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Motivating or stigmatizing? Public perceptions of weight-related language used by health providers

A Corrigendum to this article was published on 09 April 2013

This article has been updated



Research demonstrates that health providers express negative attitudes toward overweight and obese patients that can be conveyed through weight-related language, yet little is known about people’s perceptions of weight-related language used by providers. The current study examined public preferences and perceptions of weight-based terminology used by health-care providers to describe excess weight.


A national sample of American adults (N=1064) completed an online survey to assess perceptions and preferences associated with 10 common terms to describe body weight. Participants rated how much they perceived each term to be desirable, stigmatizing, blaming or motivating to lose weight (using five-point Likert scales), and how they would react if stigmatized by their doctor’s reference to their weight.


The terms ‘weight’ (3.43, 95% confidence interval (CI) 3.35–3.50) and ‘unhealthy weight’ (3.24, 95% CI 3.15–3.33) were rated most desirable, and the terms ‘unhealthy weight’ (3.77, 95% CI 3.69–3.84) and ‘overweight’ (3.51, 95% CI 3.43–3.58) were rated most motivating to lose weight. The terms ‘morbidly obese’, ‘fat’ and ‘obese’ were rated as the most undesirable (95% CI 1.61–2.06), stigmatizing (95% CI 3.66–4.05) and blaming (95% CI 3.62–3.94) language used by health providers. Notably, participant ratings were consistent across socio-demographic variables and body weight categories. A total of 19% of participants reported they would avoid future medical appointments and 21% would seek a new doctor if they felt stigmatized about their weight from their doctor.


This study advances our understanding of why individuals prefer particular weight-related terms, and how patients may react if their provider uses stigmatizing language to refer to their weight. It also offers suggestions for practical strategies that providers can use to improve discussions about weight-related health with patients.

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Change history

  • 09 April 2013

    This article has been corrected since online publication and a corrigendum is also printed in this issue


  1. Martin D Obese? Just call them fat: plain-speaking doctors will jolt people into losing weight, says minister [Internet]. Daily Mail; c2010 [updated 2010; cited 29 November 2010]. Available from

  2. Wadden TA, Didie E . What’s in a name? Patients’ preferred terms for describing obesity. Obes Res 2003; 11: 1140–1146.

    Article  Google Scholar 

  3. Volger S, Vetter ML, Dougherty M, Panigrahi E, Egner R, Webb V et al. Patients’ preferred terms for describing their excess weight: discussing obesity in clinical practice. Obesity (Silver Spring) 2012; 20: 147–150.

    Article  Google Scholar 

  4. Dutton GR, Tan F, Perri MG, Stine CC, Dancer-Brown M, Goble M et al. What words should we use when discussing excess weight? J Am Board Fam Med 2010; 23: 606–613.

    Article  Google Scholar 

  5. Flegal KM, Carroll MD, Kit BK, Ogden CL . Prevalence of obesity and trends in the distribution of body mass index among US adults, 1999–2010. JAMA 2012; 307: E1–E7.

    Article  Google Scholar 

  6. Andreyeva T, Puhl RM, Brownell KD . Changes in perceived weight discrimination among Americans: 1995–1996 through 2004–2006. Obesity (Silver Spring) 2008; 16: 1129–1134.

    Article  Google Scholar 

  7. Puhl RM, Heuer CA . Obesity stigma: important considerations for public health. Am J Public Health 2010; 100: 1019–1028.

    Article  Google Scholar 

  8. Puhl RM, Brownell KD . Confronting and coping with weight stigma: an investigation of overweight and obese adults. Obesity (Silver Spring) 2006; 14: 1802–1815.

    Article  Google Scholar 

  9. Price JH, Desmond SM, Krol RA, Snyder FF, O’Connell JK . Family practice physicians’ beliefs, attitudes, and practices regarding obesity. Am J Prev Med 1987; 3: 339–345.

    Article  CAS  Google Scholar 

  10. Schwartz MB, Chambliss HO, Brownell KD, Blair SN, Billington C . Weight bias among health professionals specializing in obesity. Obes Res 2003; 11: 1033–1039.

    Article  Google Scholar 

  11. Brown I . Nurses’ attitudes towards adult patients who are obese: literature review. J Adv Nurs 2006; 53: 221–232.

    Article  Google Scholar 

  12. Huizinga MM, Bleich SN, Beach MC, Clark JM, Cooper LA . Disparity in physician perception of patients’ adherence to medications by obesity status. Obesity (Silver Spring) 2010; 18: 1932–1937.

