How to communicate about obesity without promoting stigma

Chioma Ihekweazu, PhD, received her doctorate in health communication from the University of North Carolina at Chapel Hill. Her current research focuses on examining trends in nutrition news coverage, and studying how this coverage impacts dietary behaviors.

It’s not hard to tell when the CDC has released updated information on obesity rates in America. A quick scan of Facebook or Twitter and you’ll likely see headlines like “10 Fattest States in America,” and “Americans are getting even Fatter.”

obesity stigma

Examples of news images that promote obesity stigma.

The pictures published alongside these articles often show people with obesity, slovenly dressed and eating or carrying food. In this CBS News slideshow there’s a picture of a woman holding up a double-meat cheeseburger with the American flag in the background, while a Washington Times article shows a headless figure sitting on a bench eating. The text may be equally off-putting–a Los Angeles Times article started off by saying, “If you dread the prospect of hauling your lazy rear end to the gym…the extra weight you’ve been carrying around may be to blame.”

This matters: Judgmental and dehumanizing word and image choices promote stigma–as content analyses like these reveal. Research shows that a culture of prejudiced behavior toward people with obesity is not only linked with many negative outcomes like bullying and depression, it also makes it less likely that people with excess weight and obesity will seek treatment–not just for losing weight, but for even basic preventive care. 

Fortunately, by being mindful of the following points, journalists can help advance public dialogue about obesity and weight loss without stigmatizing people.  

Avoid ‘headless’ imagery

An example of an image that does not promote stigma.

Not showing a person’s face implies there is something shameful about what they are doing or who they are–yet that’s often what we see in news coverage about obesity. Videos like this one, accompanying a recent CNN news story can perpetuate damaging stereotypes about people with obesity. The video starts off with a climbing number on the scale, followed by an image of a person lying in a hospital bed, yet another person eating, and a headless figure seated on a bench wearing a shirt that leaves most of the person’s stomach exposed. An LA Times video similarly portrays people with obesity from the neck down, and in social settings where they are often eating.

To help remedy this, the Rudd Center for Food Policy and Obesity at the University of Connecticut created two free image and video databases with over 400 images and 88 b-roll videos of adults and children with higher body weight engaging in varied activities such as reading and delivering work presentations. The Canadian Obesity Network also has a free image bank of non-stigmatizing imagery. 

Weight loss is not a simple equation

There’s a common assumption that to lose weight, people with obesity simply need to eat healthier and move more. In reality, it’s far more complex for many people–long work schedules, food deserts, and unsafe neighborhoods can all stymie efforts to eat better and get more more physical activity. So, when writing a news story on obesity, it’s important to acknowledge the challenges that people may face, or alternatively, the abundant tools they’ll need when trying to lose weight.

A New York Times article from last year did a good job of addressing some of the environmental challenges that people with obesity face when trying to lose weight, such cheap, unhealthy food served in large portions. Another article published in The Chicago Tribune acknowledged the tools that people need to support their weight loss efforts, like community-based programs and policies.

Use words wisely

With body positivity and “fat acceptance” social movements, activists are attempting to reclaim power over use of the word “fat.” However, it is still a controversial term that can be used in derogatory ways. Try to avoid value-laden language like “fat” and “weight problem” when describing obesity, and rely on scientific terms instead.

For example, instead of saying “morbidly obese,” refer to obesity based on its “classes” as outlined by the CDC and NIH. Class 1 obesity refers to someone with a BMI between 30 and 35, class 2 obesity refers to someone with a BMI between 35 and 40, and class 3 obesity refers to someone with a BMI of 40 or greater.

In determining what counts as value-laden language, consider whether the language in question could potentially demean or embarrass someone. If it could, ask whether that language is needed to communicate the article’s main point. A Washington Examiner article published earlier this year could have made the point that the global prevalence of obesity is rising without referring to “French fry loving Americans” and how “…American children and adults are leading the obesity parade.”

In this instance, this type of language only serves to mock and embarrass people with obesity, making it inappropriate and unnecessary.

Finally, consider the label you’re using to describe people with obesity. It would likely strike you as odd to see an article reference a “cancerous” or “diseased” person, yet, so often we refer to “obese persons” in news stories about people with obesity. Try to put the person before the condition.

Headlines set the tone

While the headline may be the last part of a news story to be written, it is the first thing that readers see. Consequently, it sets the tone for the rest of the article. A headline like “F as in Fat: Top 15 fattest US states” makes for a poor choice for a headline because it equates fat with a failing grade.

