By Dr. Asnat Raziel, bariatric surgeon specializing in obesity treatment, metabolic health and healthy longevity; Director of the Multidisciplinary Center for Obesity Treatment, Assia Medical, Assuta Ramat HaChayal, Tel Aviv
Obesity stigma: why words are part of treatment
Respectful language that avoids obesity stigma isn’t just a matter of good manners; it is part of treatment itself. The words that doctors, researchers and the media use to describe obesity shape how people see themselves and their disease. That is why a new paper in Harefuah, the journal of the Israel Medical Association, proposes a unified, respectful set of terms in Hebrew. The paper builds on the recommendations of the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO). In this article, I translate it into everyday language.
Who wrote the recommendations, and why now
Five professionals from clinical pharmacy, endocrinology and obesity medicine wrote the paper: Almog Eliyahu Dahan, Idit Dotan, Dror Dicker, Arik Dahan and Carmil Azran. They come from Ben-Gurion University, Rabin Medical Center, Clalit Health Services, Maccabi Healthcare Services and the Hebrew University.
The reason for writing it is simple. Knowledge about obesity treatment has grown rapidly, but the terminology has remained confused. The same phenomenon goes by different names in different papers, both in English and in Hebrew translation. According to the authors, this confusion makes it harder to compare studies, and sometimes it also stigmatizes patients. Against this background, IFSO published a list of recommended terms, and the Israeli paper adapts it to Hebrew and to the local culture.
Fighting obesity stigma starts with the person, not the diagnosis
The first principle in the paper is person-first language, that is, language that puts the person before the diagnosis. Instead of “fat” or “fat people,” the authors recommend saying “a person living with obesity.” Likewise, “a diabetic” becomes “a patient with diabetes,” and “morbid obesity” becomes “severe obesity.”
The difference may seem small, but the studies the authors cite suggest otherwise. A large systematic review found that people prefer neutral terms. Moreover, hurtful words about weight are linked to low self-esteem and even to a higher risk of eating disorders. In other words, hurtful language is a health risk in its own right. Weight stigma is a topic I have written about before.
Not “success” or “failure”: how to describe results
One of the paper’s key recommendations concerns how we describe results. The authors ask us to avoid the words “success,” “failure,” “sufficient weight loss” and “insufficient weight loss.” Instead, they propose two terms: “optimal clinical response” and “suboptimal clinical response.”
Why does this matter? Because the response to treatment, whether medication or surgery, depends on many biological, behavioral and environmental factors. It isn’t black and white. In addition, the authors recommend quantitative definitions. These include body mass index (BMI, weight in kilograms divided by height in meters squared), percent total weight loss (%TWL) and improvement in metabolic markers.
Furthermore, weight loss is not the only goal of treatment. The paper also highlights diabetes control and improvements in blood lipids, blood pressure, fatty liver, sleep apnea and daily functioning. A person with a “suboptimal” weight response may still gain a great deal in health. So the word “failure” is simply wrong.
Obesity classes by numbers, not labels
Instead of “extreme obesity” or “super-extreme obesity,” the authors recommend a quantitative classification based on BMI. Class I obesity is a BMI of 30 to 35, class II is 35 to 40, and class III is 40 to 50. Beyond that, class IV is 50 to 60, and class V is 60 to 70. These definitions allow precise comparisons between studies.
Avoiding obesity stigma in the operating room
On the surgical side, the paper recommends the term “bariatric-metabolic surgery” rather than “weight-loss surgery” or simply “bariatric surgery.” The reason is that these operations affect not only weight but also hormones, the neuroendocrine system and metabolism. For the same reason, the authors also ask us to drop the old classification of operations into “restrictive” and “malabsorptive.”
The paper recommends describing the operations themselves by their anatomy: “gastric bypass with two anastomoses (Roux-en-Y gastric bypass),” “one-anastomosis gastric bypass” (not “mini bypass”) and “sleeve gastrectomy.” In addition, we should distinguish between “revisional surgery” and “conversional surgery.” Revisional surgery modifies the same operation, for example by reducing the gastric pouch after a bypass. Conversional surgery, by contrast, switches to an operation with a different mechanism, for example from a sleeve to a one-anastomosis bypass. Finally, the recommended long-term term is “recurrent weight gain,” not “weight gain after surgery.” I have written in detail about recurrent weight gain after sleeve gastrectomy.
“Obesity management medications,” not “diet drugs”
When it comes to medication, the authors are clear. The correct term is “obesity management medications,” not “diet drugs.” The difference is fundamental, and here too, avoiding obesity stigma means being precise: this is a medical intervention for a chronic disease, not a cosmetic aid. This approach sees obesity as a chronic disease that requires ongoing, multidisciplinary care.
My own website often uses the phrase “weight-loss injections,” because that is how people search for information. Still, the new recommendation invites all of us to be more precise. You can read about the medications themselves in my guide to obesity medication, and from now on I will try to call them by their proper name.
Patients, participants and comorbidities
The paper adds two smaller distinctions. First, in clinical papers the term “patients” is preferable, whereas in general studies we can say “people” or “participants.” Second, instead of “associated diseases,” the authors recommend “obesity-related comorbidity,” because it is more clinically precise.
The glossary in brief: what to replace, and with what
- Fat → a person living with obesity
- Diabetic → a patient with diabetes
- Morbid obesity → severe obesity
- Success or failure → optimal or suboptimal clinical response
- Extreme obesity → class III, IV or V obesity, by BMI
- Weight-loss surgery → bariatric-metabolic surgery
- Mini bypass → one-anastomosis gastric bypass
- Weight gain after surgery → recurrent weight gain
- Diet drugs → obesity management medications
- Associated diseases → obesity-related comorbidity
Obesity stigma in everyday life: what it means for you
First, you are entitled to ask your care team to use respectful language. If a word hurts you, say so. Second, if your treatment led to a “suboptimal” response, that is not a personal failure. It is clinical information, and it calls for adjusting the treatment, not for blame. Third, pay attention to the language you use when you talk to yourself and about yourself. “I live with obesity” sounds completely different from “I’m fat.”
Finally, language matters at home too. A respectful conversation with the people closest to you can make treatment easier for everyone.
Bottom line
Words don’t just describe reality; they shape it. Respectful language that avoids obesity stigma, together with a unified set of terms, will improve research, teaching and the conversation between doctor and patient. The authors recommend adopting these guidelines in Hebrew-language medical journals and in clinical training, and I join that recommendation. The change starts with the next sentence each of us says.
The information in this article is general only and is not personal medical advice. For any question about your own condition, consult your doctor.
References
Weighing words: a unified terminology for obesity treatment and bariatric-metabolic surgery (Harefuah, in Hebrew)
IFSO Accepted Nomenclature (for abstracts, articles, presentations, surveys, congresses, etc.)
