Why “Morbid Obesity” Still Hurts — and Why the Language Matters

[TheBigBlue]

There's solid research showing a strong association between childhood trauma and adult obesity. Trauma affects the stress-response system, emotional regulation, and health behaviors across the lifespan. So for many of us with CPTSD, weight is not a simple "willpower issue" but a long-term biopsychosocial consequence of early adversity.

And then there is the term "morbid obesity."

"Morbid" literally means deadly. It's still used by many clinicians for the most severe form of obesity (BMI ≥ 40), even though the WHO's ICD-11 now uses the more neutral Obesity Class III. The CDC also explicitly advises health professionals: "By using clinically accurate terms such as 'Class 3 Obesity' instead of 'morbid obesity due to excess calories,' providers can create a more supportive environment for patients with obesity" and "... can help reduce weight bias and stigma ..." (https://www.cdc.gov/obesity/media/pdfs/2024/12/adult-partner-promotion-materials-icd-10-codes-508.pdf).

But in practice, this hasn't filtered into everyday care. Many of us still read on their charts or walk into appointments and hear:
"You are morbidly obese."
"Morbid obesity is your main problem."

Calling someone "morbidly obese" is like diagnosing a patient with "deadly cancer" instead of "stage 4 cancer". Morbid is not a neutral descriptor - it hits with the full weight of stigma.

For trauma survivors, the impact is amplified:
- CPTSD already comes with shame, body distrust, and a long history of being blamed or judged.
- Early relational trauma and neglect shape the nervous system and often the body.
- Then the medical system mirrors the childhood message: You are the problem.

"Obesity Class III" still communicates medical risk. But it just doesn't define the person as morbid.

Language won't fix trauma, but it can stop adding new wounds.
The coding system has already changed. The science has already moved.
It's time for clinical language to follow.

[sanmagic7]

it is, indeed!

[Kizzie]

Spot on TheBigBlue!   

When my son was in medical school (just graduated in May), he had a class where the doctor speaking was using some derogatory/flippant language about patients who are obese such as "a heart attack waiting to happen" and so on. I'm delighted to say that he and his fellow students texted each other about how this kind of "fat-shaming" was simply not on in a course. They then went to their Dean to complain and happily they were well received and action was taken to remind faculty that this kind of shaming language was not permitted. So, progress is on the horizon!

I personally would like to see complex relational trauma survivors referred to not as disordered, but as injured. This puts the onus, not on us but on our perpetrators and normalizes our symptoms as responses to abuse/neglect rather than some kind of character defect.

[TheBigBlue]

Thank you, Kizzie, your comment really meant a lot. It's encouraging to hear about your son and his classmates pushing back against that kind of shaming in medical training. That's exactly the shift we need. 
And I fully agree with calling us injured rather than disordered - it captures the reality so much more truthfully. Appreciate your perspective.

[Kizzie]

 

[Blueberry]

Thank you for bringing this up, TheBigBlue. Language does matter! Shaming us doesn't help, except to maybe help those who shame us. They can feel all healthy, and smug.

Kizzie, I appreciate the response of your son and his fellow students!

[TheBigBlue]

 

[Dalloway]

your post TheBigBlue

[alliematt]

I know the feeling. I have that label and it feels so personal.

[Kizzie]

I asked AI to search "obesity and Complex PTSD" and here's what it came up with:

Complex PTSD and obesity are linked through shared physiological and psychological pathways, such as chronic stress, inflammation, and hormonal dysregulation, which can lead to weight gain, metabolic dysfunction, and increased cravings for high-calorie foods. The trauma response can alter appetite-regulating hormones like cortisol, leptin, and ghrelin, while also leading to coping mechanisms like "food addiction" or binge-eating to manage emotional distress. Addressing both psychological and physical health is crucial for treating these interconnected issues.

What is interesting is that when I went to Google Scholar, lots of research about PTSD and obesity - very little about Complex PTSD that I saw after doing a quick search. A lot of what the PTSD articles talk about is food addiction as a way of self-soothing which in our case leaves out the bodily responses we have due to protracted exposure to traumatic stress. The good thing about searching with AI on is that it looks at a vast amount of research data so it is there, but it's not as easily found. 

I'm going to dig a bit more because it's something that those of us dealing with obesity need healthcare providers to understand.  That is, it's an issue with both medical and mental health components, which to my mind makes dealing with it just that much more difficult.