Responses by those experts from whom the press chose to seek a comment on the latest advice (from NICE), that people react badly to being called obese were, as usual, pretty unsympathetic. I remember Sir Liam Donaldson, challenged on the same point (in relation to letters to parents telling them their child was obese), responding with a limp Well there’s nothing we can do about that – it just is the technical medical term.
Well the history of medicine is littered with once-technical terms, such as mongol, which are now deemed offensive; in some cases – like hysteria – one often suspects they were always meant to be, if not offensive, then at least dismissive.
Obese just doesn’t sound very nice – too close to obscene perhaps – but I got a surprise when I went to the OED for its history & derivation. I had always vaguely associated it with oil or lard, without ever going to the bother of looking it up, but it turns out to come from the Latin word edere, to eat, (the same root from which we get the word edible), so it has always been linked with the idea of eating too much.
The OED says that obesity, as a word, was rare before the C19th, that although Dr Johnson included it in his dictionary he provided no illustrative quotations, & dates it as a technical medical term meaning, specifically, a BMI of 30 or more, only to the late C20th.
BMI as a measure is of course less than ideal, not least because it fails to differentiate between those whose heaviness (relative to their height) is explained by a high proportion of muscle rather than body fat.
It is instructive to compare what the OED has to tell us about the word stout, when used as a synonym for obese.
One of the oldest surviving words in the English language, stout’s earliest meaning is anything but offensive: Proud, fierce, brave, resolute. One has to go all the way down to its 12th sense for its appearance (again in the C19th) as a euphemism for fat or corpulent. Charlotte Bronte, describes a woman, in Jane Eyre, as stout but not obese.
Even more interestingly, the Tailor’s Guide : Cutting, published in 1856, asserts that ‘A man is stout when the waist … is large in comparison with the breast … he is not stout because he measures so many inches, but because he is larger in the waist than in the usual proportion.’
Some medics & nutritionist would of course prefer that waistline be used as the indicator of when fat is truly a health issue in a patient; objections include that it is hard to define precisely what is meant by waistline (perhaps especially in corpulent men), & that measurement may include getting too close & personal.
We should always remember that not everybody accepts that thin is beautiful & that there are many who would prefer to sleep in a bed with a pillow rather than a bag of bones – common everyday experience shows you this, including plenty of men who are clearly both pleased by, & proud of, their wife’s size.
Collaboration with tailors & dressmakers & artists experienced in drawing the human body (which involves learning to look really closely), as well as with others whose business is the human form, might well be the best way for medical scientists to make real progress in learning how to classify & describe the human figure, to talk to people about their (or their child’s) shape with sympathy & without causing offence & in a way that might actually help inspire those, who really need to do so, to comply with what the doctor says.
Whatever we call it, obesity is important – we need all the insights we can get.
Links
