Oh, Splenda, I can't even

This morning I ran across this little beauty. My initial reaction is that it’s just more of that unconscious weight bias inherent in our society. Today, though, I found that I didn’t like the negative connotation that implied. I think of all the things I’ve learned in my life, and I wouldn’t want people judging me on my actions about something before I knew better. We need a way to describe our society that captures the unique difficulties faced by people of size or with obesity while not demonizing those who are thin.

Some of this alteration to my thinking came from my 15 year old daughter, who has very passionate opinions about the social justice implications of the heteronormativity of our society. (Would anyone think less of me if I admitted I don’t think I’d heard the term “heteronormativity” until she taught me?) What I really like about the term is that it gives an explanation for the difficulties experienced by those who do not fit into traditional gender roles and heterosexuality. But while identifying heterosexuality as a societal norm, it does not imply that heterosexual individuals have done anything “wrong”.

I realized this matters a great deal in how we perceive weight bias. Underlying the terms we use—thin ideal, thin-obsessed, weight bias—is some level of assumption that thin is bad or that individuals are responsible for the things they say. Just like obesity, the truth is a much more complicated picture. It’s acceptable for Splenda to say “This packet has been approved for swimsuit season” not because Splenda wants to stigmatize people and we’ve simply allowed it to happen, but because our society just assumes that thin is what people are always striving for. 

In order to shift the view from “people with obesity are stigmatized” to “we need to recognize the societal roots of our beliefs”, we need a better term. Heteronormativity does not suggest that those of other sexual orientations aren’t stigmatized—of course they are. But it recognizes that stigma as rooted in a deep societal construct. By understanding what underlies stigma related to sexuality, we can consider how best to alter that stigma and lessen the strength of society’s heteronormativity.

We can do the same with obesity. If we better understand what underlies the stigma experienced by people with obesity, and accept it as a societal construct—let’s call it “thin-normativity”—then we can better isolate where stigma is rooted in individual prejudice and where it’s instead the unsurprising result of a thin-normative society.

After all, if we want people to understand that obesity is a complex issue and not simply the fault of individuals, don’t we also need to understand that weight bias is a complex issue and not simply the fault of individuals?

People-First Language

At the most recent meeting of the Obesity Society, the use of people first language was widely encouraged. "People first" means using obesity language in such a way that it is not part of the person's identity, rather that it's indicated as a condition. So, saying "people with obesity" rather than "obese people".

People first language stems from the perception that obesity is a disease, something I regularly debate with myself. As an obesity researcher, I'm a huge proponent of people-first language. But the reaction of others has been, well, mostly confused.

When trying to explain the concept--to highly educated PhDs, no less--most seem very confused. "People with obesity" works okay, but "people with overweight" just sounds strange, and that is apparent on the faces of those I try to explain this to. Some people also think the distinction is silly, that "obese people" is not offensive, that it's simply a descriptor.

But I think there is an important difference. "Obese person" makes obesity part of the identity of the person, makes it an attribute. "Person with obesity" makes obesity something that happens to a person. Using "obese person" perpetuates the concept of blame and responsibility. We haven't reached a point in the public perception that people with obesity are not blamed and held responsible, but I hope we have in the research arena. Our use of people-first language is most important in how it influences perceptions of a wider audience.

But we don't. A quick survey of the most recent issue of Obesity, fewer than 15% of articles demonstrated use of people-first language in their titles and abstracts. How do we encourage this use without seeming to either obsess over small details or scold those not using it? I don't have a brilliant answer. I think the most important thing we can do is model the behavior. I try to always use people-first language, and I bring up the concept with students, fellows, and colleagues when opportunities arise.

People first language has become the norm for most other health conditions and disabilities. However, there is plenty of reasonable criticism. One argument is that by forcing people-first language, especially in awkward ways (like "people with overweight") actually has the opposite effect of the goal to focus on the person first. Others argue that taking on the identity of a disease or disability is not inherently bad, as the condition is inseparable from the person.

Personally, I believe we should continue to promote people-first language with obesity. Individuals have the right to take on the identity of obese, or fat, or anything else for themselves. But the language we use shapes the perceptions of the world around us. People with obesity already feel like obesity is their defining characteristic, and most do not want it to be. Most just want to be seen as people. We can use other conditions (diabetes, for example) when explaining the purpose of people first language. But the most effective thing we can do is just use it. All the time.