Words are important, not only because they inform, but also because they can hurt and exclude people or push them away, or they can be used to reach out and draw people to us. The way words are used by the general public, health care professionals, and groups organized to seek level field behavior toward fat people has an impact on attitudes and practices and is therefore worth exploring.

In mid-1972, I had surgery for the repair of a torn cartilage. The hospital record of that surgery provided an interesting example of the same situation being described quite differently by two professionals.

My primary physician, an internist and endocrinologist, wrote a pre-operative summary based on a recent physical exam he had conducted. He described me as "massively obese." The surgeon in writing his post-operative notes described me as "moderately overweight." Both doctors were looking at the same 298-pound person.

In the excellent 1981 book "Dieter's Dilemma," William Bennett and Joel Gurin wrote about some of the confusion caused by the imprecise way words are used. For example, "overweight" (as compared to what standard?), "heavy" (does it refer to fat, or muscle or fluid?), and such terms as "chubby, chunky, husky, plump, zaftig, stout, portly, fleshy" which could be insults or honest attempts at description depending on the intent of the user.

They suggest that "obesity" sounds like a medical condition. And they are probably right, given their view that we use the term "obese" when we want to say someone is so fat that his or her health is threatened.

They opted to use words they thought more explicit: fat, fatness, overweight, and obese, and defined what they meant as they used them. They particularly endorse the word "fat" as having the virtue of simplicity and reasonable accuracy. To support their choice they note, "to use a word other than 'fat' then, would be as inappropriate and unwieldy as calling a lean person 'small framed' or describing shortness as 'underheight.'

They also cite the word's use by such "fat pride" groups as the "Fat Underground" and the "National Association to Aid Fat Americans."

In Living Large, I deliberately set out to establish the words "fat" and "unfat" to distinguish between two populations. "Fat" refers to me and people like me. The term "unfat" doesn't appear in any dictionary but it seems a legitimate way to refer to anyone who is not fat, whether that person is thin, averatge in weight or even slightly overweight. The term "nonfat" has been usurped by the food industry, and refers to a degree of leanness that humans cannot achieve.

A whole variety of terms have been used over the years to describe those of us who are large enough to be noticed for that attribute. In the last half of the 19th century a variety of terms came into use. Around 1850 the terms used included "dumpy, pudgy and tubby" followed by "porky (1860s), sod-packer" and "jumbo (1880s),...or butterball (1890s)."

Now as the language of political correctness sweeps the country even the discussion of obesity has developed an implicit "In" - "Out" list. Here is a list as I interpreted it from an interesting article in the Jan/Feb 1998 Healthy Weight Journal by Miriam Berg, President of the Council on Size & Weight Discrimination.

The following words are "out" - overweight, fat, larger than normal (what is normal?),obese (unless in medical journals or research articles), and morbidly obese.

The "In" words are: larger than average, chubby (only for babies), stocky/portly/big boned (if apt descriptions), heavy set, full-figured, Reubenesque, ample, a person of size, heavy, large, large-size, super-size, plus-size, mid-size, and seriously or severely obese (for medical references).

The same word applied to a woman may carry a different meaning when applied to a man. An example Berg uses is that calling someone a "big" man can have a positive connotation and is less stigmatizing than calling someone a "big" woman.

The use of a particular word may be appropriate and innocuous in one context and hurtful in another.

Berg notes " I call myself 'large' or large-sized' when speaking with someone I know but as I start to discuss the issues of discrimination, I will insert the term 'fat' into my language."

She does seem to look forward to the day when some good descriptors like "fat" can be reclaimed from the land of the pejorative.

In the end it is not the words but how they are used.

I appreciate as much as anyone the hurt that comes when a person is referred to with derision because they are fat. I doubt that my hurt would have been less had someone referred to me as that " person of size" or "supersized." Whether they shouted out "Hey fatso" or "Hey supersize", the speaker's feeling toward me and my size would have been equally clear.

Derision of fat people has grown sufficiently so that there is a term that describes this behavior - sizeism. So, be careful of what you say - you may be branded as a "sizeist."

There are a couple of other words and phrases that deserve to be clarified.

The first of these is the term "diet." This term has come to mean deprivation or some significant reduction in the amount eaten. How many times have you heard someone say "I'm going on a diet, right after this weekend?" If you define "diet" that way then it can not possibly represent something that most people can do for the rest of their lives.

There is a pretty good regimen that is called "The non-diet, diet."

The dictionary definition of "diet" generally ties the term to the food and drink that a person consumes and its effects on health. "Diet" in the greek "diaita" means "way of life." That suggests that a person could follow one diet for purposes of losing weight and then a different diet to maintain their new weight. One could, in fact, engage in a particular diet to gain weight.

I prefer the Greek definition. It is the eating pattern that a person follows whether its purpose is to lose, gain or maintain weight.

Another phrase that warrants attention is "morbid obesity." I found the following as a diagnosis in one of my medical records "exogenous obesity, morbid." I decided to find out what this phrase meant. Rather than looking for medical definitions I decided to start with "Webster's."

exogenous - externally caused (overeating for example)

obesity - very fat or overweight

morbid - characteristic of disease

disease - a disordered or incorrectly functioning system of the body resulting from the effect of genetic or developmental errors, nutritional deficiency or imbalance

fat - having too much flabby tissue

Thus another way to say "exogenous obesity, morbid" might be "very fat as a result of over-eating to an extent that certain body systems are not functioning correctly."

Actually, that was a pretty apt description of my condition at 298 pounds. But I was still not satisfied that I had found the meaning of morbid obesity. I e-mailed my favorite medical obesity specialist, my then personal physician and asked him about the term. Here is what he sent back.

"Morbid obesity is not universally defined or characterized. The term probably comes from health insurance policies that were limited to providing certain kinds of treatment coverage only to those patients with morbid obesity. In those situations it is usually defined as 100 pounds above desirable weight (whatever that is) or more than twice normal weight (whatever that is). The terminology is also sometimes tied to the body mass index."

What is the bottom line? I propose the terms "fat" and "unfat" to distinguish populations, "diet" to refer to a way of life, and "obese" or "morbidly obese" for use only by health professionals. I suggest that people who are not "sizeists" use caution about their choice of words, and to recognize that in general preferred words are those that reflect attitudes of acceptance not rejection.