Obesity is associated with early mortality and is a significant public health risk. It substantially contributes to the global burden of non-communicable diseases such as type 2 diabetes, cardiovascular disease, hypertension, and certain malignancies. Further, mechanical complications resulting from significantly elevated weight, such as osteoarthritis and sleep apnea, adversely affect individuals’ quality of life. Finally, obesity’s influence on communicable diseases, particularly viral infections [1, 2, 3], has recently been underscored by findings indicating that obese patients have a heightened risk of hospitalization and severe illness from COVID-19 [4].

Weight stigma, a key social predictor of health, hinders health equity and the achievement of sustainable development goals by affecting biopsychosocial health outcomes. Weight stigma is discriminatory and a human rights concern [5]. As such, understanding how weight stigma hinders global health promotion is crucial. A World Obesity Federation (WOF) coalition of experts and activists reviewed weight stigma studies on obesity prevention and management techniques worldwide. The goal was to develop a statement with proposals to eliminate weight stigma globally and enhance research representativeness across regions [5, 6, 7].

Most weight stigma research has been conducted in high-income countries. Still, a scoping analysis of non-Western countries identified 130 publications on weight stigma from 33 nations and territories, highlighting its global prevalence [5]. A narrative study of attractiveness ideals across cultures revealed that thinness is becoming a prevalent beauty standard in non-Western nations [8]. Although several cultures have historically seen increased body weights as symbols of rank, affluence, and allure, particularly in low- and middle-income countries (LMICs), a growing global inclination towards thinness is emerging, especially among those in upper socioeconomic strata. Consequently, among LMICs, cultural narratives concerning health, affluence, and physical appeal may significantly differ, exacerbating weight stigma throughout the entire body weight continuum [5, 9, 10].

Numerous articles on nutrition, weight, and obesity have employed broad generalizations regarding weight and health, undermining efforts to comprehend the intricacies of weight and obesity within the framework of health. As scientific research is frequently viewed as a repository of accurate knowledge and best practices, scientific writing must adhere to the greatest standards of precision. Furthermore, one must acknowledge that the terminology frequently employed in medical contexts (e.g., obesity, morbid obesity, aberrant fat, and excess fat) is often perceived as stigmatizing [5, 7, 11, 12, 13]. A recent systematic literature evaluation revealed a lack of consensus regarding the weight nomenclature across 33 studies [14]. The terminology and images employed to discuss weight and obesity significantly influence societal norms and narratives throughout research, education, policy, healthcare, and the media [15]. According to our earlier study, parents, children, and healthcare professionals underestimate children’s overweight status. Meanwhile, caregivers and children commonly underestimate their weight. Age, gender, body mass index, parental weight, ethnicity, and education contribute to this misunderstanding. Enhanced communication among healthcare providers, caregivers, and patients is essential to addressing this issue and managing childhood obesity [16].

The WOF Working Group’s eight recommendations for reducing weight stigma globally focus on respectful language use, weight-neutral health promotion, legislative and human rights initiatives, and raising awareness. The key aspects include distinguishing body size from obesity, using person-first and non-stigmatizing language and imagery, respecting individual preferences, and expanding evidence on weight stigma to foster inclusivity across cultures [5, 11, 12, 13]. Non-stigmatized language pertains to the neutral, respectful, and person-first language which avoids perpetuating stereotypes or any form of bias [13, 17, 18, 19]. As it relates to the competent management of weight and obesity, it means approaching conversations in a manner that fosters dignity, inclusion, and understanding, rather than engendering shame or blame. For instance, “a person with obesity” instead of “an obese person”, or “weight management challenges” instead of “weight problems”. Such strategies are meant to reduce stigma regarding weight, enhance relationships and communication between patients and providers, and motivate more positive interactions within healthcare [20].

