Body size

Note: This section uses “obesity” and “overweight” 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 “fat” is used, it is used as a neutral descriptor.

When to mention body size

Background:

Mentioning body size when it’s 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 “Don’t conflate weight and health”). Even phrases that may seem like compliments—such as telling someone they lost weight and look great—can reveal antifat bias and a mistaken belief that weight loss is a universal good (see also “Don’t glorify dieting, weight loss, or thinness”). 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—periods of losing and then regaining weight, which is a common result of dieting—harms health (for example, see table 5 in SAGE Open 2018, DOI: 10.1177/2158244018772888). And dieting is a risk factor for eating disorders.

In the context of eating disorders, unnecessary mentions of body size can trigger people with those illnesses and impede recovery. In “Tips for Responsible Media Coverage,” the US National Eating Disorders Association recommends not mentioning a person’s current or past weight. And the UK charity Beat’s Media Guidelines for Reporting on Eating Disorders recommends not including measurements such as body mass index.

Recommendation:

Mention body size only when it’s relevant to your content. Discussing someone’s 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:

Little People of America defines “dwarfism” as “a medical or genetic condition that usually results in an adult height of 4'10" or shorter.” Appropriate descriptors include “person with dwarfism,” “little person,” “person of short stature,” and “short-statured person,” but individuals’ preferences are highly variable. While some people use the term “dwarf,” it is not universally accepted, and the National Center on Disability and Journalism’s Disability Language Style Guide recommends using the term only when referring to a medical diagnosis or quoting someone. The word “midget” is considered a slur and should not be used. Euphemisms like “vertically challenged” can be infantilizing.

Recommendation:

Whenever possible, ask people how they want to be described, and use that language. If it’s not possible to ask, generally use “little people,” “people of short stature,” or “short-statured people.” Use “dwarf” only in reference to a medical diagnosis. Do not use the term “midget” or euphemisms like “vertically challenged.”


How to mention weight

Background:

The most appropriate language for weight is highly personal and political. Many fat activists have reclaimed the word “fat” and believe that a staunch refusal to respectfully use “fat” maintains its power to harm. Some have created new terms—such as “deathfat” (coined by author and fat activist Lesley Kinzel) and “superfat” (coined at Nolose, an organization for fat queer and transgender people)—as a means of self-empowerment and a way to describe the spectrum of higher weights. The US-based rights organization the National Association to Advance Fat Acceptance says in its constitution, “We choose to use the word fat to describe ourselves in order to remove the negative connotations normally associated with larger-than-average body size.” Others find “fat” stigmatizing and prefer terms that use comparatives, such as “people at higher weights” and “people at lower weights.”

Some people use euphemisms like “big boned” and “chubby” to avoid saying “fat,” but these words are 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 “overweight” and “obese.” These terms are problematic because they are defined by body mass index (BMI), a tool based on a mathematician’s 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—what some fat activists frame as eugenic ideology. The term “overweight” 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 “e,” place the terms in quotation marks (scare quotes), precede them with “so-called” or “alleged,” or include a content warning or note on terminology.

Organizations and some doctors focused on “obesity” prevention or treatment advocate for people-first (or person-first) language using the word “obesity” or “overweight.” They claim that saying “people with obesity” is less stigmatizing than identity-first language, such as “obese people.” In a 2016 article in Frontiers in Psychology, researchers Angela Meadows and Sigrún Daníelsdóttir note flaws in this approach: “While 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.” Similarly, researchers who have surveyed higher-weight people’s preferences on language often use a questionnaire that “prompts participants a priori to think of weight as a problem” and use terms that “were chosen after consultation with patients in treatment-seeking settings,” which limits the results’ generalizability, Meadows and Daníelsdóttir say. In their review of multiple studies’ results, they found that “although the medical establishment positions ‘obesity’ as a neutral term, higher-weight individuals do not seem to like it, and associate it with increased societal disapproval.”

Fat activists reject people-first language that uses “obesity” and wording that tries to dissociate fatness from one’s identity in such phrases as “you aren’t fat; you have fat.” They say separating the person from the weight reinforces the notion that fatness is shameful. In a 2021 Weight and Healthcare newsletter article on inclusive language, health and fitness professional, researcher, and fat activist Ragen Chastain says, “In 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 ‘The woman was affected by thinness’ or “The man with brunetteness was on the bus.” The use of [people-first language] suggests that accurately describing a higher-weight person’s 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 ‘the woman affected by obesity,’ it suggests that the problem is her body size, and not the weight-stigma and lack of accommodation that is actually harming her.”

