Weighty: NICE's Not-So-Nice Words.

Abstract

The National Institute for Health and Care Excellence (NICE) provides national guidance to improve health and social care in England. It currently influences bodies such as the NHS, local authorities, employers, and anyone else involved in delivering care or promoting well-being. NICE is also part and shapes the dominant discourse surrounding “obesity” in England. For example, in 2016, NICE published the new quality standard on the prevention of obesity and lifestyle weight management programmes (NICE, 2016). This policy builds on NICE's (2014) public health guideline PH53, which makes recommendations on the provision of weight management services for adults who are “overweight or obese [sic]” (NICE, 2014, p. 3). Both documents acclaim that weight management services cause no harm to individuals who participate in them. Specifically, NICE (2014) recommended that the providers of weight management programmes prevent weight stigma by being respectful with the terminology they use: Be aware of the effort needed to lose weight, prevent weight gain or avoid any further weight gain. Also be aware of the stigma that adults who are overweight or obese [sic] may feel or experience. Ensure the tone and content of all communications is respectful and non-judgmental. In addition, the terminology used to describe someone's condition [sic] should respect how they like to be described. (p. 4) NICE recommendations—self-defeating adverts? Despite advising practitioners to be careful with the terminology they use, NICE recommendations use the stigmatizing biomedical labels “overweight” and “obese.” This suggests that NICE has overlooked the body of literature that documents the negative psychosocial impact these labels have on the people they aim to describe. Sociological research suggests that for people with “excess” weight, the term “obese” evokes stronger negative evaluations than the term “fat” (Vartanian, 2010). Similarly, according to Monaghan (2008, p. 39): [O]besity might be a technically “neutral” term in biomedicine but it is a stigmatizing concept in everyday life. It is typically associated with physical extremes and the “Other,” such as the person who is seriously impaired because of his size. Puhl et al. (2013) also demonstrated that in public preferences for weight-based terminology used by healthcare providers to describe higher-body weight, “obese” was rated as one of the most undesirable, stigmatizing, and blaming words. Some tentative solutions to this issue of “othering” by labeling includes the use of a type of language that considers the person holistically instead of defining them by a particular characteristic. In this field of research, this would mean using the terms “person with obesity” instead of “obese person” (Kyle and Puhl, 2014). However, critics of this approach suggest that this language has also failed to free the person from the adverse judgment associated to obesity (Meadows and Danielsdottir, 2016). As a result, Vartanian and Smyth (2013) pointed out the paradox that the current situation generates. That is, public health campaigns should focus on facilitating behavior and on behavioral change, yet by unwittingly using stigmatizing labels they may impede the likelihood of behavior change for any given individual. In recent years, evidence has identified experienced (and internalized) stigma as a unique contributor to negative health outcomes and behaviors. Both correlational and randomized studies have concluded that adults and children who experience weight stigma are more likely to avoid exercise and physical activity, and to engage in unhealthy diets and sedentary behaviors (Bauer et al., 2004; Hayden-Wade et al., 2005; Schvey et al., 2011; Smyth and Heron, 2011). Furthermore, a recent systematic review by Puhl and Suh (2015) confirmed that weight stigma can reduce quality of life amongst individuals who experience it, interfering with their efforts to improve health, lose weight, or prevent weight gain. Despite these negative consequences have been documented in social science research for decades (Puhl and Heuer, 2010), NICE has only recently attempted to acknowledge the public health implications of weight stigma (see NICE, 2014). Although this shows an improvement from previous guidelines, unfortunately NICE still fails to practice what it preaches: that is, in seeking to guide practitioners to “do good,” by using biomedical terms NICE is (un)consciously behaving in a manner that they advise “others” to avoid. For example, if their policy audiences (i.e., those who have daily, face to face contact with people with excess weight) adopt NICE's approach and use the terms “overweight” and “obese” in their practice, aren't practitioners most likely to do harm? This inconsistency is also evident in the recently released NICE (2016) quality standard, in which discussions around stigma and the terminology used to refer to people with “excess weight” are conspicuous by their absence.