The problem with the word “obesity”
The word “obesity” is harmful and stigmatizing. It is derived from the Latin word obesus which means “having eaten until fat.” This is both stigmatizing and inaccurate, as body weight in humans is influenced by a variety of factors, including genetics, health conditions, and history of dieting. (4)
The classification of “obesity” is based on body mass index (BMI), which is a mathematical equation calculated based on a person’s height and weight. BMI was designed as a statistical tool to compare members of a population, and was never intended to assess individual health status. Categories based on BMI such as “normal weight”, “overweight”, and “obese” are arbitrary and have been changed over time. (5)
In a 2013 study, researchers found that many individuals classified as “obese” based on BMI did not have a higher risk of death than those with lower BMIs. (9)
While this study was not well received by many public health professionals, many of whom are deeply invested in perpetuating weight stigma, these results have been replicated many times, with the conclusion being that “obesity” is not a valid word to refer to a medical condition.
Social issues with the word “obesity”
In a social and cultural sense, the term “obesity” carries substantial stigma, which has been repeatedly perpetuated through recent public health campaigns. While people of all genders experience stigma and oppression based on body size, this is often more extreme for women and transgender individuals. (6)
The institutionalization of the term “obesity” - as evidenced by social media, the medical industrial complex, and even government departments responsible for “obesity” - has medicalized and pathologized body size. This is not based on science and is extremely damaging.
People who are classified as “obese” by the inaccurrate and racist BMI equation are constantly subjected to dire warnings about their health and pressured to change their bodies.
One of the major problems of the word “obesity” is that it perpetuates the myths that body size is a behavior and that health is determined by body size. Neither of these things are true, and they ignore the role of genetics in influencing both body size and health, as well as structural factors including the social determinants of health. (7)
The conditions in which people work, live, and play, their income, their access to health care, and their experiences of oppression affect their health outcomes to a much larger degree than their individual behaviors - including what they eat and their activity levels. Increasing access to affordable food, accessible healthcare, and safe housing is essential for improving public health and decreasing inequality.
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Health at every size (HAES)
The Health at Every Size (HAES) movement shifts the focus off weight change and on to helping people of all sizes receive competent care for their medical needs without being told to manipulate their weight. HAES seeks to end weight discrimination, promote health equity, and boost access to quality healthcare regardless of size or weight.
The HAES principles reinforce the idea that health status or weight should never be used to oppress, judge, or determine the value of a person.
- Weight Inclusivity: Accept the diversity of body shapes and sizes and reject the pathologizing and idealizing of certain body weights.
- Health Enhancement: Improve access for all to services that improve physical and mental well-being, with a focus on the physical, social, economic, and emotional needs of the individual.
- Eating For Well-Being: Learning to eat based on nutritional needs, hunger, satiety, and enjoyment, rather than following a restrictive eating plan aimed at weight suppression.
- Respectful Care: Work towards ending weight discrimination, stigma, and bias and support environments that address these issues.
- Life-Enhancing Movement: Encourage and support enjoyable movements that allow people of all shapes and sizes to participate at a level they choose.
Research has shown that the HAES principles improve health habits, psychological well-being, metabolic health, and self-esteem, regardless of weight.
The bottom line
Weight stigma doesn’t and will never change people’s body sizes or improve public health outcomes. Of course, the problems of stigmatization and prejudice won’t disappear by getting rid of this problematic word. Removing this word from public health and health care usage is one important part of reframing the current understanding of body size and health and moving towards a more supportive and health promoting paradigm.