Recommendation:

Whenever possible, ask individuals how they want their weight to be described, and use that language. When it’s 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 “higher-weight people,” “people with higher weights,” “larger-bodied people,” “people in larger bodies,” “people with more weight,” “larger-size people,” and “people of size.” Examples for thinner people include “lower-weight people,” “people with lower weights,” “smaller-bodied people,” “people in smaller bodies,” “people with less weight,” and “straight-size people.” If you’re using “fat” as a neutral descriptor and your audience is receptive to that term, or if you’re discussing fat activism or fat acceptance, use it as a way of dissociating the word “fat” from its negative connotations, and explain why you’re using it. The terms “plus size” and “full size” 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’re using “fat” as a neutral descriptor in keeping with organizations such as the National Association to Advance Fat Acceptance. Do not use “fat” as a negative descriptor (see “Avoid using ‘fat’ to mean something negative”).

Avoid the terms “obesity,” “obese,” “morbidly obese,” and “overweight” unless you’re 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 “big boned,” “curvy,” “fluffy,” “heavy,” “plump,” and “fit” unless the person you’re describing uses those terms. Use caution with the term “average”—an average size in the US is a misses 16–18, or a women’s plus-size 20W, according to a 2016 study by Deborah A. Christel and Susan C. Dunn in the International Journal of Fashion Design, Technology and Education. If your intended meaning is “lower weight” or “straight size,” say that instead. Do not use “normal,” “healthy,” “abnormal,” or “unhealthy” to describe body size or weight, and do not insist on people-first language. See also “Ask people how they want to be described, and respect that language.”

Examples:

Use:

“The 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’s 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” (C&EN, Oct. 17, 2021).

Avoid:

people who have obesity

 

Use:

“The project creators note that while the literature tends to use stigmatizing language—such as ‘overweight’ and ‘obese’—we do not endorse this language as it is both oppressive and incorrectly pathologizes and medicalizes bodies based on their size” (“Resources,” HAES Health Sheets).

Use:

“In most cases, I use quotation marks or ‘scare quotes’ around the medicalized terms for large body size including ‘overweight’, ‘obese’, or ‘obesity’. 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” (“Fat Studies and Public Health,” in The Routledge International Handbook of Fat Studies, 2021).

Use:

“Please do not prescribe to your larger patients what would be diagnosed as an eating disorder in thinner patients” (Resilient Fat Goddex, accessed Dec. 5, 2022).

Avoid:

people affected by obesity

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 “Don’t conflate weight and health.”)

 


How to describe antifat oppression

Background:

Several terms describe oppression related to body size. Merriam-Webster defines “sizeism” as “discrimination or prejudice directed against people because of their size and especially because of their weight.” In a 2018 BMC Medicine article, researchers A. Janet Tomiyama, Deborah Carr, Ellen M. Granberg, Brenda Major, Eric Robinson, Angelina R. Sutin, and Alexandra Brewis define “weight stigma” as “the social rejection and devaluation that accrues to those who do not comply with prevailing social norms of adequate body weight and shape.” 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 “weight” paired with any form of oppression and the word “sizeism” can mask the fact that higher-weight people are disproportionately mistreated. Naming the group that faces the most harm—for example, using terms like “antifat bias” and “antifat discrimination”—is clearer. Writer and fat activist Aubrey Gordon explains in a 2021 Self article, “When we aren’t 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.” Some people also view the neutral term “weight” as irreflective of the seriousness of fat hatred. Researcher and university educator Kristen Hardy asks in a 2021 Polyphony article, “Is it ‘weight stigma’? Or is it eugenic ideology?”

The term “fatphobia” is often used to describe society’s fear of fatness, but some activists criticize the term for being ableist—discriminatory to people with disabilities. Gordon explains in her article, “Discriminatory attitudes aren’t a mental illness. Mental health advocates and activists in the Mad Pride mental health movement have been clear: Oppressive behavior isn’t the same as a phobia.” Likening antifat discrimination to a mental disorder may also unintentionally absolve people of blame. In addition, “fatphobia” 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, “It invites defensiveness rather than transformation from the very people who most need to change.” A lesser-known term for a hatred of fat is “fatmisia.”

