The Power of Language: Reducing Stigma in Chronic Disease


The Power of Language: Reducing Stigma in Chronic Disease

Ayana HabtemariamContributor: Ayana Habtemariam MSW, RDN, LDN

Language is a powerful social phenomenon that functions as the vehicle by which we shape and understand our world, express ideas, and relate to others. Language and words are the foundation of the paradigms that we use to understand human behavior. In other words, they are the very building blocks of our world view. Because language is so central to our understanding of our world and those in it, it is critical that we stay mindful of our words and how we use them.

As cultures evolve, so do the ideas, values, and beliefs that underscore them. As a result, the meaning and way that words are used changes in conjunction with cultural shifts. Over the past few decades or so, diet culture has emerged as the dominant worldview by which health and wellness are viewed and understood in the western world. Diet culture can be defined as the shared customs, values, and artifacts that shape our current understanding of health in the western world. Specific examples include:
Customs such as labeling foods as clean, dirty, good or bad, ignoring internal cues like hunger, eliminating food groups, or counting points, calories, or macros.
Values such as smaller, thinner, or more shapely bodies are healthier, more beautiful, or morally superior, and larger or less shapely bodies are unhealthy, less beautiful or morally inferior, or diseased.
Artifacts such as fitness trackers, calorie trackers, scale, waist trainers.

This shift in our understanding of health brought with it a change in the language used to describe certain health conditions. Notice the words in the specific examples of diet culture: clean vs. dirty, good vs. bad, smaller, thinner, shapelier being associated with moral superiority. This language can certainly influence how we understand and feel about ourselves.

Over time chronic conditions like type 2 diabetes and high blood pressure came to be accepted as conditions that were preventable or manageable through lifestyle modification. As a result, those whose conditions were more difficult to manage were viewed as irresponsible and deviant. It was assumed that they lacked the willpower to make the necessary lifestyle modifications to prevent or manage their diseases. If they just ate cleaner or decreased their weight, it was assumed that most of their problems would dissipate. The fact is that modifiable risk factors don’t always mitigate the risk of disease because there is a complex interaction of other factors at play. Therefore, using language such as preventable is misleading and inaccurate.

The label non-compliant, likely the most common and overused label imposed on people living with type 2 diabetes, overgeneralizes and diminishes individual genetic, social, and environmental factors that contribute to difficulties with managing blood sugar. Using words such as noncompliance to describe a person struggling to manage diabetes can make a lasting negative impression in the patient’s medical record, which may contribute to implicit health bias among healthcare providers and the internalization of such labels among patients.

Stigma, defined by Merriam-Webster dictionary as a stain or mark of shame, can either be reduced or perpetuated by the words we use to describe ourselves as well as the words that healthcare practitioners use. Reducing stigma is a vitally important task for improving health outcomes. People who experience stigma are less likely to seek medical attention or schedule routine doctor’s visits to avoid shaming by their healthcare provider. Even without blatant blaming or shaming, imposing labels like non-compliant carry a negative connotation and infer blame.

Language Dos and Don’ts:

  1. Don’t label foods as good / bad or clean/dirty. When you do this, it’s easy to fall into the trap of saying that you were either good or bad. This implies that food has moral value. It doesn’t. Eating a particular food won’t make you good or bad. Instead, call foods exactly what they are: more nutrient-dense, energy-rich, tasty, crunchy, pleasurable, etc.
  2. Don’t identify as your condition. Instead of saying you are a diabetic, say that you have diabetes. You are a whole person who lives with diabetes. It is a small part of who you are, not the sum total.
  3. Do name your challenges with managing your diabetes and bring them up with your healthcare provider. Is your job so demanding that you can’t stop to eat during the day? Do you only have access to a certain type of food? Are you under a consistent amount of stress? Let your healthcare provider know. If you feel comfortable enough, ask them to be specific in naming and addressing the challenges instead of imposing a label such as non-compliant.
  4. Do practice self-compassion. Don’t be so hard on yourself. If your blood sugar is running high or if you engage in eating that you’re not happy with, speak to yourself the same way you would with a loved one. Use gentle language.

Ayana Habtemariam MSW, RDN, LDN is a nutrition therapist, certified intuitive eating counselor, and macro social worker. She is the founder of Truly Real Nutrition, LLC, a private nutrition practice where she empowers clients to give up dieting in exchange for trusting their bodies and breaking free from food rules that result in feelings of failure and shame. Ayana is committed to increasing awareness of intuitive eating and weight inclusive philosophies in Black communities. She believes that weight-centric approaches to health and wellness only serve to exacerbate body image issues, stress, and anxiety, which contribute to increased rates of chronic diseases commonly seen in Black and other communities of color.