If you're not a doctor, odds are you probably wouldn't offer guidance on how a person should handle their type 2 diabetes, heart disease or other serious medical condition. But when it comes to weight, many people feel it's OK to give unsolicited advice or make comments.
Unfortunately, obesity is a visible disease, and because we can see it, we feel that we have the right to speak about it without a person's request, says Fatima Cody Stanford, MD, MPH, an obesity medicine physician-scientist.
But even if your remark or suggestion is seemingly well-meaning, it might have a harmful effect on the person's physical or mental health.
Here, Dr. Stanford discusses seven things you should avoid saying to someone struggling with obesity.
1. 'I’m Just Concerned About Your Health'
At first glance, this comment sounds so reasonable — we know that obesity is linked to a greater risk for other diseases — but often it's just anti-fat attitudes masquerading as concern. Think about it: You'd probably never express your worry to a thin person with an unhealthy diet. How they look is what matters.
Plus, when you say this, you're implying that the person isn't concerned about his or her own well-being when, in fact, they may be significantly worried about their health and may have even undergone multiple therapies for obesity, Dr. Stanford says.
"When you're dealing with patients who have obesity, you don't know where they started or where they are currently," Dr. Stanford says. "For example, I have patients who have weighed as much as 550 pounds that are now down to 300, which means they've lost and maintained 250 pounds of weight."
In other words, don't assume anything about a person with obesity (or anyone for that matter), especially if you don't know the whole story.
People with obesity don't need criticism — they need thoughtfulness, caring and empathy, just like every other human.
2. 'Should You Be Eating That?'
Rude, rude, rude. You have no right to comment on (or police) what someone else eats, even if the person is your partner, family member or friend.
"We need to be thoughtful about how judgmental this is," Dr. Stanford says. First, no one judges a lean person if they happen to eat a cookie or some chips. "They may eat horribly all the time, but their bodies don't show or demonstrate obesity, so we assume that they must be eating very healthy overall," Dr. Stanford says.
Which brings us to the second point: When you say "should you be eating that?," you're assuming that's how a person eats all the time when that might not be the case.
"Maybe this is the first time they've had a treat in several months, and they're waiting for a special occasion, which is when you see them," Dr. Stanford says. The last thing someone needs is a value judgment when they're trying to enjoy a small indulgence.
"To be judged by everything that you do feels horrible," Dr. Stanford says. People with obesity don't need criticism — they need thoughtfulness, caring and empathy, just like every other human.
3. 'You’re So Brave/Inspiring'
Calling someone courageous for dealing with obesity might sound like a compliment, but this comment might not be as encouraging as you intend and can stir up a lot of unwanted feelings.
Just like when someone is going through cancer, obesity isn't a chosen path, Dr. Stanford says. "It's just the cards they were dealt, and they're trying to navigate it."
While some people may welcome motivation from friends and family, others might prefer you not highlight their struggle with obesity because it's an issue that causes them a lot of pain, Dr. Stanford says. For some, obesity began in childhood and has been a lifelong battle. For others, the disease developed after they began taking medication for a psychiatric disorder or as a result of multiple miscarriages.
"There are so many potential causes, and we have to be mindful of what may be going on behind the scenes," Dr. Stanford says.
4. 'If You Just Set Your Mind to It, You Could Lose Weight'
Just to be clear: Losing weight when you have obesity is not a simple mind-over-matter situation.
This frustrating fallacy is one of Dr. Stanford's top pet peeves. "This makes me very angry actually," she says. "I get to see the struggles of my patients every day — people who require every single form of evidence-based treatment that we have here in the U.S. and still struggle with their obesity."
Many people with obesity are putting in a lot of effort, so to make assumptions that they're not trying hard enough or doing everything they can is extremely inconsiderate, uninformed and hurtful, Dr. Stanford says.
Time and time again, "people with obesity have been told that they are a failure, and I don't want them to judge their value or their worth based on their weight," Dr. Stanford says.
"Judging people negatively because they’ve chosen to use evidence-based medical tools like surgery or medication is a major travesty and a fallacy that we really need to undo."
5. 'Have You Tried Exercising?'
"Again, the implication is just because you have obesity that you're not doing the work," Dr. Stanford says. When, in fact, a lot of people with obesity are more active than lean people because they have been dedicating themselves to a healthier lifestyle, she says.
What's more, inferring that exercise is the solution to weight loss is erroneous. While exercise boasts a boatload of benefits — it boosts cardiovascular and mental health while helping to decrease the risk of dementia and certain types of cancers — it doesn't drive sustainable weight loss for many people and shouldn't be relied on as a sole strategy for shedding pounds, Dr. Stanford says.
6. 'You Have Such a Pretty Face'
This is the quintessential backward compliment. "It implies that the rest of you looks horrible," Dr. Stanford says.
And it feeds into the thin ideal, that being lean is attractive while having excess body weight means you're less desirable. "This is not the message we want to be selling to people," says Dr. Stanford, who calls this weight bias really shortsighted.
For the record, beauty is not a function of body size. We need to shift our values away from physical appearance and instead focus on the things that make us happy and healthy on the inside, Dr. Stanford says.
7. 'It's Great That You're Losing Weight Naturally'
Giving someone kudos for losing weight "naturally" — i.e., without assistance from medications or surgery — is just another value judgment wrapped in the guise of a compliment.
"I really get frustrated when people judge others for what forms of therapies they've used to treat their obesity," Dr. Stanford says. "Judging people negatively because they've chosen to use evidence-based medical tools like surgery or medication is a major travesty and a fallacy that we really need to undo."
In fact, these FDA-approved obesity treatments often go vastly underutilized (only 1 and 2 percent of patients who meet the criteria for surgery and medicines, respectively, ultimately undergo treatment) partly because of the associated stigma, Dr. Stanford says.
"That's a failure on the part of us as health care providers, but also on the part of the general public for not accepting that these therapies work," she says.
Whereas people wholeheartedly support medical interventions for other serious illnesses like diabetes, cancer, heart disease and COVID, they see the use of obesity-related medicine as a character flaw. We need to ditch this double standard.
As a general rule, the topic of someone else's body should be out of bounds. The subject of weight is not to be discussed, commented on or criticized.
"We are very casual about these things [i.e., talking about another person's size or physical appearance] since this is how we've been indoctrinated, unfortunately, and it has to stop," Dr. Stanford says.
We must be more cautious and caring with our comments, especially because weight gain (or loss) could be the result of something serious or traumatic a person is experiencing, such as the death of a loved one, depression or divorce, to name a few. "There are so many other things that can be going on, and our comments can be fuel to the fire," Dr. Stanford says.
And when it comes to chitchat about someone's health, zip it up. If you're not an obesity medicine doctor, you can't possibly understand the nuances of the condition. "The heterogeneity of the disease is so complex that even within the same gene pool we see such differences" in terms of response to treatment, Dr. Stanford says.
In fact, even well-intentioned physicians can make unhelpful comments or incorrectly assume something about their patients' situation, Dr. Stanford says. "It's unfortunate that we're causing these really negative things to be perpetuated from the medical community," she says.
Again, this has a lot to do with our weight bias, the second most common form of bias in the U.S. after racial bias, Dr. Stanford says. "You can imagine how the obesity stigma is compounded for those from racial and ethnic minority communities," she says.
All this is to say, check your bias — judging a book by its cover is unfortunate and unfair — and refrain from commenting on someone else's body, appearance or health status.