Senate report on obesity uses inappropriate terminology, according to recent critical review

Words matter, says Angela Alberga. Whether they come from friends, family, a schoolmate, a respected peer or the federal government, words can be either helpful or harmful to the person towards whom they are directed.

That’s why the assistant professor in Concordia University’s Department of Health, Kinesiology and Applied Physiology found a 2016 report by the Canadian Senate on obesity so problematic.

She has little doubt that the report, titled Obesity in Canada: A Whole-of-Society Approach for a Healthier Canada, was written with the best of intentions. However, she did not find the terminology used in it appropriate — indeed, it may have made people living with obesity feel singled out and ridiculed.

In a critical review of the report published in the Journal of Obesity this past July, Alberga and her co-authors from the University of Calgary call on future government reports to pay more attention to the terms and examples they draw on when discussing obesity — and to incorporate the voices of people living with obesity for their input.

“There were a lot of things we felt were missing in this report,” she says. “It was not up to date with the current research on the topic.”

She argues that the report placed too much responsibility on people who were living with obesity to make better lifestyle choices and downplayed or ignored social determinants of health that are out of the individual’s control.

These social determinants are largely determined by the conditions in which people live, work, learn and socialize, the families they are born into, their income, their education levels, race, ethnicity and other factors.

They are foundational and fundamental, she argues, and as such should be considered when discussing difficult issues like the causes of obesity.

“Weight management and obesity are complex,” says Alberga, a recent Concordia University Research Award winner.

“When we oversimplify weight management by saying ‘diet and exercise more,’ we place too much individual responsibility on the person, which causes blame and shame. This makes us neglect those foundational social determinants of health people are born with that people do not have any control over.”

Fat blaming and shaming are by now familiar terms in our cultural lexicon. But while they are most often associated with schoolyard taunts or media representations, Alberga says they can also come from health care providers and policy-makers.

That can add government legitimacy to the practice of weight bias or weight stigma. Those are the negative attitudes, beliefs and behaviours towards people who live in a larger body, says Alberga. They include assumptions of laziness, of low intelligence, of lack of professional success or ability, of poor hygiene, romantic attractiveness, or even overall likeability or trustworthiness.

Going back to the Senate report, Alberga adds that using unnecessarily aggressive language — phrases like “war on obesity” and the “need to battle this epidemic” — reinforces the perception of people with obesity as problems that need a solution.

“Imagine being someone who is living with obesity and reading a report by someone who wants to declare a war against you, or a condition you are living with,” she says.

It can reinforce existing feelings of shame and fear and even prevent people from participating in behaviours that could help them, such as visiting a health-care provider or going to the gym for fear of being treated disrespectfully due to weight stigma.

Future reports and literature on obesity need to be more sensitive and respectful in several important ways, according to Alberga. We should incorporate discussions on social determinants of health rather than blaming individuals; the terminology used should be less hostile; and people living with obesity should be consulted prior to publishing.

“We should be talking about health and how to promote healthy behaviours, instead of this oversimplified focus on weight all the time,” she believes. Government policies should be more concentrated on promoting and subsidizing environments that help support healthy lifestyles, rather than placing individual responsibility on them to make better lifestyle choices.

“We can all be healthier, we can all eat less processed foods, more fruit and vegetables, sleep better, partake in less sedentary behaviours and more physical activity” she concludes. “But the focus should not be on our body weight.”