Fat or too heavy?
The words that doctors use to discuss weight with their patients have an effect on the doctor-patient relationship. A Norwegian study gives clues as to the best and worst words to use.
The developed world is in the middle of an obesity epidemic, one that Norway has not escaped. That raises the question of how doctors should talk to their overweight or obese patients about weight.
And should doctors raise the question of weight if their overweight patients don’t raise the issue themselves?
The question is more than semantic. People with weight problems are often stigmatized. And many medical words that are used to describe weight, such as obese and morbidly obese, don’t sound that nice in everyday conversation.
That means it can be difficult for doctors to talk about this subject without the patient feeling like the conversation is offensive.
So what words should a doctor use?
To answer this question, a group of Norwegian researchers examined how a sample of patients responded to various expressions used to describe obesity.
Weight is best, and fat is worse than obese
The participants in the study ranked the following words from appropriate to highly inappropriate:
- Weight problem
- BMI (body mass index)
- Too heavy
- High BMI
- Too stout
- Excess weight
- Morbid overweight
- Too big
Eighty per cent of respondents believed that the physician's choice of words had a significant effect on the relationship with the patient. But not everyone was equally sensitive to different words. Women and patients who became obese early in life and individuals who were highly educated were the most sensitive.
Almost all those surveyed believed it was right for doctors to take the initiative to talk about weight problems. But only about 30 per cent of participants had had this experience.
This last fact is a little startling, considering that all the patients in the study initially were referred to St. Olavs Hospital in Trondheim to be treated for morbid obesity.
The researchers behind the study say they have no clear answers as to which words doctors should use when discussing weight with overweight and obese patients.
For health professionals, for example, a BMI between 25 and 30 is defined as overweight, whereas someone with a BMI of over 30 is correctly described as obese.
However, many patients perceive the word obese as being negative. But the researchers also ask whether it is right to let the patients' perception of expressions control the kind of language that health care personnel use.
They point to research that suggests that direct, more confrontational phrases are more likely to motivate change.
If a doctor tells the patient that he or she is fat, perhaps the patient will realize the seriousness of the situation, the researchers wrote, while also pointing out that the use of offensive expressions can also be counterproductive.
Small sample size
The researchers asked a total of 157 patients to answer questions about how they would react to various words used to describe weight in a hypothetical situation at the doctor's office, during which they talked to their doctors about obesity for the first time.
In reality, some time would have passed since the patients in the study had had this first conversation, so this may have influenced their answers.
The survey was also done with patients from central Norway. It is possible that patients from other parts of Norway would react differently to more or less direct language.
Last but not least, the authors note, the study was conducted with people who initially were obese, and who at the time of the survey were morbidly obese. The researchers point out that the results cannot necessarily be assumed to apply to people who are overweight.
Read the Norwegian version of this article at forskning.no
- M. Strømmen, I. J. Bakken, E. Andenæs, C. A. Klöckner, R. Mårvik, B. Kulseng, A. Holen: Obese, fat or just overweight? Journal of the Norwegian Medical Association, October 2015. doi: 10.4045 / tidsskr.14.0828.