Obesity and Language, Part 6

Readers will remember Rebecca Puhl, Ph.D. (currently deputy director for the Rudd Center for Food Policy & Health) from the landmark 2011 study indicating the need for increasing awareness of weight bias in both news reporting and professional communications.

When children are exposed to bullying, body-shaming, and even negative language, journalist Jennifer Gerson says,

Puhl’s research has found that […] they are then put at higher risk for developing depressive symptoms, anxiety, lower self-esteem and worsened body image. In adolescents, this can translate into higher rates of suicidal thoughts and substance abuse.

Both boys and girls report experiencing emotional distress when they are stigmatized about their weight… but girls report experiencing a higher level of intensity of emotional distress as a result.

Much has been said by Childhood Obesity News about the latest guidelines issued by the American Academy of Pediatrics, and the American Academy of Eating Disorders has responded vigorously. That organization has submitted a request to the AAP to revise its guidelines, this time with input from mental health professionals, which none of the original co-authors apparently were.

“Just grow up”

While the situation has improved in some ways, at the same time there has been a backlash against what some critics regard as an overdose of sensitivity. Lawrence M. Krauss encourages people to take responsibility for their own responses to the things they see and hear:

Without context and interpretation, and unless one chooses to internalize them, words are impotent, and that gives us power over them, not vice versa. We may be influenced by what we read or hear, but we own our responses, including our actions, which, after all, speak louder than words…

The trauma may be very real, but the underlying psychological issues and healing processes are ones that you, not others, need to take primary ownership of. You have not been victimized; you have been traumatized.

That emotional sensation of having been traumatized, he believes, is something that lies under the control of the individual — but nobody wants to hear it. Many people who feel damaged do not, for whatever reasons, want to take ownership of their psychological health. Many people who sympathize with the traumatized want to find solutions in legislation, censorship, and other punishments for the offenders.

Krauss holds that the solutions are more likely to be found in a rational discussion “and even ridicule,” and for backup he cites comedian/philosopher George Carlin. (Not recommended, by the way. Carlin’s fat humor is brutal, excessive, abrasive, and occasionally X-rated.)

Basically, Krauss proposes that the inherent negative influence of certain words is a myth, because they have no power except that which we give them, and we can choose not to grant them that power:

[I]n a world where words are treated as if they are both weapons and attackers, and where we shield ourselves from them for fear that they might induce feelings in us that we don’t like, we don’t become the victors — we only further victimize ourselves.

Your responses and feedback are welcome!

Source: “Language for treating childhood obesity carries its own health risks to kids, experts say,” 19thnews.org, 03/09/23
Source: “Words Don’t Matter,” Quillette.com, 03/13/23
Image by Thunderchild 7/CC BY 2.0

Obesity and Language, Part 5

We mentioned the coalition of professionals who are trying to make a difference in an important area. Apparently, many who deal with members of the obese public employ a communication style that tends to alienate prospective patients and clients, sending them off into the wilderness of self-treatment by dubious methods, or even no treatment at all.

An ever-increasing number of pros hope to build a better public narrative around childhood obesity, one that reflects current scientific knowledge rather than knee-jerk victim-blaming. Sadly, in the view of these authors at least, obesity-related professionals of all kinds seem weirdly slow to catch on. Apparently, patient-centered language is not making much headway. Consequently…

[…] there is a need for extensive and continued education of all individuals who interact with children and adolescents with obesity across multiple settings, to minimize bias and stigma in their interactions. These individuals include healthcare staff, caregivers, teachers, coaches, peers, siblings, parents and families, who may, either directly or indirectly, contribute to stigmatization.

The Obesity Society allied itself with other organizations based in the U.S., Canada, and Europe to condemn stigmatizing language and encourage an overhaul of the lingo. This is noteworthy because, for the first time, scientific societies and major international organizations have made a point of joining all their voices.

The Obesity Society’s Aaron Kelly, Ph.D., says, “Using people-first language is a seemingly small, yet powerful way, to set the right tone for kids and their families.” But what is people-first language? One example is “people with obesity,” which is preferred over “obese people.” It demonstrates that the speaker is putting the person first, not their disease. This is one of the many areas in which the latest American Academy of Pediatrics guidelines faced a hostile reaction.

Words

Jennifer Gerson reported that one concern people have with the new guidelines is the language:

[…] primarily, the very use of the terms “overweight” and “obesity,” words that research has found to be some of “the most stigmatizing terms.”

The guidelines have prompted a host of questions from experts on children’s general health versus the long-term effects that weight stigma can have on kids. That means taking into account how words like “overweight” and “obese” themselves could hurt children not just today, but in the future. Gerson wrote,

[C]onversations about weight and health with children can be fraught, especially for girls, who disproportionately feel the effects of weight stigma as they internalize messaging from their peers and from their consumption of media at a point in their lives where they are forming their sense of self.

Your responses and feedback are welcome!

