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Weight bias and stigma exist in a variety of realms in our society (media, education, employment, and health care), and unfortunately many view it as a socially acceptable form of discrimination. Patients with obesity often avoid scheduling appointments for health promotion visits and routine care due to perceived weight bias and stigma from their health care provider. Within the health care setting, it is important that health care providers strategically focus on reducing obesity bias and provide high-quality obesity management. People-first language should be used and waiting rooms and examination rooms should be accommodating to people of all sizes.

The healthcare environment plays a big role in whether or not patients with obesity seek healthcare. When it is not welcoming physically and emotionally, they are more likely to delay or avoid healthcare settings. The built environment needs to be weight inclusive with adequately sized furniture and equipment that is readily available to patients and staff. All members of the healthcare team should be educated about how to communicate with patients, family members, and other staff members in a manner that is sensitive and respectful. People-first language should be used in all discussions with and about patients with obesity. Negative experiences with staff or with the physical environment cause harm to patients and must be avoided through careful attention to creating a welcoming, safe experience.

This survey study evaluates responses to people-first language and terms for describing a body mass index of 40 or more among patients seeking bariatric surgery and explores patients’ receptivity to discussing weight stigma in weight management.

OBJECTIVES: Weight-related stigmatization is pervasive in American society with health and social consequences. The public increasingly gets news online and it can influence how they understand health issues, including obesity. Online media has a wide reach and can perpetuate the social acceptability of weight stigma through language and visual content. To combat weight bias, experts recommend the use of People-First Language (PFL) and avoidance of stigmatizing images by the media. Research has not yet analyzed the use of weight-related PFL or images in online coverage of any presidential physical exam. Our first objective was to determine the prevalence of PFL in online news coverage of the 2018 presidential physical exam. Our second objective was to examine the images that accompanied the online coverage. METHODS: Google search engine was used to identify all US based online news articles that covered the physical exam between December 7, 2017 and February 17, 2018. Articles meeting inclusion criteria were coded for the presence of weight-related language keywords and use of PFL. We then performed a content analysis on the images that accompanied the online news articles. Four coders systematically reviewed the visual content to capture images that may be stigmatizing. Simple descriptive statistics were used to summarize data. RESULTS: Exactly 1242 articles were obtained based on keyword searches and 376 met inclusion criteria. After excluding duplicates, 179 articles were included in the final analysis. Use of PFL was observed in 2% (4 of 179 articles) of coverage. Use of the adjective “obese” occurred in 44% of coverage, the condition “obesity” in 19% of coverage and “overweight” in 37% of coverage. About 28% (64 of 227) of images portrayed the president as exercising, but of those, 84% (54 of 64) were portrayed in a stigmatizing way. Of 227 photographs of the president accompanying the online news coverage, 37% (83 of 227) were portrayed in a negative and stigmatizing manner. CONCLUSIONS: Prevalence of weight-related PFL was low and use of stigmatizing images was noticeable. Exercise should display positive characteristics in an image. However, in our study it was counterintuitively used for stigmatizing portrayals. Future research should identify factors surrounding the lack of PFL and use of stigmatizing images by online news media. FUNDING SOURCES: LJ received funding from the U.S. Dept. of Education HSI STEM grant.

Patient letters provide a permanent record of the genetic counseling that was provided and are unique in medical care; rarely do other health care providers send summaries written specifically to their patients and families. We surveyed genetic counseling training program directors and found that while the acquisition of patient letter-writing skills was considered important, there were no specific guidelines made available to students. To develop letter-writing guidelines, we evaluated patient letters, reviewed references on professional correspondence, surveyed the medical literature, and worked with a writing consultant. The guidelines we subsequently developed and present here include a format for writing patient letters, suggestions on presenting medical information in understandable terms, and wording considerations. These patient letter-writing guidelines are intended to serve as a guide for teaching students this important skill and as a resource for practicing health care professionals.

Dr. William Dietz is correct in pointing out that our support for people-first language in Obesity has been more a case of “talking the talk” than “walking the walk.” We thank Dr. Dietz for bringing this important issue to our attention. We will institute the following changes in our policies for both potential authors and accepted manuscripts. First, we will amend our Author Guidelines, Submission Checklist, and Ethical Policies documents to inform authors of our support for people-first language, including our position that "obese” should not be used to describe individuals or groups of individuals. Second, our editorial team will work with authors to change “obese” as an adjective to terms such as “people with obesity” and “populations with obesity.” Such changes will take time and will need careful consideration from both the editorial team and the authors in order to “walk the walk.”

(1998). People First Language in Middle and High Schools: Usability and Readability. The Clearing House: A Journal of Educational Strategies, Issues and Ideas: Vol. 72, No. 2, pp. 115-117.