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  7. Eliminating weight stigma - guidelines for BDA communications

Eliminating weight stigma - guidelines for BDA communications

Summary

Stigma and discrimination toward people living with obesity are pervasive in society and have numerous negative consequences for their health(1). People living with obesity face these challenges in education, in the workplace, the mass media, with friends and family, and even in healthcare settings(2). Doctors, dietitians, physiotherapists and others have all shown a propensity to ascribe stereotypical characteristics to people living with obesity, and in some instances, do not provide the advice, support and care needed(3). Fear of discrimination and weight-based stigma can also lead people living with obesity to avoid seeking medical care. This may increase health risks and can create barriers to seeking healthcare treatment.

In 2018, an All-Party Parliamentary Group on Obesity report indicated that only “26% of people with obesity reported being treated with dignity and respect by healthcare professionals when seeking advice or treatment for their obesity”, and “42% of people with obesity did not feel comfortable talking to their GP about their obesity”(4).

The BDA wants to do all it can to avoid and end weight stigma. These simple guidelines are designed to ensure we do so in our published materials and communications.

It is important to understand that these guidelines are about how we communicate as an organisation and not individualised discussion with people living with obesity. In practice, it is important that you use the language that is most acceptable for each individual(5).

Guidelines for BDA communications

Respecting people’s self-definition

The movement of people working to end weight stigma is growing, and as the professional association for dietitians in the UK, our ambition is to contribute to this agenda through improved understanding and communication about weight. We acknowledge and respect that at present there is no consensus on the exact preferred language to use, and sometimes people living with obesity may ‘reclaim’ terms for themselves.

For example, fat activists have reclaimed the word ‘fat’ for themselves. They argue that ‘fat’, like tall, short, brunette, or blonde, should be a descriptor without judgement. There are also many people living with overweight and obesity who do not feel this way, and data shows that ‘fat’ is generally a disliked term which elicits a negative emotional response(5,6).

Therefore, when discussing a named individual, we will follow the way they describe themselves alongside our style guide.

Using person-first language around obesity

In an absence of a consensus and in line with current evidence, we at the BDA will use person first language when discussing overweight and obesity.

Do use:

  • “Person with obesity”
  • “Person living with obesity”
  • “Child living with obesity”
  • “Patient with overweight”

Don’t use

  • “Obese person”
  • “Overweight person”
  • “Child who is obese”

There may also be times when it is appropriate to talk about people living with obesity without talking explicitly about obesity. For example, when discussing the way weight stigma can impact people’s lives. In these instances, the below phrases may be appropriate:

  • “Person with a higher weight”
  • “Individual with a higher weight”

Avoiding stigmatising language

Hurtful and offensive words that are used to describe people living with obesity, to make assumptions about health based on body size or to ‘explain’ why someone might have obesity, are not appropriate.

Don’t use

  • Pejorative language about people’s size, body weight or their relationship to food, e.g. “too fat”, “pig-out”
  • Stereotypes about the supposed character or actions of people with obesity, e.g. “lazy”, “lacking will power”, “unsuccessful”, “non-compliance”

Avoiding combative language

Often, when discussing efforts to support people with overweight or obesity, either in terms of supporting services or policy proposals, people will use combative language. Using combative language can feel like an attack and can lead to frustration which may reduce engagement in health behaviours.

Do use:

  • “Treating overweight and obesity”
  • “Supporting people with overweight or obesity”
  • “Helping people to reach and maintain a healthier weight”
  • “Supporting families to adopt healthier lifestyles”
  • “Encouraging health-promoting behaviours”

Don’t use:

  • “The obesity crisis”
  • “Fighting obesity”
  • “Eradicating obesity”
  • “Tackling the issue of overweight and obesity”
  • “Suffering from obesity”
  • “The other pandemic”

Using appropriate imagery

It can be important to add images to communications, especially on social media. However, when it comes to illustrating people living with obesity, media and websites often resort to stereotypical and dehumanising images that represent them as being lazy, unhappy or eating very poor diets. Media often utilise images that are not representative of most people living with overweight or obesity, and are designed to perpetuate common stereotypes. In addition, the heads of people living with obesity are often cut out of images with a focus on a person’s midriff.

Whenever possible the BDA should use non-stigmatising images, such as those available from the World Obesity Federation or Obesity Canada image banks. These images portray people living with obesity in a much more humanising and fair way:

If you know of any other image banks such as these, get in touch with our media office: [email protected].

Do use:

Images that show people living with obesity as human beings engaging in everyday activities, including healthy lifestyles where appropriate.

Weight stigma image 1.png Weight stigma image 2.png Weight stigma image 3.png

 

 

Don’t use:

Images that dehumanise people living with obesity by showing only the midriff of a person with obesity, or portraying a person living with obesity in a stereotypical way (such as grotesque, lazy, ugly, miserable).

Considering context

It is always useful to consider the full context and purpose of anything we communicate to the public or colleagues. Many of us could benefit from healthier nutrition regardless of our body weight, but weight stigma assumes that poor nutrition is only relevant to people living with obesity. It is important that we work to remove this assumption when creating resources regarding nutrition or health promotion.

Do:

  • Celebrate tasty, nutritious food and a varied diet.  
  • Offer different information for different populations.

Don’t:

  • Assume that anyone looking for ‘healthier eating’ information wants to lose weight.
  • Create healthy eating resources that focus entirely on weight loss or people living with overweight or obesity.

Why do people have different body sizes?

Body weight regulation, size and shape is highly complex and influenced by multiple factors. These include psychological, genetic, biological, environment and societal(7). In most cases, it will be a combination of many of these factors, and is not simply driven by personal responsibility or how much we eat and exercise.

Critically, it is important that when we discuss obesity we communicate, in line with the now substantial evidence, that it is not an issue of personal failing or choice. It is key to identify that in order to support the population to reach and maintain a healthier weight there is a need for structural change across all levels, and thus, a whole systems approach to engender policy change.

More information:

Acknowledgments

Particular thanks go to Dr Adrian Brown and Dr Stuart Flint without whose significant time, effort and expertise this guidance would not have been possible.

Thanks also to all the other members who took time to review these guidelines and contribute their thoughtful feedback including: Susan Short, Bahee Van der Bor, Katherine Kimber, Aisling Pigott and Christian Lee.

The responsibility for any errors remains with the BDA (Published 23 July 2021)