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

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 “antifatness,” “antifat bias,” “fat stigma,” and “antifat oppression” instead of “weight bias” and “weight stigma” unless you are reporting the results of studies with those terms or you’re discussing stigma against both lower-weight and higher-weight people. When using “sizeism,” terms paired with the word “weight,” and “body shaming,” 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 “fatphobia.” See also “Avoid metaphorical uses of disability-related terms.”


Body size movements

Background:

There are several names for movements related to fighting antifat oppression. Body positivity—loving one’s body, regardless of what it looks like—originated from fat activists but has been coopted and diluted by some corporations and mainly White, thin people. Fat activists have criticized a focus on body positivity 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 “all bodies” tend to ignore the highest-weight people and are reminiscent of “all lives matter” instead of “Black lives matter.” Body neutrality is similar to body positivity but does not require self-love; it focuses on just accepting one’s 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 “size acceptance,” but because its name doesn’t 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 “last acceptable prejudice.” 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’s seriousness by saying that behavior toward fat people wouldn’t be tolerated if it were directed at Black people. In Fat Activist Vernacular, therapist, writer, and fat activist Charlotte Cooper explains that these comparisons are problematic because they imply that anti-Black racism doesn’t 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’s rights. Receiving full civil rights should not be contingent on improving one’s health. See also “Avoid healthism.”  

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 “fat activism,” “fat acceptance,” or “fat liberation.” Avoid conflating weight-neutral or weight-inclusive health with the civil rights movements. Avoid implying that antifat discrimination is the last acceptable form of discrimination. See also “Avoid healthism” and “Recognize intersectionality in body size.”


Recognize intersectionality in body size

Background:

Intersectionality, a term coined by law professor and scholar Kimberlé Crenshaw to explain the compounded oppressions on Black women, applies to content on body size because antifatness is rooted in anti-Blackness. As sociology professor Sabrina Strings writes in a 2020 New York Times article, “My research showed that anti-fat attitudes originated not with medical findings, but with Enlightenment-era belief that overfeeding and fatness were evidence of ‘savagery’ and racial inferiority.” Strings’s book Fearing the Black Body: The Racial Origins of Fat Phobia and Da’Shaun L. Harrison’s 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, “The world’s 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.”

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 antifatness with anti-Blackness 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, sociology lecturer Francis Ray White describes work by Dean Vade and Sandra Solovay on fat and trans experiences: “In their opening sentence, they refer to ‘people who are transgender, fat, or both’ (p. 167), but in what follows, the ‘or both’ option disappears and discussion is confined to people who are fat (and implicitly cisgender) or trans (and implicitly thin).  .  .  . The tendency to compare and contrast fat and trans experiences in approaches such as Vade and Solovay’s has the effect of erasing the experience of those who are both fat and trans.”

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:

“One could argue that it’s 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 ‘least likely to survive’ 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” (Wear Your Voice, Sept. 8, 2021). (Writer Da’Shaun Harrison uses “and/or” and the slash in “Black/fat” to show people who hold more than one marginalized identity.)

Avoid:

just because they are fat or disabled

Use:

“While 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” (“Anti-fat Bigotry,” in Moving Toward Antibigotry: Collected Essays from the Center for Antiracist Research’s Antibigotry Convening, May 2022).


Avoid using “fat” to mean something negative

Background:

When people use “fat” 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 “You’re not fat; you’re beautiful,” sets up fatness in opposition to positive things.  

Recommendation:

Use a specific adjective that describes a feeling instead of using the phrase “feel fat.” Do not use “fat” 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’s a sloppy, uninformed politician.

Avoid:

a fat, sloppy, uninformed politician

Use:

They’re a great athlete. (It’s not necessary to mention someone’s size in the context of athleticism. See “When to mention body size.”)

Avoid:

fat but a great athlete


Don’t conflate weight and health

Background:

In 2013, the American Medical Association declared “obesity” a disease despite a recommendation from its Council on Science and Public Health to not do so. The International Classification of Diseases also considers “obesity” a disease. As part of this medicalization of higher weight, organizations and doctors categorize people according to body mass index (BMI), a deeply flawed tool that is not predictive of actual health (for example, Sage Open 2018, DOI: 10.1177/2158244018772888).