A better headline would be this one from The Chicago Tribune, “American obesity report: 1 in 3 adults are beyond overweight.” This headline meets many of the criteria discussed above by focusing on the report’s main findings, and avoiding controversial or value-laden language.

Finally, focus on findings, not feelings

When focusing on the facts, the findings from research studies are put front and center like in this CBS News article. While photo selection could have been better, the article itself describes the findings of two different obesity research reports without introducing unsupported opinions or value judgments about people with obesity.

Conversely, when focusing on feelings, stigma emerges. That was the case in a UK Telegraph article with this judgmental headline, “Fat but fit is a myth, and big is not beautiful so stop making excuses for obesity.” The story states that people with obesity lack the willpower and motivation needed to make healthy lifestyle choices, with the author primarily basing this on personal experience. 

“Life is complicated, and if any amount of guilt, shame, blame, or even desire were sufficient to help patients cultivate permanent, intentional, behavior changes, the world would be a much thinner place,” says HealthNewsReview.org contributor Dr. Yoni Freedhoff, MD, an assistant professor of family medicine at the University of Ottawa, and founder and medical director of the Bariatric Medical Institute, which focuses on non-surgical weight management. 

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Comments (12)

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Michelle Vicari

December 7, 2017 at 7:57 am

Thank you for this article. As a person affected by obesity I appreciate your efforts to educate the public. Another great source for free, non-stigmatizing imagery, evidence-based information on obesity and initiatives to eradicate weight bias is the Obesity Action Coalition obesityaction.org

Liz Goodfellow

December 7, 2017 at 8:27 am

This article is a great resource! Thank you for putting it together.

Candy Clouston

December 7, 2017 at 10:15 am

I’m surprised to see that this article doesn’t address the reality that (1) exercise doesn’t seem to be the key to weight loss and (2) the ability to lose weight differs greatly from body to body without regard to food desserts, long working hours, or unsafe neighborhoods. Losing weight is typically more difficult for women, particularly post-menopausal women. Not regaining weight is difficult, perhaps because changes in metabolism triggered by calorie reduction make it difficult to keep weight off without what many would consider an excessive commitment to exercise (although the data on that is too limited to inspire confidence). Research on weight loss really isn’t providing great guidance, in part because it’s so difficult to do. It seems that not gaining excess weight in the first place is the best approach to preventing obesity, but once the train has left the station, results are difficult for most people to achieve and sustain, even if they live where healthy living is easy.

Tim Kirn

December 7, 2017 at 3:18 pm

Thank you, Dr. Ihekweazu.
There are a number of suggestions that you have here that I would not have known about. This is very helpful.
For the sake of more discussion, though, allow me to play devil’s advocate here.
Journalists generally do not use such language gratuitously. We use it to pique interest in the story, to compel people to read it, or, if reading already, to continue.
In general, journalists believe information is good, some information is better than none, and the more people who have information the better. We tend not to qualify that much — except that it has to be accurate, of course.
Every news-media communication is necessarily flawed. Even a deep-dive magazine article is not a book.
But we generally believe that what we are writing about is important, probably really important, and we desire that the most people possible know it — even if 10 minutes later they’ll maybe only remember a single number and the main point.
So, isn’t there virtue in getting the information out to more people even if to do so we use language that isn’t overly sympathetic? Aren’t we better served with “Top fattest states” over “obesity report” if 100,000 people read it, as opposed to only 50,000, as long as the information in the article is correct and is presented without any conscious, concerted effort to shame?
Sure, overweight people have a difficult time. Yes, clearly, a social mileiu that bullies, discounts, and/or torments them is not what any of us want — especially since “they” is “we.” And, all discussion contributes to the culture and molds it.
But is there any direct evidence that language like that, in a headline or news article, causes people not to read the article, and get the information, which ultimately leaves them better off, and probably serves to send the message that ‘Hey, this is a problem for a whole lot of people. You are not alone?’
Moreover, can’t we reclaim this previously offensive language now? Shouldn’t we? After all, we are no longer talking about an afflicted minority here any more. These days, more than half of us are chubby and fully a third of us are obese. And the problem is still growing (maybe). It’s all of us. If it is not you and me, it is our sister, our brother, our good friend. Aren’t we helped by being able to talk about it freely? With language that is clear and straightforward and does not have to be censored? Don’t we need to move beyond the stigma, because we have an extremely frightening health problem here?
Thanks much,

