for Disease Control and Prevention鈥檚 publication of an incorrect estimate of deaths attributable to 鈥渙besity鈥� in the Journal of the American Medical Association. The number of uncritical citations of the erroneous number meant that even after the CDC admitted its error, the public had begun to believe that higher weight was an 鈥渆pidemic.鈥� See also 鈥淎void problematic frames of weight.鈥�

In Fat Activist Vernacular, some questions that therapist, writer, and fat activist Charlotte Cooper recommends asking of 鈥渙besity鈥� research include 鈥淲ho are they studying to prove their theories about fat people? . . . How many of them? Who is paying for the study? How is the sample being found? Who is being paid? What is the sample's relationship to the researchers?鈥� Similarly, a 2020 developed by the Strategic Training Initiative for the Prevention of Eating Disorders recommends that public health professionals understand 鈥渉ow obesity research contributes to weight stigma.鈥�

In contrast to the coverage of anti-鈥渙besity鈥� researchers, the media often discount the lived experiences of higher-weight people. This invisibility is compounded for people who are multiply marginalized, such as higher-weight people of color, LGBTQ+ people, people with disabilities, and people of lower socioeconomic backgrounds.

Recommendation:

In content about body size, critically assess what stories to cover, how to cover them, whom to treat as experts, whether those experts have financial interests in the diet industry鈥攕uch as being funded by pharmaceutical companies鈥攁nd whether the results of studies truly show what the authors claim. Recognize when people or organizations coopt language about reducing stigma while still treating higher-weight people as in need of treatment regardless of their health status.

Provide the necessary context for readers to understand in concrete terms what a study showed and why. For example, avoid using 鈥減romising,鈥� 鈥渞easonable,鈥� and 鈥渓ong term鈥� without defining what those terms mean, and (e.g., of weight). If your content is about weight loss, explain the 鈥攕uch as developing eating disorders and weight cycling (which has negative health consequences)鈥攁nd be realistic about and side effects. Ensure any statements about weight, health, and weight loss can be backed by high-quality science鈥攆or example, studies that account for confounding factors like antifat bias, use strong sampling methods, and don鈥檛 conflate correlation and causation. Question , such as the myth鈥攖he belief that losing weight is simply a matter of consuming fewer calories than are burned.

When deciding whom to quote or treat as experts, center higher-weight people. Aim for a diverse set of higher-weight voices, including people of color, LGBTQ+ people, disabled people, and people at the highest end of the weight spectrum, as their opinions are the most often marginalized. Ensure you credit higher-weight people for their ideas, and cite them appropriately. Also reveal any conflicts of interest, and recognize how the websites you link to may legitimize organizations predicated on the medicalization of higher-weight people.

Examples:

Use:

鈥淪ome of the most interesting targets in potential weight-loss drugs are analogs of hormones that act in hunger- and satiety-related metabolic pathways, says Indiana University Bloomington chemist Richard DiMarchi, a former Lilly researcher who sold his diabetes start-ups to Novo Nordisk鈥� (). (Writer Megha Satyanarayana reveals a source鈥檚 conflict of interest with the diet industry to contextualize his opinions on weight loss.)

Avoid:

chemist Richard DiMarchi

Use:

鈥淣oom鈥檚 own published research can鈥檛 claim any better: 64% of people who stuck with the program lost an average of 7% of their body weight after five months on the plan, according to the 2016 analysis the company includes in its press kit. But there is no data offered on whether these users maintained the weight loss over the subsequent two to five years, when most dieters regain. And Noom鈥檚 study followed 43 people鈥攐nly 36 of whom completed the program. That 鈥�64%鈥� is just 23 people鈥� ().

Avoid:

Sixty-four percent of people using the app showed significant weight loss.

Use:

鈥淓very single one of the study鈥檚 14 authors disclosed receiving funds of some kind from Novo Nordisk, although most listed long strings of industry giants like AstraZeneca, Johnson & Johnson, Eli Lilly, and Boehringer Ingelheim. Three authors, Dr. Marie T.D. Tran, Dr. Salvatore Calanna, and Niels Zeuthen, are employed by Novo Nordisk; Calanna and Zeuthen additionally own stock in the company鈥� ().


Avoid problematic frames of weight

Background:

The way higher weight is framed can reveal negative attitudes and fuel stigma and antifat discrimination. Examples include situating higher weight and higher-weight people as a burden or blameworthy, such as being or at fault for a . In contrast, language that puts the burden of providing accessibility on health-care providers is more inclusive.