Studies have failed to find a causal link between high weight and poor health (for example, J. Obes. 2014, DOI: 10.1155/2014/983495; Nutr. J. 2011, DOI: 10.1186/1475-2891-10-9). People at all weights can be healthy or unhealthy. And in fact, some studies have shown a protective effect of higher weight—what some call the “obesity paradox,” a problematic phrase because it pits higher weight against health. Organizations and doctors claiming that high weight causes poor health often rely on shaky science—for example, science that finds only correlation, not causation, and that does not control for confounding factors such as exercise, diet, weight cycling (repeated loss and regain of weight), fat stigma, or medications (for example, Nutr. J. 2010, DOI: 10.1186/1475-2891-9-30). See also “Critically examine the evidence and sources, and provide context.”

People linking high weight and poor health also often fail to acknowledge the effects of lower-quality and biased health care—including doctors’ spending less time with higher-weight patients, not performing appropriate procedures, misdiagnosing them, and providing less health education than for lower-weight patients (BMC Med. 2018, DOI: 10.1186/s12916-018-1116-5). Physicians’ bias and a lack of accessibility, such as too-small blood pressure cuffs, also create barriers to higher-weight people’s seeking health care, which may result in delays in seeking treatment. Furthermore, health practitioners and insurance companies often refuse care to higher-weight people 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 National Eating Disorders Association recommends, “Don’t fall in to the trap of referring to all people with Anorexia Nervosa as ‘underweight’ and people with Binge Eating Disorder as ‘overweight or obese.’ ”

Language that conflates higher weight with disease is inappropriate because it does not accurately reflect the science; it contributes to fat stigma, 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’s lives at risk through the negative effects of weight cycling, weight-loss medications, weight-loss surgery, and dieting. Diets do not work for the vast majority of people, they often cause weight cycling, and they are a risk factor for developing eating disorders. And weight-loss surgery—a fraught term often called “bariatric surgery” by anti-“obesity” doctors and sometimes “stomach amputation” or “stomach modification surgery” by fat activists—has 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 chronic health condition, which is still stigmatizing and problematic because it treats higher-weight people as in need of a “cure.” As Marilyn Wann explains in the foreword to The Fat Studies Reader, framing interventions for higher weight as “cures” 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’t 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 “healthy” (an amorphous concept itself) to earn a lack of discrimination. As Google’s  “Plus-Size People” marketing guide (developed in partnership with the National Association to Advance Fat Acceptance) explains, “Large people are sometimes unhealthy just as thin people are sometimes unhealthy; this should not be a deterrent to rights, respect, or representation.” See also “Avoid healthism.”

Recommendation:

Avoid equating higher weight with disease, and thinness with good health. Don’t 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 behaviors such as smoking. 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 “healthy” behaviors are worthy of being free from discrimination and hate. See also “Avoid healthism.”

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’s problematic. Also use care with the words “treatment,” “prevention,” and “cure,” which frame higher-weight people as problems that need to be eradicated. See also “Avoid problematic frames of weight.”

Examples:

Use:

“In 2014, over 70 percent of Americans were considered to be ‘overweight’ or ‘obese.’ This does not account for the anti-Blackness and racism inherent to the Body Mass Index (BMI) scale” (Them, Sept. 27, 2018). (Author Da’Shaun Harrison specifically calls out the problematic nature of BMI to give readers context behind the numbers.)

Use:

“Smaller-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 ‘obese’ category” (Wired, April 17, 2020).

Avoid:

Obesity is an independent risk factor for swine flu. (The phrase “risk factor” may imply causation, and when used alone, it doesn’t 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 flaws in rhetoric linking high weight to COVID-19 risk. See also “Critically examine the evidence and sources, and provide context.”)


Avoid healthism

Background:

Healthism, 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 “healthy” or perform health-promoting behaviors. It compounds ableism—discrimination against people with disabilities—because society often views disabled people as not “healthy.” It also involves classism because it assumes that everyone has access to health-promoting resources. In addition, the definition of “health” is not fixed or clearly defined. In a 2021 talk hosted by Community Leaders in Health Equity and Transformative Alliances, poet, activist, and author Sonya Renee Taylor explains why healthist rejoinders of “But what about their health?” are problematic when directed toward higher-weight people: “When we start asking these questions about health, we have to say, ‘What do we really mean when we say healthy? .  .  . Whose definition of health are we applying in this conversation?’ 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.”

