The Significance and Necessity of Person-Centered Language When Addressing Obesity and Diabetes

Author's Note: In recognition of Obesity Care Week and our commitment to the Obesity Action Coalition's Commit to Care Pledge, I felt compelled to reflect on how we translate that promise into everyday clinical practice. Language, whether spoken in the exam room or written in diagnostic codes, can either perpetuate stigma or promote respect. I chose this topic because committing to care is not accomplished by signing a pledge alone; it is realized through the words we choose and the systems we shape.

Language can open a door just as quickly as it can close one; a single word or phrase can shape an encounter and the trajectory of clinical outcomes. It can indicate respect, active listening, shared problem solving and decision making, or it can reinforce shame and division. For clinicians, health systems, and others designing care models, choosing words intentionally is an act of clinical care. It's also a critical tool in addressing weight bias, stigma, and the real harms they cause.

Person-first language matters because labels define how we see people. Referring to someone as an "obese person" or a "diabetic" reduces their identity to a condition. Saying "a person with obesity" or "a person living with diabetes" affirms personhood first and acknowledges the condition as only one part of a complex life. This shift is more than semantic. It reinforces the fact that obesity is a chronic disease with biological, social, and environmental drivers rather than a moral failing. Professional organizations and patient advocates have encouraged this approach because it supports dignity and builds rapport.

"Saying 'a person with obesity' [...] affirms personhood first and acknowledges the condition as only one part of a complex life".

Certain terms carry unintended moral weight and clinical inaccuracy. The words "morbid" and "severe" in casual use fuel fear and judgment. Instead, use obesity classifications when clinical precision is required, for example "class I, II, or III obesity." This approach is clearer, less stigmatizing, and better aligned with contemporary frameworks that emphasize adiposity, distribution, and obesity-related complications rather than pejorative adjectives. Such complication-based diagnostic models help clinicians focus on risk and treatment needs rather than on blame¹.

Diagnostic Codes and Charting

Words also matter in documentation and billing. I've had patients tell me they were deeply hurt when they saw insurance diagnoses such as "obesity due to excess calories." That phrase implies a purely behavioral etiology and erases the genetic, neurohormonal, and social complexity of adiposity. Unless a thorough, documented dietary assessment over weeks supports such an attribution, clinicians should avoid assigning etiologic language that suggests blame. Diagnostic codes should reflect careful evaluation, not shorthand assumptions.

Be aware that some ICD-10 codes carry stigmatizing language or imply patient fault when used without context. Examples include:

• E66.01 — Morbid/Severe obesity due to excess calories
• E66.09 — Other obesity due to excess calories
• Z91.11 — Patient's noncompliance with dietary regimen
• Z91.12 — Patient's noncompliance with medication regimen

Using codes like E66.01 or language such as "due to excess calories" without careful supporting documentation can perpetuate bias and damage trust. Codes for "noncompliance" likewise imply moral judgment. Before selecting such codes, clinicians should document the clinical assessment, barriers to adherence, social determinants, and shared decision making that led to the conclusion. Often a more accurate and less stigmatizing approach is to document observed behaviors, barriers, and a plan for support rather than attributing intent or moral failure.

Similarly, avoid morally laden shorthand for diabetes status. Describing someone as "controlled" or "uncontrolled" glosses over context and can carry judgment. Better clinical language describes specific metrics or goals, for example "A1c is above the individualized target" or "glycemic levels have been variable and we will discuss treatment options." This communicates clinical information while preserving dignity and inviting shared problem solving.