Source: “Championing the use of people-first language in childhood overweight and obesity to address weight bias and stigma,” Wiley.com, 04/01/23
Source: “TOS endorses global editorial on people-first language and pediatric obesity,” EurekAlert.org, 04/05/23
Source: “Language for treating childhood obesity carries its own health risks to kids, experts say,” 19thnews.org, 03/09/23
Image by Quinn Dombrowski/CC BY-SA 2.0

Obesity and Language, Part 4

Sadly, a nine-author paper from last year found “discriminatory language used by peers and adults, which may be compounded by use within the medical community and in published research.” Those writers analyzed 300 articles from PubMed and found that “only 21.7% were adherent to PCL guidelines.” The abbreviation refers to Person-Centered Language.

Over the past half-century or so, only the manufacturing community seems to have learned a thing or two. Today, we would probably not see an ad like the one shown here. In the 1950s, L. Gidding & Co. sold the Chubbette clothing line through “stores that care.” In addition to a catalog of the offerings, also available by mail was…

“Pounds and Personality” — a booklet for parents of a chubby girl (understanding her problems, talent development, shyness, tactless remarks, the “game” of dieting, etc.) Written by Dr. Gladys Andrews…

Given the negative effects of stigma among children with obesity, it is imperative to advocate for PCL use within the medical community. Increased stringency by journal editors and publishers may be the next step in this process.

More PCL

A recent multi-author paper bears the very explicit title, “Championing the use of people-first language in childhood overweight and obesity to address weight bias and stigma,” and is described as a joint statement from 8 different European, Canadian, and international organizations. They are talking about the realms of clinical practice, research, education, and advocacy communications, and in every area they hope to popularize PCL, also known as person-first and or patient-first language:

The use of compassionate, patient-centred language and imagery is considered a core strategy for addressing weight bias and obesity-related stigma… Biases are largely based on misconceptions of obesity being the result of individual weakness and consequently being an individual’s responsibility to address…

On the contrary, obesity is “a disease with complex biological, genetic, psychosocial and environmental drivers.” Regarding the psychosocial component, children at every stage of development are vulnerable to trauma from being shamed, name-called, teased, scolded, excluded, ridiculed, etc. because of their physical size. Going into excruciating detail about the damage that can be done, the authors list the…

[…] serious lifelong consequences including psychological distress, poorer social and academic outcomes, and adverse physical consequences impacting personality development, self-image, self-esteem and confidence, and overall quality of life.

Regarding such serious outcomes, it is to be hoped that most people would not want to be at cause. Through Wiley.com and whatever other channels are available, the members of these organizations hope to influence others, including “academic institutions, public health-authorities, professional organizations including healthcare, media, public health services and governing bodies.”

Your responses and feedback are welcome!

Source: “Use of person-centred language among scientific research focused on childhood obesity,” NIH.gov, May 2022
Source: “Chubettes, the badly-named clothing line for overweight girls, 1957,” BoingBoing.net, 11/18/11
Source: “Championing the use of people-first language in childhood overweight and obesity to address weight bias and stigma,” Wiley.com, 04/01/23

Obesity and Language, Part 3

We’ve been looking at a 2015 paper that explored the pros and cons of policing the language around obesity, and speculated on how better methods might be implemented. The authors recognized that some people with obesity (and in the fat acceptance movement) still prefer to be designated “fat,” and explained the psychology behind the choice.

They compared this to similar efforts by human rights activists to reclaim and own certain other items of terminology, and restore them to public acceptance:

[R]eclamation of the word as a neutral descriptor aims to counter the negative stereotypes that have become associated with it, and normalize the existence of fat bodies. Thus, identifying as “fat” becomes an act of empowerment and a marker of self-respect and unity.

Despite caring very much about creating positive change, the authors were also cautiously ambivalent, asking the editors of professional journals not to be hardcore adamant about using person-first terminology in every instance, because it “precludes more nuanced consideration of the implications of language use.”

We are currently at a moment in history where this fight has only just begun, and we are bound to witness considerable changes in the way we think about bodies, and acceptable terms for those bodies, in the years to come.

So here we are, almost a decade later, still engaged in debates and disagreements over person-centered language, or PCL. For ConscienHealth.org, Fatima Cody Stanford and Ted Kyle point out that an important starting point is language that meets the standard of being respectful, at the very minimum.

Without a modicum of reasonableness, there might not even be any kind of a start at all, because:

Language can set the tone for productive dialogue with youths and parents or it can prevent dialogue from ever happening. Research suggests that a physician labeling a child with stigmatizing language can lead to parents seeking a different physician or avoiding medical appointments for their children altogether.

“You don’t get a second chance to make a first impression.” Since ancient times, this has been universally true of humans. For any health professional or therapist, there can be no helping if the prospective patient or client is turned off within the first few minutes of the initial meeting. And one causal factor of immediate rejection is careless talk. This article says,

Using people-first language means that the patient comes first and obesity surfaces as only a medical condition. Physicians should take cues from patients and parents about acceptable terminology. Motivational interviewing skills can help in finding constructive language… But in no case does labeling a patient as an obese child enhance a child’s self-concept.

Your responses and feedback are welcome!

