Ask Tufts Experts: Why We Say “People with Obesity”; Cholesterol and Genes

“People with obesity” sounds odd to me. Why don’t you just say, “obese people?”

Jillian Reece, RD, a dietitian with the Tufts Medical Center Weight and Wellness Center, answers: “Many people are not aware that obesity is a complex disease with multiple causes including genetic, biological, and other noncontrollable factors. In June 2013, the American Medical Association House of Delegates voted to recognize obesity as a disease state. We therefore need to talk and write about obesity as we would any other disease. What is known as ‘people-first language’ recognizes that a person is more than a diagnosis. We therefore say, ‘the person with diabetes’ rather than ‘the diabetic’ and ‘a person with obesity’ instead of ‘an obese person.’ This language is less stigmatizing and helps us to focus on addressing the condition rather than blaming the person.

“Weight bias can have a harmful effect on an individual’s mental and physical health. It can impact every aspect of life, including employment opportunities, quality of healthcare services, and social interactions. Having obesity, or any level of excess body fat, increases the risk for a wide range of other diseases, including cardiovascular disease, diabetes, and cancer. Referring to individuals as ‘obese’ has been shown to influence how individuals feel about their condition and how likely they are to seek medical care.”

[Editor’s Note: Tufts Health & Nutrition Letter strives to consistently employ ‘people-first’ language. When writing about research or conditions associated with obesity, we will say people ‘with obesity’ or ‘having obesity.’ When discussing issues impacted by both overweight and obesity, we will say, ‘people with excess body fat.’]

It seems like everybody in my family has high cholesterol. I try to eat well and exercise, but my numbers are still high. Could it be in my genes?

José M. Ordovás, PhD, senior scientist and leader of the Nutrition and Genomics team at the Jean Mayer USDA Human Nutrition Research Center on Aging and a professor of nutrition and genetics, answers: “Your genes play a significant role in determining whether you will have high LDL cholesterol. Early studies with twins revealed that, on average, genetic factors accounted for about 50% of the variability in blood cholesterol levels, the remainder being due to lifestyle factors such as diet.

“Interestingly, the most impactful story about the genetics of cholesterol comes from an observation that did not start in cardiology or internal medicine clinics but rather in the field of dermatology. Some patients had orangish deposits on the skin that, when analyzed, turned out to be made primarily of cholesterol. This initial observation led to the discovery of Familial Hypercholesterolemia (FH), a disease affecting about one in 300 individuals. FH is associated with very high levels of circulating LDL cholesterol and premature cardiovascular disease. The study of this disease helped us understand how cholesterol is metabolized in the body, which provided the basis for the development of statins, one of the most consumed drugs globally, aimed at decreasing LDL cholesterol levels and cardiovascular risk.

“Hundreds of DNA mutations associated with FH and milder forms of hypercholesterolemia (high LDL cholesterol) have already been identified.

In the future, we will be able to determine the genetic risk of high LDL cholesterol in an individual (even before they manifest signs) and provide dietary recommendations and address other environmental factors to help prevent high LDL cholesterol levels, even in the presence of a genetic predisposition.”

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