I found this blog harder to write than I expected. It’s difficult to look back at myself when I was younger and recognise the pain I was in due to my weight. Words hold real power. They can do great harm, or help to heal, and the language around obesity is no exception.
I have been overweight since I was a child, and how I was viewed by the world changed as I grew. From a cute chubby baby or plump toddler to a fat teenager and an overweight or obese woman. Cruel words were delivered with malicious intent when I was bullied as a child. As an adult they were justified as well-meaning concern or straight-talking truth. But it always made me feel not good enough, undisciplined, weak-willed and ugly.
It also had a huge impact on the language I used with myself: I thought I was fat and ugly. I recall putting pictures of my stomach and thighs on my bedroom wall to guilt myself into losing weight. I compared myself to my cousins, who were all ‘normal’ despite eating much more than I did. I learned there was ‘good’ and ‘bad’ food; I felt guilty every time I ate the wrong thing, and I often felt embarrassed to eat in public. I went through a ton of fitness fads and diets, and I joked about myself, to get a laugh I at least felt in control of.
Struggling with weight is already so complicated. The last thing needed on top of that is the stigma, the assumption of what causes it (laziness, poor decisions) and the over-simplification of what will ‘fix’ it. It wasn’t just my internal voice and my family and friends I had to contend with. Excess weight was something everyone could see, and for some reason felt they could voice an unsolicited opinion on. There was a perception that if I just followed their advice – just eat less and move more, it’s not that hard – then I’d lose weight, and if I didn’t it was my fault.
Going to university broadened my horizons, and I started to have a healthier attitude and language about weight. I got advice on nutrition, learned about metabolism and the cycle of comfort eating and guilt. As a result I started making small changes to improve my health – not just my weight. I walked more, joined a gym, and introduced healthier eating habits so that I would feel better, not look better.
I have long-term health conditions and medications that affect my weight, so I have had to relearn how to be kind to myself. I am less physically able than I was in my 20s, and I can’t go to the gym as often, but I don’t berate myself for it. I do what I can to make healthy choices, and my focus is now on being as healthy as I can be, not as thin as I can be.
Rowena Skinner is co-chair of the BMA patient liaison group
‘As doctors, we should question the cultural narrative’
Obesity is a multifaceted challenge – not simply a matter of personal lifestyle choices, but a condition shaped by genetics, environment, socioeconomic factors and, importantly, societal attitudes.
As doctors in the UK, our approach to managing obesity can benefit from examining not only clinical practices but also the broader cultural narratives at play.
Many of us have been trained to see obesity through a clinical lens, focusing on metrics like BMI, waist:hip ratio, diet and exercise. Yet there is growing recognition that this approach can inadvertently perpetuate stigma. Is it enough to view obesity as a clinical problem? Or should we also interrogate the social context?
Some argue that medical discourse has long been complicit in reinforcing stereotypes – emphasising personal responsibility and neglecting the structural factors that contribute to obesity. Over 100 acts of parliament to try and tackle obesity have focused on personal responsibility; indeed, earlier this year health secretary Wes Streeting declared that we would be providing injectable therapy to ‘get people back to work’.
This perspective invites the question: how might our language and clinical practices be reformed to reflect a more nuanced understanding of obesity?
Language as a catalyst for change
When we say ‘obese patient’ versus ‘person living with obesity’, we might seem to make little difference in clinical outcomes. However, such subtleties matter. People-first language serves as a reminder that our patients are individuals with stories that extend far beyond a medical diagnosis. By consciously choosing our words, we both foster a more empathetic dialogue and challenge the prejudiced narratives that have, historically, created a culture of judgment.
The clinical environment
Consider the design of consultation rooms, the accessibility of medical equipment, and the demeanour of the healthcare team. How often do our patients struggle to access chairs, corridors, indeed the clinical areas themselves? Small changes can transform a space from one that feels judgmental to one that offers safety and acceptance. Clinical settings could be redesigned with patient dignity at the forefront, even in seemingly minor details.
Holistic and multidisciplinary care
It is essential to see obesity not solely as a physical condition but as one that intertwines with mental health. It needs integrated care, combining physical health with mental and social wellbeing. In practice, this means collaborating with dietitians, mental health professionals and community support groups; however, in a resource-limited service, access to these specialists is regarded as aspirational.
Doctors as advocates
Our role as doctors extends beyond individual consultations. We are part of a larger social and political fabric. This raises further questions: what responsibility do we have in shaping public policy or community initiatives that address the determinants of health? How can we leverage our expertise to challenge societal biases?
Some clinicians argue for a more activist role – engaging in public health debates, policy reform, and community outreach. Others feel a strictly clinical focus is most appropriate. This debate is itself instructive; it reminds us there is no single path to reducing stigma. It is a multifaceted endeavour that needs both personal reflection and collective action.
A culture of reflection and improvement
Ultimately, the discussion about obesity stigma is a call for continuous reflection and evolution in our practices. It challenges us to be mindful of our biases, to listen more deeply to our patients’ experiences, and to remain open to change. By doing so, we create a space where our clinical practices not only treat the condition but support a broader cultural shift towards acceptance and understanding.
David Strain is chair of the BMA board of science
Obesity stigma is prevalent in hospital environments and many healthcare facilities are not equipped to meet the needs of patients living with obesity.
The ASO (Association for the Study of Obesity) – a member of the Obesity Health Alliance alongside the BMA – is looking for feedback from UK healthcare professionals, researchers, people living with obesity, and their carers/family members. We encourage both clinicians and patients to take the survey (closing 7 March).