Source: “What’s in a Word? On Weight Stigma and Terminology,” NIH.gov, 10/05/15
Source: “Why Is Respectful Care for Childhood Obesity Remarkable?,” ConscienHealth.org, undated

Obesity and Language, Part 2

There is still more to say about the subjects broached in yesterday’s gleanings from a paper titled, “What’s in a Word? On Weight Stigma and Terminology,” published back in 2015 when the topic was starting to heat up. There seemed to be some hope that all the larger-bodied people would agree about preferred verbiage. But the authors point out a very troubling obstacle. It is one thing to decide that the target group should be allowed to pick their own label (in which case they would first probably elect to ditch the hostile phrase “target group”).

Here is the fly in that particular ointment:

[T]his 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…..

[A] coalition of size-acceptance and fat rights groups have challenged the claim that these organizations speak for larger people as a whole, criticizing the top-down setting of the terminology agenda and the absence of grassroots input…

[R]esearch on the preferences of this group has been skewed toward treatment-seeking populations, and therefore the findings of such research cannot be regarded as representing a “consensus.”

Even if the scientific community had been magnanimous about letting all people with obesity vote on what they want to be called, how would they reach the ones who never go to doctors because they don’t want to be body-shamed or have their concerns ignored once again?

Let every voice be heard

Actually, thanks to the Internet, there is a way to find out what the alienated and disaffected members of the public are thinking — through many varieties of social media. That research could be pretty uncomfortable for medical professionals who had not previously given much consideration to their vocabularies. And anyway, the report admitted, “consensus within a socially marginalized group can neither be realistically expected nor made to serve as a prerequisite for moving toward social justice and equality.”

The complications multiplied when studies got underway that attempted to more fairly discover individual preferences. One such attempt asked how each individual would like a doctor to break the news, “You are at least 50 pounds over recommended weight.” This time, two factors made progress difficult:

First, the questionnaire prompts participants a priori to think of weight as a problem. Secondly, the 11 terms used in the Weight Preference Questionnaire were chosen after consultation with patients in treatment-seeking settings. Thus, neither the list of words generated, nor the scenario used in the exercise, is judgment-free.

The least acceptable words were found to be “obesity” and “fat.” Except in Australia, where four out of five adults were fine with both “fat” and “overweight.” Go figure!

Your responses and feedback are welcome!

Source: “What’s in a Word? On Weight Stigma and Terminology,” NIH.gov, 10/05/15
Image by Kilian Evang/CC BY 2.0

Some Problem Areas

Author Aubrey Gordon is no fan of the recent American Academy of Pediatrics guidelines. Talking about interventions for a fat adult is fine, but the AAP seems to be recommending dietary intervention for kids as young as 2 years. On the other hand, some would question why the author has a problem with that, since it is the easiest kind of intervention to implement. At such a tender age, kids are not in a position to fight back against the healthful diet, or to travel to the store on their own, and they usually don’t have any money.

Dietary intervention with an infant is not a radical notion, but a combination of science and art which is generally deemed to be helpful. In addition, it has been well established that the sooner obesity is prevented, the less likely it is to take over a life.

Gordon is also against “weight loss drugs including injections as young as grade school and weight loss surgery and permanent body-altering and life-altering lifelong surgical procedure as young as 13…” No argument there!

Stigma rears its ugly head

Author Virginia Sole-Smith gives a capsule description of one way in which obese people are traumatized:

Providers spend less time with patients with high BMIs, and are sometimes even less willing to perform standard care, like pelvic exams at the gynecologist’s office. And in 2019, Nutter surveyed 400 Canadian doctors and found that 24% admitted they were uncomfortable having friends in larger bodies, and 18% felt disgusted when treating a patient with a high BMI.

On the other hand, one of this writer’s grievances is that according to the findings of a 2011 study, “medical students were more likely to blame people for conditions like respiratory distress if they were in a bigger body, and tended to prescribe weight-loss strategies, rather than symptom management.” However, it is objectively true that obesity can cause respiratory distress, and this is particularly hazardous when a very large patient is on the operating table. To keep that person supplied with air is an extra challenge.

The other objection is even more shaky. A very large number of complaints accuse the healthcare industry of the exact opposite — of resting content with treating symptoms (to the benefit of the pharmaceutical industry) rather than addressing the root causes of physical malfunction. This is particularly true when the patients are economically disadvantaged. Money can often buy a cure for a condition that the poor are expected to endure by taking over-the-counter pain meds.

The situation is capsulized by a quotation from the producers of a live call-in program:

Conscious and unconscious negative attitudes from health care professionals have impacted the treatment and care of people living with obesity. Patients have reported that physicians blame their weight first and treat their presenting symptoms second — if at all.

Your responses and feedback are welcome!

Source: “How Fatphobia Is Leading to Poor Care in the Pandemic,” Medium.com, 01/10/21
Source: “Patients report that weight stigma has led to difficulties getting treatment, and avoidance of seeking future healthcare,” TPR.org, 08/08/22
Image by John Benson/CC BY 2.0