    Article  CAS  Google Scholar 

  13. Puhl RM, Wharton C, Heuer CA . Weight bias among dietetics students: implications for treatment practices. J Am Diet Assoc 2009; 109: 438–444.

    Article  Google Scholar 

  14. Amy NK, Aalborg A, Lyons P, Keranen L . Barriers to routine gynecological cancer screening for White and African-American obese women. Int J Obes 2006; 30: 147–155.

    Article  CAS  Google Scholar 

  15. Friedman KE, Ashmore JA, Applegate KL . Recent experiences of weight-based stigmatization in a weight loss surgery population: psychological and behavioral correlates. Obesity (Silver Spring) 2008; 16: S69–S74.

    Article  Google Scholar 

  16. Vartanian LR, Novak SA . Internalized societal attitudes moderate the impact of weight stigma on avoidance of exercise. Obesity (Silver Spring) 2010; 19: 757–762.

    Article  Google Scholar 

  17. Annis NM, Cash TF, Hrabosky JI . Body image and psychosocial differences among stable average weight, currently overweight, and formerly overweight women: the role of stigmatizing experiences. Body Image 2004; 1: 155–167.

    Article  Google Scholar 

  18. Carels RA, Young KM, Coit CB, Harper J, Gumble A, Hobbs MW et al. Internalized weight stigma and weight loss treatment outcomes in treatment-seeking adults. Ann Behav Med 2009; 37: 350–355.

    Article  Google Scholar 

  19. Calle EE, Rodriquez C, Walker-Thurmond K, Thun MJ . Overweight, obesity, and mortality from cancer in a prospectively studied cohort of US adults. New Eng J Med 2003; 348: 1625–1638.

    Article  Google Scholar 

  20. Mokdad AH, Ford ES, Bowman BA, Dietz WH, Vinicor F, Bales VS et al. Prevalence of obesity, diabetes, and obesity-related health risk factors, 2001. JAMA 2003; 289: 76–79.

    Article  Google Scholar 

  21. Thomas SL, Hyde J, Karunaratne A, Herbert D, Komesaroff PA . Being ‘fat’ in today’s world: a qualitative study of the lived experiences of people with obesity in Australia. Health Expect 2008; 11: 321–330.

    Article  Google Scholar 

  22. Lewis S, Thomas SL, Blood RW, Hyde J, Castle DJ, Komesaroff PA . Do health beliefs and behaviors differ according to severity of obesity? A qualitative study of Australian adults. Int J Environ Res Public Health 2010; 7: 443–459.

    Article  Google Scholar 

  23. Gray CM, Hunt K, Lorimer K, Anderson AS, Benzeval M, Wyke S . Words matter: a qualitative investigation of which weight status terms are acceptable and motivate weight loss when used by health professionals. BMC Public Health 2011; 11: 513.

    Article  Google Scholar 

  24. Ward SH, Gray AM, Paranjape A . African American’s perceptions of physician attempts to address obesity in the primary care setting. J Gen Intern Med 2009; 24: 579–584.

    Article  Google Scholar 

  25. Tailor A, Ogden J . Avoiding the term ‘obesity’: an experimental study of the impact of doctors’ language on patients’ beliefs. Patient Educ Couns 2009; 76: 260–264.

    Article  Google Scholar 

  26. Brochu PM, Esses VM . What’s in a name? The effects of the labels ‘fat’ versus ‘overweight’ on weight bias. J Appl Soc Psychol 2011; 41: 1981–2008.

    Article  Google Scholar 

  27. Berg M . Choose sensitive, accurate terms. Healthy Weight J 1998; 12: 12–13.

    Google Scholar 

  28. National Association to Advance Fat Acceptance. We come in all sizes [Internet]. c2010 [cited 29 November 2010]. Available from

  29. Vartanian LR . ‘Obese people’ vs ‘fat people’: impact of group label on weight bias. Eat Weight Disord 2010; 15: e195–e198.

    Article  CAS  Google Scholar 

  30. United States Census Bureau 2009. Population estimates: general demographic characteristics [Internet]. c2011 [cited 25 Mar 2011]. Available from

  31. Markman EM . Categorization and Naming in Children. MIT Press: Cambridge, MA, USA, 1989.

    Google Scholar 

  32. Link BG, Phelan JC . Labeling and stigma. In: Aneshensel CS, Phelan JC, (eds). Handbook of the Sociology of Mental Health. Kluwer Academic/Plenum Publishers: New York, NY, USA, 1999; pp 481–494.