Practical Documentation Guidance

• Prioritize objective measures and complications: Document BMI class, relevant comorbidities, functional limitations, and adiposity-related complications that drive treatment decisions.
• Describe data and context, NOT character: Instead of "noncompliant with diet," document specific behaviors and barriers, for example "patient reports difficulty accessing recommended foods due to transportation and cost; discussed strategies and referrals."
• Avoid etiologic shorthand unless proven: Do not code "due to excess calories" unless a careful dietary assessment and clinical reasoning justify that phrasing and it is recorded in the note.
• Use complication-based language: When clinically relevant, frame obesity as adiposity-based chronic disease and note complications that guide therapy. This aligns documentation with modern diagnostic frameworks and reduces blame.
• Make the plan visible: Document the shared plan, referrals (dietitian, behavioral health, social work), and the agreed next steps. Notes that emphasize partnership and support signal therapeutic intent to patients and payers.

The Damage of Stigmatizing Language

The harms of stigmatizing language are well documented. Weight bias and stigma are associated with delayed care, reduced preventive screening, greater psychological distress, and behaviors that ultimately worsen cardiometabolic risk2.3. In clinical settings, patients who experience bias are less likely to seek care and more likely to avoid follow up, which undermines long-term outcomes. The emotional burden of stigma also contributes to stress pathways that negatively affect physiology and behavior. Addressing language is therefore a clinical intervention that improves access, trust, and outcomes.

"Patients who experience bias are less likely to seek care and more likely to avoid follow up, which undermines long-term outcomes".

Language alone will not erase structural barriers. Policy and coverage gaps leave many patients without access to evidence-based treatments and behavioral care, and those gaps amplify the consequences of stigma¹. Still, careful terminology is a practical, immediate step clinicians and teams can take at every encounter while broader system change proceeds.

Practical Guidance for Everyday Practice

• Use person-first phrases: Say "a person with obesity" or "a person living with diabetes" rather than "an obese/diabetic person."
• Replace "morbid/severe" with clinical classifications: For example "class II obesity."
• Avoid "controlled/uncontrolled": Instead describe metrics and goals, for example "A1c is 8.2 percent, above the individualized target."
• Offer neutral, supportive explanatory language: Try "people often experience side effects when starting therapy; here are strategies we can try" rather than "you need to try harder."
• Model respectful language across teams and documentation: Patients notice both spoken words and written notes.

Self-Internalization of Stigmatizing Language

Importantly, stigmatizing language is not only imposed by medical systems or society. It's often internalized and used by patients themselves and even directed toward others with obesity or diabetes. Terms like "lazy," "failed," or "noncompliant" are commonly adopted as self-descriptors, reflecting years of exposure to blame-based narratives. This internalized stigma is associated with increased shame, avoidance of care, disordered eating, reduced treatment engagement, and poorer cardiometabolic outcomes³. When stigma circulates within patient communities, it further erodes trust, reinforces isolation, and undermines collective advocacy, therefore making respectful, biology-informed language essential not only in clinical settings, but in patient-to-patient, person-to-person, dialogue as well.

Language alone isn't a solution, but a catalyst. When we shift from labeling to describing, we change the clinical framing. We invite collaboration, reduce shame, and begin to dismantle one of the most pervasive drivers of inequity in obesity and diabetes care. As clinicians, choosing words that respect personhood is a simple, evidence-informed act we can take every day to improve health, trust, and the therapeutic relationship.

Take Action, Get Involved, Access Resources

Meaningful change in obesity care requires collective action. The Obesity Action Coalition (OAC) is a national leader in challenging weight bias, advancing access to evidence-based treatment, and elevating the voices of individuals living with obesity. Through initiatives like Obesity Care Week, OAC equips clinicians with practical tools to reduce stigma, improve documentation practices, advocate for policy change, and deliver person-centered care.

When asked what meaningful action employers, healthcare leaders, and policymakers could take during Obesity Care Week, James Zervios, OAC Vice President and Chief Operating Officer, states "I would want all of these parties to understand that obesity is a chronic disease deserving of treatment, and that individuals affected by obesity deserve to be treated with dignity and respect".

I encourage healthcare professionals to explore OAC's education and support resources, share materials within their teams, participate in Obesity Care Week, and formally take the Commit to Care Pledge. Advancing equitable obesity and diabetes care begins with individual accountability and grows through collective advocacy.