Healthism creates a “good fatty–bad fatty dichotomy”—a 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 “healthy” behaviors of higher-weight people without explaining that health isn’t necessary for people to deserve nondiscrimination. English professor April Herndon, who studies representations of fatness, explains in The Routledge International Handbook of Fat Studies, “Arguments 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 ‘health’ as another moral standard by which people are judged worthy of protections (or not).”

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—care that does not manipulate weight to advance health—or 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:

“Fat 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” (Pipe Wrench, spring 2022).

Avoid:

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

Use:

“First, as always, remember that health is an amorphous, multifactorial concept and is not an obligation, barometer of worthiness, or entirely within our control” (Weight and Healthcare, July 16, 2022).


Critically examine the evidence and sources, and provide context

Background:

In content on body size, the decision about what studies to report or stories to tell, 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 coopt the language of fat liberation, but if their solution to that stigma is eliminating higher-weight people (for example, by pushing people to lose weight), then they aren’t truly working to end antifat discrimination. Furthermore, the media often accept as truth long-held beliefs that aren’t backed by sound science. In a 2007 Qualitative Sociology article, sociology professor Natalie Boero says, “In the media, pre-existing, yet largely unexamined cultural understandings of fatness form the plinth of representations of scientific debate or agreement about weight.”

Health and fitness professional, researcher, and fat activist Ragen Chastain offers several guides on how to spot organizations that purport to help higher-weight people but actually promote antifat beliefs. Some clues are uncritically using the terms “obese” and “overweight” (medicalized terms for higher weight), calling higher weight a disease or chronic health issue, promoting weight loss as a “solution” 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 2022 Weight and Healthcare newsletter article, “When we talk about weight gain as a side effect of dieting or weight stigma, it’s 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.”

In addition, fat studies scholars, activists, and critical obesity studies researchers have pointed out deep flaws in anti-“obesity” research, including the conflation of correlation and causation, conflicts of interest, a lack of long-term studies, a lack of controlling for confounding factors, high dropout rates that aren’t explained, and poor citation practices, such as citing research that doesn’t support statements and failing to cite statements at all (for a review of problematic studies, see Nutr. J. 2010, DOI: 10.1186/1475-2891-9-30). If content creators uncritically repeat the claims of people focused on higher weight as a disease, they can perpetuate inaccurate beliefs that lead to harm and contribute to antifat prejudice (for example, Soc. Sci. Med. 2014, DOI: 10.1016/j.socscimed.2014.03.026).

For example, in Belly of the Beast: The Politics of Anti-fatness as Anti-Blackness, theorist, abolitionist, and writer Da’Shaun L. Harrison explains how bias, poor research, and unethical publishing practices led to the US Centers for Disease Control and Prevention’s publication of an incorrect estimate of deaths attributable to “obesity” 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 “epidemic.” See also “Avoid problematic frames of weight.”

In Fat Activist Vernacular, some questions that therapist, writer, and fat activist Charlotte Cooper recommends asking of “obesity” research include “Who 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?” Similarly, a 2020 “Roadmap for Addressing Weight Stigma in Public Health Research, Policy and Practice” developed by the Strategic Training Initiative for the Prevention of Eating Disorders recommends that public health professionals understand “how obesity research contributes to weight stigma.”

In contrast to the coverage of anti-“obesity” 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—such as being funded by pharmaceutical companies—and 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 “success,” “clinically proven,” “promising,” “reasonable,” and “long term” without defining what those terms mean, and do not conflate “statistically significant” with a “significant amount” (e.g., of weight). If your content is about weight loss, explain the harms of pursuing weight loss—such as developing eating disorders and weight cycling (which has negative health consequences)—and be realistic about weight-loss strategies’ failure rates and side effects. Ensure any statements about weight, health, and weight loss can be backed by high-quality science—for example, studies that account for confounding factors like antifat bias, use strong sampling methods, and don’t conflate correlation and causation. Question assumptions about weight and health, such as the “calories in, calories out” myth—the 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:

“Some 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” (C&EN, Oct. 17, 2021). (Writer Megha Satyanarayana reveals a source’s conflict of interest with the diet industry to contextualize his opinions on weight loss.)

