Obese patients from six diverse primary care practices rated the terms “fatness,” “excess fat,” “large size,” and “heaviness” as undesirable for describing excess weight. These findings were observed in both men and women, in whites and African-Americans, and in participants with a BMI < or ≥ 40 kg/m2
. Such terms may be perceived as derogatory and may reinforce negative weight-related attitudes towards obese individuals (5
). The term “obesity” also elicited an undesirable rating. This finding is particularly important because obesity is a standard medical term that is used to describe excess body weight. Patients may have very different perceptions of the meaning of obesity compared to their health providers (3
), and may associate the term with society's disapproval or stigmatization of overweight individuals (9
By contrast, participants rated “weight” as the most desirable descriptor. This term elicited positive ratings from both genders, as well as from African-Americans and whites. The term “weight” may be preferable because it is both neutral and nonjudgmental -- it does not imply any negative attributes or impose any personal blame. Other descriptors that included the word “weight” were also rated as desirable, including the terms “weight problem,” “excess weight,” and “unhealthy body weight.” The term “BMI,” which is commonly used in clinical settings to describe body weight in relation to height, was also rated as desirable.
Results from the present investigation replicate those from our prior study published in 2003 (5
) and show that the negative attitudes toward the term obesity and fatness are not limited to patients treated in an obesity-specialty clinic. While results from the two patient samples are similar, we note that participants in the present study did not rate “obesity” or “fatness” as negatively as respondents in the prior study. Obese female participants in the prior study gave the term “obesity” a mean rating of -1.4 and “fatness” a rating of -1.8, compared to ratings of -0.6 and -1.1, respectively, in the current study. Similar changes were found with men. We do not know whether the modest improvements in these ratings reflect the current participants' greater awareness of the obesity epidemic or are simply attributable to a difference in the two populations surveyed.
We found no support for our hypothesis that patients with severe obesity (≥ 40 kg/m2
) would be more accepting of the terms “obesity” and “fatness.” This finding is consistent with results reported by Puhl et al. who examined experiences of weight bias in 318 overweight and obese adults (11
). They found that participants reported similar experiences, perceptions, and stereotypes about obesity, regardless of BMI. We also failed to find differences in ratings provided by men and women.
Strengths of the present study include a large (N = 390) and diverse sample recruited from six primary care practices. This is in contrast to the more homogeneous cohort of participants recruited from a specialty clinic in our previous study (5
). The addition of two open-ended questions to the Weight Preference Questionnaire allowed participants to share their suggestions for desirable terms to describe excess weight (which can be assessed in future studies).
This study also has several limitations. If the topics of weight and obesity had been framed (or worded) in a different manner, we may have obtained different (potentially more desirable) ratings of “obesity” and some of the other descriptors. Similarly, the questionnaire format, with the open ended questions following the 11 listed terms, may have encouraged participants to refer back to the listed terms and, thus, influenced their responses. All participants in the present study were recruited to participate in a weight loss trial and may have been more sensitive to weight-related terminology than obese persons who do not seek weight reduction. Thus, the present study needs to be replicated in a randomly-selected sample of persons who do not seek weight loss. Finally, this study also did not assess the desirability of preferred terms in an overweight population (BMI 25 to 29.9) or evaluate the acceptability of several other descriptors, including “overweight,” which was proposed in response to the open-ended questions.
The present results have important clinical implications for all health care professionals who treat obese individuals. In broaching a discussion of excess body fat and its associated health complications practitioners are encouraged to avoid using undesirable terms -- such as “obesity” or “fatness.” Use of such terms may offend or distress some patients and prevent them from continuing to discuss their weight. We encourage health care providers to use patient-friendly terms, such as “weight,” “weight problem,” or “BMI,” when broaching the topic of weight with their obese patients.