Responses to the Word Obese: Definitions, Associations, and Assumptions Made by Adolescents and Emerging Adults

The use of the word obese is common in health care settings and within public health campaigns. Understanding responses of youth to weight-related terms such as obese can provide important context to the potential implications associated with using this term. We conducted an open-ended survey of 1,266 adolescents and emerging adults (ages 14-24) participating in the MyVoice text message cohort. Participants provided responses via text message to the question "What do you think of when you hear the word 'obese'?" Open-ended text message responses were coded using a mixed-methods approach. The mean (SD) age of participants was 18.7 (3.0) years, and 56.0% identified as female, 37.6% as male, and 6.3% as other. Most participants (69.5%) identified as White, and 8.8% identified as Black; 10.5% as Asian; and 11.3% as a race other than White, Black, or Asian; 12.3% identified as Hispanic. Responses provided by MyVoice participants included definitions, associations, and assumptions, suggesting a range of conceptual understanding of the question posed. Many adolescents defined obese by numerical thresholds (42.9%) and size descriptors (28.6%). Some made associations of disease states (31.4%) and weight-based stereotypes (6.3%). Last, youth made assumptions about the causes of obesity and were far more likely to cite causes related to personal responsibility (9.2%) than noncontrollable environmental or genetic factors (1.2%). Adolescents and emerging adults have varied definitions, associations, and causal assumptions regarding the word obese, many of which reinforce negative weight-based stereotypes and could contribute to the stigmatization of people of higher body weights.