Bibliometric analysis, a subset of scientometrics, employs mathematical and statistical methods to explore scientific trends and knowledge domains [21, 22, 23]. This approach has been widely applied in obesity research [24, 25]. However, a significant gap remains in examining weight stigma and the role of language in obesity management. Despite increasing awareness of the harmful effects of stigmatizing language in healthcare, no study, to the best of our knowledge, has comprehensively analyzed how research on non-stigmatizing language has evolved over time, or how it influences clinical and public health communication. This study systematically analyzes trends in research on non-stigmatizing language in obesity and weight management (RnSLO) by identifying key scholars, leading nations, collaboration networks, and evolving keyword dynamics. Specifically, we explore how RnSLO research has evolved, the most influential contributors in the field, primary research themes, knowledge gaps, and emerging trends, and how this research informs healthcare communication strategies and policy development. Understanding these trends is critical, as stigmatizing language in obesity-related communication has been linked to reduced healthcare engagement, psychological distress, and poorer treatment outcomes. By mapping this research landscape, we provide evidence-based insights for clinicians, policymakers, and researchers to promote inclusive and effective health communication strategies. Further, the findings may help improve patient-provider interactions, reduce weight bias in clinical settings, and shape future policies that foster more equitable obesity care and public health messaging.

In research, education, legislation, healthcare, and media, the language and imagery used to discuss weight and obesity significantly affect societal norms and narratives. This study utilized bibliometric analysis to scrutinize RnSLO research based on data-driven studies. Original articles should preferably be used in bibliometric analysis because of their primary data sources, reliability, citation impact, in-depth analysis, knowledge generation, peer-reviewed nature, granularity of data, and ability to reflect current research trends. Together, these contribute to a more robust and informative bibliometric assessment [30, 31, 32].

Recent shifts in social attitudes, policies, and health communication technology [33, 34] have accelerated RnSLO research output growth. This growth aligns with the rising awareness of weight-related stigma, the number of health policies incorporating social inclusion, and digital health advancement. The citation impact also fluctuated. This indicates a shift in focus within the field, which is important for understanding the movement towards more comprehensive and patient-centered healthcare services, and reducing weight bias.

Meanwhile, we note concerns about the field’s depth and uniformity. For instance, RnSLO has received little study interest, with only 480 publications published. Variations in documents, citation counts, and focus in a few years indicate inconsistent research and lack of consistency. Furthermore, different growth rates in publication output across countries over decades may indicate inconsistencies, possibly reflecting financing and collaboration. Additionally, the differences in the average number of citations per manuscript suggest various degrees of attention to RnSLO research, making one even more suspicious of the sector’s recognition. To make RnSLO research more relevant and positive, regular practices, improved teamwork, and increased exposure can overcome these challenges. Obesity and weight stigma research [24, 25, 35, 36] supporting these findings is more extensive than investigations into communicative strategies to address this issue. Initiating corresponding research initiatives and urging healthcare practitioners to adopt non-stigmatizing language may expedite the transition to more affirmative and health-enhancing narratives around health and weight [5, 35, 37].

RnSLO research still predominantly comes from the United States, which has the largest share of publications due to powerful academic institutions, established policies, and substantial funding. Harvard Medical School and Johns Hopkins University are some renowned institutions which have led the field. Meanwhile, contributions from Asia and South America are lower, perhaps due to the differences in health policies, cultural attitudes toward weight, and research funding availability. Many non-Western cultures tend to perpetuate weight stigma, with relatively limited concern about using weight as a criterion for inclusion in healthcare [38, 39]. Moreover, the research budget in wealthy countries that support the study of weight stigma as a primary focus is disproportionate to that in poorer countries, where other more pressing public health issues take precedence [5]. Thus, RnSLO research is highly concentrated in one area, highlighting the need for more comprehensive multicultural studies on weight stigma.

Data visualization and bibliometric mapping are essential instruments for identifying and examining existing and prospective joint research [30, 31, 32]. This article has effectively produced several valuable visualizations depicting existing and prospective RnSLO cooperation. The United States is the most active country collaborating in research dedicated to communication and non-stigmatizing language as it relates to obesity, Numerous studies have been conducted in collaboration with researchers from various institutions in the United States, which has positively influencing the field’s development [40, 41, 42]. Our results are consistent with previous findings on the dominance of the United States in scientific collaboration in various research fields [21, 32, 43] and obesity [24, 25, 35].