Phrases such as 鈥渢he obesity epidemic鈥� and 鈥渢he war on obesity鈥� frame higher-weight people as problems that need to be solved. These frames , shame about body size, and a fear of fatness (for example, see author and sociology professor Abigail C. Saguy鈥檚 ). In a , health and fitness professional, researcher, and fat activist Ragen Chastain says that 鈥渢he obesity epidemic鈥� frame is 鈥渁n intersection between healthism, ableism, and sizeism. There should be no shame attached to body size, health, or dis/ability鈥攖he 鈥榦b*sity epidemic鈥� propaganda encourages all three.鈥�

Pharmaceutical companies, diet companies, and other organizations that profit on the idea that higher-weight people are a problem in need of a cure often point to increases in the number of higher-weight people. In addition to being stigmatizing, these arguments ignore the history of how organizations have classified higher weight. Body mass index, which is used to categorize people as 鈥渦nderweight,鈥� 鈥渘ormal weight,鈥� 鈥渙verweight,鈥� and 鈥渙bese,鈥� has a and for individuals. Furthermore, in 1998, the US National Institutes of Health for the 鈥渙verweight鈥� category, leading to 29 million people previously classified as 鈥渘ormal weight鈥� moving to the 鈥渙verweight鈥� category. Arguments stoking fear about rising rates of higher-weight people also often ignore the impact of diet culture and fat stigma.

Some people blame higher weight on an individual鈥檚 actions or inaction鈥攆ailing to eat the right foods, exercise the right way, or do other 鈥渉ealthy鈥� behaviors. Others point to the so-called obesogenic environment鈥攁n environment that supposedly creates more higher-weight people because it encourages eating high-caloric foods and being sedentary. Although the environmental frame can be seen as more progressive because it doesn鈥檛 blame individuals, it still sets up higher weight as something unnatural, wrong, and in need of a solution. The obesogenic argument is also problematic because it can focus on top-down solutions for people of lower socioeconomic status and people of color and can create inaccessible spaces for people with disabilities. This focus can lead to 鈥渢he hyper-surveillance of communities of color through state nutritional and health programs,鈥� says writer and cultural historian . She adds that initiatives targeting the 鈥渙besogenic鈥� environment can 鈥渘ot only vilify fat people, but render fat communities of color as inept, infantile, and irresponsible.鈥�

Looking for reasons for the number of higher-weight people or 鈥渟olutions鈥� to higher weight frames weight as a problem. In Fat Activist Vernacular, therapist, writer, and fat activist Charlotte Cooper says, 鈥淓xplanations for fat people's apparent deviance from thin normativity reinforces the idea that something makes fat people fat, that this shouldn't be so, that people should be thin, not that some people are just fat. In looking for a reason most people are looking for a cure, something that will make fat people go away.鈥�

While systemic size-based oppression affects higher-weight people the most, sizeism can also affect thin people in language that treats straight-size people as inferior. For example, 鈥渞eal women have curves鈥� implies that women without curves aren鈥檛 鈥渞eal鈥� women.

Recommendation:

Avoid framing higher weight or higher-weight people as a burden, source of blame, or problem in need of a solution or explanation. For example, avoid 鈥渂attle,鈥� 鈥渇ight,鈥� 鈥渟truggle,鈥� or 鈥渟uffer鈥� in relation to higher weight. Avoid alarmist language such as 鈥渢he threat of obesity,鈥� and 鈥渢he obesity crisis.鈥澨齏hen discussing the change in the number of higher-weight people, provide historical context about the change in definitions over time, explain why body mass index is problematic, and note that framing higher-weight people as blights upon society is unfair and discriminatory. Any explanations about rising rates of higher-weight people should also take into account 鈥檚 and while recognizing that being higher weight is not bad. Be aware that looking for explanations for and 鈥渟olutions鈥� to a rise in the rate of higher-weight people can fuel stigma. In addition, a focus on personal responsibility feeds shame and an inaccurate view that weight can be easily controlled, and a focus on the environment can seem to blame groups of low socioeconomic status and communities of color. Any discussion of environmental factors should , as a goal.

Avoid any language that sets a body size as a standard that others must attain (as in 鈥渞eal women have curves鈥�).听

Examples:

Use:

How can we end antifat discrimination?

Avoid:

How can we prevent obesity?

Use:

Antifat bias and discrimination are public health crises.

Avoid:

Obesity is a public health crisis.

Use:

鈥淚 am so sorry that the MRI wasn鈥檛 built to accommodate you, let鈥檚 look at other options for getting the information we need鈥� ().

Avoid:

鈥�You are too big for the MRI machine鈥� (). (Writer Ragen Chastain shows examples of wording that health-care providers should avoid.)


