A systematic review of quantitative and qualitative studies examining preferences for weight-related terminology.

Weight management is an important component of health care and the words used to discuss body weight can potentially undermine the success of these efforts. To ensure that healthcare providers’ language is respectful and does not further expose patients to weight-based stigma, the American Academy of Pediatrics and American Medical Association have recommended careful consideration to communication about weight and use sensitive, non-stigmatizing language.

This goal of this systematic review was to analyze existing literature on perceptions and preferences for weight-related terminology. The review included 33 studies (23 quantitative, 10 qualitative) that examined body weight and language/communication. The author of the review reported that neutral words or phrases such as “unhealthy weight” or “your weight may be damaging your health” were most preferred among many samples. Words such as “obese”, “fat” and “heavy” were the least preferred. In addition, when discussing children’s weight with parents, use of “fat”, “chubby” and “plump” were the least preferred. Some parents reported that “obese” and “overweight” and references to BMI were motivating, but others did not. Inconsistent findings were also noted between males and females, among persons of different race/ethnicity, and by participants’ BMI status. For example, one study found that the terms “fat,” “fatness” and “excess fat” were more undesirable to White individuals compared to Black individuals.

Review strengths: This review provided a comprehensive analysis of weight-related terminology preferences using both qualitative and quantitative studies.

Review limitations: Most studies included samples of predominately white women and focused on preferences for weight-related terminology for use in clinical/medical settings. Additional studies are needed that reflect the preferred words/phrases in different contexts among more diverse samples. The review also revealed the paucity of studies on the use of weight-related terminology on patient care/outcomes, and perceptions of self and others.

What this means for your practice: The existing literature, as reviewed here, did not identify a single term or phrase that is universally accepted. When speaking to parents about children’s weight, it may be best to avoid assumptions about what is preferred. An alternative approach is to initiate the conversation with a question such as, “Could we talk about you (or your child’s) weight today?” and acknowledge that people have different preferences regarding words used to discuss weight. By asking a patient/parent about their preferences, providers can avoid unintentional use of stigmatizing language.

Sugary drinks are associated with overweight and obesity among both children and adults. As appropriate, consider asking patients and their parents about family drink choices. Advising parents to limit sugary drinks and promoting choices such as water and low-fat milk may help children reach and maintain a healthy weight. Rethink Your Drink Nevada has a variety of FREE educational resources for medical and dental care settings. For more information about these resources, write to rethinkyourdrink@cabnr.unr.edu.

Original citation: Puhl, R. M. What words should we use to talk about weight? A systematic review of quantitative and qualitative studies examining preferences for weight-related terminology. Obesity Reviews, 2020. 1-28.

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