Puhl R. M., a prominent scholar at the Rudd Center for Food Policy & Obesity at Yale University in New Haven, Connecticut, emerges as one of the most prolific researchers in RnSLO. Her impactful studies have delved into various critical aspects of weight-related interactions in healthcare and familial settings. From exploring physicians’ stigmatizing attitudes towards individuals with type 2 diabetes to investigating parental communication patterns about body weight and health among adolescents, Puhl’s research reveals the complex dynamics surrounding weight bias, communication practices, and their implications for patient care and adolescent well-being. Further, through studies examining topics such as weight bias internalization among adolescents seeking weight loss and adolescent reactions to parental discussions about weight, Puhl’s work underscores the importance of understanding and improving communication strategies regarding body weight across different age groups and healthcare professions [11, 12, 13, 37, 44, 45, 46, 47, 48]. Puhl also explores preferred language and communication styles when discussing obesity with clients, highlighting the significance of sensitive and effective communication in promoting positive health outcomes and reducing weight stigma in diverse healthcare settings.

Author co-citation analysis is used for mapping knowledge domains and illustrating scientific conceptual frameworks [49]. Lyna P., a highly co-cited researcher from Duke University in the United States, has significantly contributed to the field by focusing on physician-adolescent patient communication in community-based practices. She has examined recruitment challenges and solutions in this context, developing web-based interventions to enhance physician communication with adolescents about healthy weight (Teen CHAT), and the impact of physician communication styles on overweight patients’ perceptions of their encounters. Additionally, Lyna and colleagues have explored physician communication techniques for weight loss in adults (Project CHAT), predictors of weight loss communication in primary care visits, factors influencing weight-related communication with overweight adolescents during primary care encounters, and the effectiveness of teaching motivational interviewing through communication coaching on clinicians’ and patient satisfaction in primary care and pediatric obesity-focused offices [50, 51, 52, 53, 54, 55, 56]. Overall, her work underscores effective communication strategies’ importance in addressing weight-related issues in healthcare settings, particularly focusing on adolescents and weight management.

Childhood obesity, defined as excess body fat, is among the hot topics in RnSLO (Table 3). The consequences include diabetes, heart disease, and mental health problems. Causative factors include the consumption of unhealthy food, physical inactivity, genetic predisposition, and environmental factors. Corresponding measures to tackle it include an appropriate diet, regular physical exercise, and improvements in social conditions. Such approaches include education, involvement of family members, policy-oriented solutions, and community-based approaches. In the fight against childhood obesity, family units, schools, healthcare specialists, authorities, and society must collaborate to establish conditions conducive to children’s well-being [57, 58, 59, 60]. On RnSLO, several studies have measured the influence of communication tone and the use of non-stigmatizing language on child obesity. Bednarek et al. [17] suggested criteria for evaluating attitudes toward weight stigma using a language perspective. Carcone et al. [61] measured the effect of provider communication behaviors on black obese adolescents’ motivation to change. Falbe et al. [62] developed and examined the communication strategies employed by Promotoras in an obesity intervention in Latino families. Flegal and Ogden [18] addressed the problem of consistency in the language used when discussing childhood obesity. Related research has also concentrated on childhood obesity discourse on social media such as Twitter, the family-centric approach towards childhood obesity treatment, and the medical home for obese children [63, 64]. KavehFarsani et al. [65] studied the impact of family communication and body image satisfaction on obese girls’ health. Another study examined the role of threatening communications and health beliefs on changes in body weight among obese children [66]. Kushner et al. [67] created an intervention for rectifying weight bias and communication among medical trainees. Stanford and Kyle [68] underscored the importance of language and care in dealing with childhood obesity. Yu [69] focused on analyzing how different ways of speaking to children affect their perceptions of weight issues and food marketing. Clearly, effective communication and non-stigmatizing language are critical for managing child obesity, as it promotes self-motivation for change, enhances intervention measures, and the overall well-being of children and adolescents.

