This study expands understanding of how university students use and react to fat-related terms. The study was conducted in three phases: (1) a tool development phase, (2) a survey phase, and (3) an in-depth interview phase. We highlight a few marked trends in attitude towards and use of certain terms and words indicating larger body size, as well as the implications of these trends. Tellingly, some words are considered more negative than others. Perceived negativity significantly impacts how, where, when, and with whom such terms are used. A high degree of awareness that a term is unflattering at best and highly stigmatizing at worst does not appear to result in sensitive use of said term across all social and clinical settings. An important implication of this is that people know fat may be used behind their backs to describe them pejoratively—and regardless of any polite backpedalling in face-to-face confrontations—and this profoundly limits their social health, as well as their potential participation in health-related activities. Thus, in order to truly be effective, university-based health initiatives must not only promote healthy eating and activity behaviors but also must address fat stigma.

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