Avoid:

chemist Richard DiMarchi

Use:

“Noom’s own published research can’t 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’s study followed 43 people—only 36 of whom completed the program. That ‘64%’ is just 23 people” (Bustle, Oct. 4, 2021).

Avoid:

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

Use:

“Every single one of the study’s 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” (Marquisele Mercedes, June 23, 2021).


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 costly to society or at fault for a lack of appropriately sized medical equipment. In contrast, language that puts the burden of providing accessibility on health-care providers is more inclusive.

Phrases such as “the obesity epidemic” and “the war on obesity” frame higher-weight people as problems that need to be solved. These frames contribute to fat stigma and antifat attitudes, shame about body size, and a fear of fatness (for example, see author and sociology professor Abigail C. Saguy’s “Frames Effects”). In a 2014 article on Dances with Fat, health and fitness professional, researcher, and fat activist Ragen Chastain says that “the obesity epidemic” frame is “an intersection between healthism, ableism, and sizeism. There should be no shame attached to body size, health, or dis/ability—the ‘ob*sity epidemic’ propaganda encourages all three.”

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 “underweight,” “normal weight,” “overweight,” and “obese,” has a racist origin and isn’t predictive of health for individuals. Furthermore, in 1998, the US National Institutes of Health lowered the body mass index threshold for the “overweight” category, leading to 29 million people previously classified as “normal weight” moving to the “overweight” 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’s actions or inaction—failing to eat the right foods, exercise the right way, or do other “healthy” behaviors. Others point to the so-called obesogenic environment—an 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’t 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 “the hyper-surveillance of communities of color through state nutritional and health programs,” says writer and cultural historian Athia N. Choudhury in The Routledge International Handbook of Fat Studies. She adds that initiatives targeting the “obesogenic” environment can “not only vilify fat people, but render fat communities of color as inept, infantile, and irresponsible.”

Looking for reasons for the number of higher-weight people or “solutions” to higher weight frames weight as a problem. In Fat Activist Vernacular, therapist, writer, and fat activist Charlotte Cooper says, “Explanations 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.”

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, “real women have curves” implies that women without curves aren’t “real” 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 “battle,” “fight,” “struggle,” or “suffer” in relation to higher weight. Avoid alarmist language such as “the obesity epidemic,” “the war on obesity,” “the threat of obesity,” and “the obesity crisis.” When 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 fat stigma’s and dieting’s effects on weight while recognizing that being higher weight is not bad. Be aware that looking for explanations for and “solutions” 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 focus on equity, not thinness, as a goal.

Avoid any language that sets a body size as a standard that others must attain (as in “real women have curves”).

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:

“I am so sorry that the MRI wasn’t built to accommodate you, let’s look at other options for getting the information we need” (Weight and Healthcare, July 23, 2022).

Avoid:

You are too big for the MRI machine” (Weight and Healthcare, July 23, 2022). (Writer Ragen Chastain shows examples of wording that health-care providers should avoid.)


Don’t 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 National Eating Disorders Association says, “Don’t focus on weight loss as a measure of ‘recovery’ 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.”

Some people use the term “weight management,” but it can be seen as code for weight loss. In The Routledge International Handbook of Fat Studies, lecturer Katariina Kyrölä says that the term “weight management,” “although 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.” In addition, in a 2022 Body Positive University newsletter article, author and fat activist Virgie Tovar recommends using “food restriction” instead of “diet” to more clearly describe what dieting is.

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 weight cycling (repeated loss and regain of weight), which is linked to negative health effects. Also, to avoid perpetuating myths about weight-loss interventions, note the high failure rates of diets and other intentional weight-loss measures. Avoid using “weight management” as a euphemism for weight loss. See also “Critically examine the evidence and sources, and provide context.”

Examples:

Use:

It’s so good to see you.

Avoid:

Did you lose weight? You look great!

Use:

Need a break from the conference room? Try strolling meetings!

Avoid:

Need help dropping those holiday pounds?

If someone declines to eat a dessert:

Use:

[No comment on what someone eats or doesn’t 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