Steve Tally

December 7, 2017 at 4:32 pm

Thank you for this article, but one word of caution: the article edges close to subtly reinforcing a well-worn bias about fat people eating too much and not getting enough exercise (despite the link to the NYT article) when it states that obstacles “can all stymie efforts to eat better and get more more physical activity.” This view (calories in vs. calories out) sets up obesity as a character issue, and the science of this view has been—if not debunked—hotly disputed. Many researchers recognize obesity as a hormonal disorder, insulin resistance. Physical activity has been found to have little influence on weight in many, if not most, people. (See this excellent lit review: https://www.vox.com/2016/4/28/11518804/weight-loss-exercise-myth-burn-calories . And also https://www.nature.com/articles/ejcn2011132#ref87 ) I want to emphasize that I don’t believe that the author was in any way trying to add to the stigma of being obese or morbidly obese, but may have unknowingly supported a common—and hurtful—misunderstanding about obesity.

Amanda Klein

December 8, 2017 at 10:13 am

I agree with so many of Dr. Ihekweazu’s points, as well as Candy and Steve’s comments that the article could have done more to challenge myths about the causes of obesity. I would love to see suggestions for plain language wording alternatives: though I definitely don’t want anybody using the term “morbidly obese,” it seems very cumbersome to define the classes of obesity in an article.

Bill Fabrey

December 9, 2017 at 4:39 pm

This great piece is long overdue and is a refreshing read considering the dismal track record most of the media has on the topic. Most photos and captions (or narration) are used mainly to sensationalize, as attention-grabbers. Larger people constitute a badly stigmatized population in our society!

nick mulcahy

December 11, 2017 at 11:05 am

Excellent, important piece—hope you are promoting strongly on social. These are needed vision and words.

Joy Victory

December 11, 2017 at 1:08 pm

Candy — Thank you for taking the time to share your thoughts. Your points are valid. However, our post is not intended to serve as an argument about the most effective weight loss methods, or about which groups of people lose weight more easily than others. Rather, this article was written to discuss how we can better communicate about obesity without stigmatizing people with obesity. Exercise was brought up because it can be a pitfall in obesity news stories – writers may make recommendations to exercise without acknowledging how challenging regular exercise can be for many people.

Joy Victory

December 11, 2017 at 1:10 pm

Tim — Thank you for reading and sharing your thoughts on this topic. To your comment about using certain language to get more readers, we seriously question the value of getting out information to more people if the information being shared contributes to bias or stigma (even if the information is factually correct). The effects of these stigmatizing portrayals can have damaging psychological and physical effects on people with obesity. What happens is you end up getting more eyes on stigmatizing content; it does more harm than good.

The focus should be on tools to help people with obesity get to a healthy, sustainable weight. Since research has shown that stigmatizing language doesn’t help them get there (in fact, it can have the opposite effect*) why should it be used?

*See the following studies:
https://www.sciencedirect.com/science/article/pii/S0022103113002047
http://onlinelibrary.wiley.com/doi/10.1038/oby.2011.204/full

To your point about reclaiming the offensive language, the language is not ours to reclaim. It’s an individual choice as to whether someone wishes to use that language to describe him or herself. It’s not for the news media to place that label upon people, especially since it’s often used in a demeaning manner.

Ultimately, we agree with you that we need to move beyond the stigma to address the rising prevalence of obesity. However, in order to do so we have to change our language because that’s what contributes to the stigma that currently exists.

Joy Victory

December 11, 2017 at 1:13 pm

Steve — Thank you for your comment and sharing the resource. We’d like to stress that the purpose of this article was to discuss how we can communicate about obesity without promoting stigma. Since exercise is frequently mentioned in obesity news stories, and we’ve found it to be a pitfall as it relates to stigma, we mentioned it here. It was simply to point out that there’s not always an acknowledgement of how challenging regular exercise can be.

Aleta Kerrick

December 12, 2017 at 10:09 am

Another issue with imagery is the media’s near-exclusive use of “attractive” (i.e, young, thin, fit, stereotypically pretty/handsome) people to illustrate healthy-lifestyle articles. Older &/or heavier people are seldom shown eating well or being physically active in general-info coverage of nutrition and exercise.

Sometimes media’s fondness for only showing “pretty people” is carried to ludicrous extremes. Several years ago, an NYT report on the health benefits of mild exercise for overweight seniors was illustrated with a very fit young woman running.