Why we should stop using the word 'obesity'

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Quick, what image pops into your mind when you see or hear the word "obesity"? You think of a fat person, right? I know I do. I also know that I don't think of junk food or the industry that so heavily promotes it, even though they are a primary culprit behind America's rising rates of type-2 diabetes, cardiovascular disease and other chronic illnesses.

Obesity is merely a symptom of a much bigger problem. Yet many of the very groups that are working hard to improve health equity by exposing the role of junk food marketing, income inequality, and other forces beyond individual control have nevertheless placed responsibility -- and shame -- for the country's growing waistlines and related health issues squarely on the shoulders of individuals. It's not intentional. But it happens every time we utter that all-too-familiar "O"-word.

This is a problem because once the conversation is framed in ways that highlight individuals, public health advocates must jump over even higher hurdles to show that we have a need for solutions beyond changes in individual behavior.

That's the trap that former U.S. Surgeon General Dr. David Satcher and physician Pamela Peeke fell into in February when they debated law professor Paul Campos and TV host John Stossel in a panel called "Is Obesity The Government's Business?" Without saying a word, Satcher and Peeke started off at a disadvantage, given the title of the debate.

Similarly, the Centers for Disease Control and Prevention may have done themselves a disservice by framing their recent Weight of the Nation conference using words that focus on fat bodies, rather than on the unhealthy foods that saturate our surroundings or environments that impede physically activity. Genes and lifestyle aren't enough to explain the country's growing battles with food-related chronic illnesses. And even though the CDC ultimately wants to reframe the conversation to show this, approaching the issue with a focus on weight accomplishes just the opposite.

Airing tonight on HBO, a Weight of the Nation documentary series presented by the Institute of Medicine with the CDC and National Institutes of Health will no doubt face the same challenges.

Framing health issues in terms of obesity not only stigmatizes fat people, it also benefits the food industry. As public health lawyer Michele Simon writes, "[I]t is a problem food companies can supposedly help fix. They can market healthier foods! They can help fund playgrounds and exercise programs!" Ever notice how food companies don't shy away from the word? That itself should sound alarm bells for public health advocates.

Of course, avoiding the "O"-word is difficult even when we know it's problematic. BMSG discussed the trouble with using "obesity" as far back as 2006, yet we still find ourselves reaching for it from time to time.

To successfully reframe the issue will be challenging and may take more than a single word. Still, public health advocates should make it a priority to do so. After all, the people who control how a problem is framed have the best chance of influencing the solution. Public health advocates showed this to be true with tobacco when they stopped talking about smoking cessation and started talking about tobacco control. A small shift in language -- coupled with attention to the policies that shaped environments -- produced a big shift in the public's thinking so that we now see the problem as one related mostly to industry, not just individuals. With enough collaboration and creative thinking, public health can do the same with food.


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