Don鈥檛 glorify dieting, weight loss, or thinness

Background:

Language that assumes everyone wants to lose weight or that weight loss is always good can perpetuate antifat bias, contribute to body dissatisfaction, and encourage dieting, all of which can have negative health effects, including the development or exacerbation of eating disorders. A focus on weight loss in the context of eating disorders is particularly harmful. The US-based says, 鈥�Don鈥檛 focus on weight loss as a measure of 鈥榬ecovery鈥� for people in higher weight bodies with eating disorders. Recovery sometimes includes weight loss, but usually does not and should not be a measure of success.鈥�

Some people use the term 鈥渨eight management,鈥� but it can be seen as code for weight loss. In The Routledge International Handbook of Fat Studies, lecturer Katariina Kyr枚l盲 says that the term 鈥渨eight management,鈥� 鈥渁lthough meant as a more subtle alternative to dieting, expands the threat into a potentiality that concerns all bodies, not only those visually or measurably marked as fat in the now.鈥澨�

Recommendation:

Avoid language that assumes weight loss, thinness, or dieting is a universal good. If your content mentions weight loss, such as weight-loss drugs or other approaches, provide context that striving for weight loss can be harmful, such as being a risk factor for eating disorders, contributing to antifat bias, and causing (repeated loss and regain of weight), which is linked to negative health effects. Also, to avoid perpetuating myths about weight-loss interventions, note the and other intentional weight-loss measures. Avoid using 鈥渨eight management鈥� as a euphemism for weight loss. See also 鈥淐ritically examine the evidence and sources on body size, and provide context.鈥�

Examples:

Use:

It鈥檚 so good to see you.

Avoid:

Did you lose weight? You look great!

Use:

Need a break from the conference room? Try !

Avoid:

Need help dropping those holiday pounds?

If someone declines to eat a dessert:

Use:

[No comment on what someone eats or doesn鈥檛 eat]

Avoid:

Good for you. What self-control! (Congratulating someone for not eating something turns a food choice into a moral decision. It sets up eating certain foods as morally inferior and a sign of a personal failing.)


Resources on inclusive language for body size

  • Chastain, Ragen. Weight and Healthcare (newsletter). July 23, 2022.
  • Chastain, Ragen. Weight and Healthcare (newsletter). Nov. 3, 2021.
  • Chastain, Ragen. Weight and Healthcare (newsletter). May 28, 2022.
  • Chastain, Ragen. Dances with Fat (blog). March 7, 2016.
  • Chastain, Ragen. Weight and Healthcare (newsletter). Oct. 5, 2022.
  • Cooper, Charlotte. . London: Charlotte Cooper, 2019.
  • Gordon, Aubrey [Your Fat Friend, pseud.]. Medium, Oct. 15, 2019.
  • Gordon, Aubrey [Your Fat Friend, pseud.] Self, March 29, 2021.
  • Kinavey, Hilary, and Carmen Cool. Women Ther. (2019): 1鈥�15. https://doi.org/10.1080/02703149.2018.1524070.
  • Kylstra, Carolyn. Self, June 25, 2018.
  • Little People of America.
  • Little People of America. Sept. 2015.
  • Meadows, Angela, and Sigr煤n Dan铆elsd贸ttir. Front. Psychol. 7 (2016): 1527. https://doi.org/10.3389/fpsyg.2016.01527.
  • Mercedes, Marquisele. Pipe Wrench, spring 2022.
  • Montgomery, Amanda. University of Illinois Chicago School of Public Health. Oct. 28, 2021.
  • National Eating Disorders Association.
  • O鈥橦ara, Lily, and Jane Taylor. SAGE Open 8, no. 2 (2018). https://doi.org/10.1177/2158244018772888.
  • Paus茅, Cat, and Sonya Renee Taylor, eds. . New York: Routledge, 2021.
  • Rich, Emma, and John Evans. Soc. Theory Health 3 (2005): 341鈥�358. https://doi.org/10.1057/palgrave.sth.8700057.
  • Saguy, Abigail C. Chap. 5 in What鈥檚 Wrong with Fat? The War on Obesity and Its Collateral Damage. Oxford: Oxford University Press, 2013. https://doi.org/10.1093/acprof:oso/9780199857081.003.0005.
  • Shelley, Crystal. Rabbit with a Red Pen. Feb. 15, 2021.
  • Wann, Marilyn. in The Fat Studies Reader, edited by Esther Rothblum and Sondra Solovay, ix鈥揦XV. New York University Press, 2009. https://doi.org/10.18574/nyu/9780814777435.003.0003.