    Google Scholar 

  33. Degher D, Hughes G . The adoption and management of a ‘fat’ identity. In: Sobal J, Maurer D, (eds). Interpreting Weight: The Social Management of Fatness and Thinness. Aldine De Gruyter, Inc.: Hawthorne, NY, USA, 1999; pp 11–28.

    Google Scholar 

  34. Puhl RM, Andreyeva T, Brownell KD . Perceptions of weight discrimination: prevalence and comparison to race and gender discrimination in America. Int J Obes 2008; 32: 992–1000.

    Article  CAS  Google Scholar 

  35. Schafer MH, Ferraro KF . The stigma of obesity: does perceived weight discrimination affect identity and physical health? Soc Psychol Q 2011; 74: 76–97.

    Article  Google Scholar 

  36. Muenning P, Haomiao J, Lee R, Lubetkin E . I think therefore I am: perceived ideal weight as a determinant of health. Am J Public Health 2008; 98: 501–506.

    Article  Google Scholar 

  37. Survey Sampling International. The science of sampling. [Internet]. c2011 [updated 2011; cited 20 October 2010]. Available from

  38. Puhl RM, Peterson JL, Luedicke J . Parental perceptions of weight terminology that providers use with youth. Pediatrics 2011; 128: e786–e793.

    Article  Google Scholar 

  39. Puhl RM, Heuer CA . Public opinion about laws to prohibit weight discrimination in the United States. Obesity (Silver Spring) 2011; 19: 74–82.

    Article  Google Scholar 

  40. Centers for Disease Control and Prevention. Defining overweight and obesity [Internet]. c2010 [updated 2010; cited 18 November 2008]. Available from

  41. Kelly JF, Westerhoff CM . Does it matter how we refer to individuals with substance-related conditions? A randomized study of two commonly used terms. Int J Drug Policy 2010; 21: 202–207.

    Article  Google Scholar 

  42. Bacon JG, Scheltema KE, Robinson BE . Fat Phobia scale revisited: the short form. Int J Obes 2001; 25: 252–257.

    Article  CAS  Google Scholar 

  43. National Heart, Lung, and Blood Institute. How are overweight and obesity diagnosed? [Internet]. c2010 [updated 1 November 2010; cited 21 December 2010]; Available from

  44. Pietilainen KH, Saarni SE, Kaprio J, Rissanen A . Does dieting make you fat? A twin study. Int J Obesity 2012; 36: 456–464.

    Article  CAS  Google Scholar 

  45. Franz MJ, VanWormer JJ, Crain AL, Boucher JL, Histon T, Caplan W et al. Weight-loss outcomes: a systematic review and meta-analysis of weight-loss clinical trials with a minimus 1-year follow-up. J Am Diet Assoc 2007; 107: 1755–1767.

    Article  Google Scholar 

  46. Post RE, Mainous AG, Gregorie SH, Knoll ME, Diaz VA, Saxena SK . The influence of physician acknowledgment of patients’ weight status on patient perceptions of overweight and obesity in the United States. Arch Intern Med 2011; 171: 316–321.

    Article  Google Scholar 

  47. Loureiro ML, Nayga RM . Obesity, weight loss, and physician’s advice. Soc Sci Med 2006; 62: 2458–2468.

    Article  Google Scholar 

  48. Bleich SN, Pickett-Blakely O, Cooper LA . Physician practice patterns of obesity diagnosis and weight-related counseling. Patient Educ Couns 2011; 82: 123–129.

    Article  Google Scholar 

  49. Pedersen PJ, Ketcham PL . Exploring the climate for overweight and obese students in a student health setting. J Am Coll Health 2009; 57: 465–480.

    Article  Google Scholar 

  50. Finset A . One size does not fit all: how to talk to patients about obesity. Patient Educ Couns 2009; 76: 147–148.

    Article  Google Scholar 

  51. Stommel M, Osier N . Temporal changes in bias of body mass index scores based on self-reported height and weight. Int J Obesity 2012; e-pub ahead of print 1 May 2012; doi:10.1038/ijo.2012.67.

  52. United States Preventive Services Task Force. Screening for obesity in adults: recommendations and rationale. Ann Intern Med 2003; 139: 930–932.

    Article  Google Scholar 

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Research and project support were provided by the Rudd Center for Food Policy and Obesity.

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Correspondence to R Puhl.

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Puhl, R., Peterson, J. & Luedicke, J. Motivating or stigmatizing? Public perceptions of weight-related language used by health providers. Int J Obes 37, 612–619 (2013).

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  • stigma
  • language
  • health
  • health care
  • communication

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