Healthcare practitioners and patients are the focus of patient-provider communication. Most related research has centered on face-to-face clinical encounters. However, recent scholarship has extended to include secure messaging between physicians and patients. Medicine, medical education, anthropology, sociology, sociolinguistics, and communication studies examine patient-provider communication, given its importance in understanding communication. Patient-provider communication research in various healthcare settings addresses several themes, including successful communication tactics and impediments. Themes include difficulties in interacting about pregnant women’s body weight, weight gain communication with first-time pregnant women and obstetricians, communication satisfaction between Spanish- and English-speaking parents in primary care, the effect of providers’ communication on patients’ perceptions and behavior toward a health center’s farmers market, weight counseling between primary care providers, and a paradigm shift. Overall, these studies illuminate the complexities, intricacies, and importance of patient-provider communication [33, 70, 71, 72, 73, 74, 75, 76, 77].

We used overlay visualization to show trending topics (highlighted in yellow frames). An emerging research area is obesity prevention. Various studies have explored communication’s role in the prevention [19, 34, 57, 58, 60, 78, 79, 80]. These include research on human-centered designed communication tools for early life obesity prevention; communication’s importance in multilevel interventions; comparisons of obesity prevention content in mainstream and Spanish-language media; formative research for obesity prevention strategies during pandemics; challenges and solutions in obesity prevention partnerships; tailored communication resources for diverse populations; tools for engaging policymakers in childhood obesity prevention initiatives; and feasibility studies on tailored communication for obesity prevention in pediatric primary care. These studies collectively emphasize the critical role of communication strategies in addressing obesity while considering diverse populations and unique challenges [19, 34, 57, 58, 60, 78, 79, 80].

First, this study is based on Scopus alone. While Scopus is a huge and reputable database, its lack of coverage in other databases may limit the breadth of analysis. Second, the study has non-English language publications. Although this approach supports an international scope, it excludes important evidence from non-English-speaking countries. Third, this bibliometric study is descriptive and based on quantitative indicators, such as publication and citation activity, while consistently testing the study’s research rigor or profundity is wanted. Lastly, although Bibliometrix and VOSviewer are excellent in analyzing information, a serious concern is “over-labeling”, which can result in a complete misunderstanding of the results. This adds to thematic mapping issues. Nonetheless, these trends serve useful points in understanding RnSLO research development.

RnSLO research has significantly expanded, becoming increasingly relevant in obesity management and health communication. This study reveals the field’s interdisciplinary nature, and increasing emphasis on preventive healthcare and effective communication strategies. Greater geographical and disciplinary diversity, and integrating AI and data analytics are needed to enhance research insights. Future efforts should prioritize multidisciplinary collaboration, fostering innovative approaches to improve non-stigmatizing language and its impact on healthcare outcomes.

$\bullet$ This bibliometric study analyzes 480 publications on non-stigmatizing language in obesity management (RnSLO) from 1953 to 2024, identifying key research trends, leading institutions, major contributors, and thematic developments that shape the field’s evolution and influence.

$\bullet$ North America, particularly the United States and Canada, dominates RnSLO research, with significant contributions from institutions such as Harvard Medical School and Johns Hopkins University, while Europe, Asia, and Oceania also contribute to the growing body of literature.

$\bullet$ Key research themes include obesity, language, patient-provider communication, health communication, and diabetes management, with a growing emphasis on preventive healthcare and non-stigmatizing communication strategies to improve public health and patient outcomes.

$\bullet$ The study highlights the integration of digital health technologies, including artificial intelligence, machine learning, and natural language processing, as emerging research trends that enhance obesity management and facilitate more effective, personalized health communication.

$\bullet$ Despite significant advancements, RnSLO research faces challenges, including regional disparities, limited interdisciplinary collaboration, and methodological constraints in bibliometric analysis, emphasizing the need for broader global participation and multidisciplinary approaches.

$\bullet$ Future research should expand geographical representation, leverage AI-driven data analysis, and encourage policy-driven interventions to enhance the understanding and application of non-stigmatizing language in obesity care and public health communication.

The datasets are available upon reasonable request.

AFA participated in the conception, study design, execution, data acquisition, analysis, and interpretation, drafted, revised, and critically reviewed the article, gave final approval of the version to be published, agreed on the journal to which the article was submitted, and agreed to be accountable for all aspects of the work.

Not applicable.

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This research received no external funding.

The author declares no conflict of interest.