Choosing words wisely when talking to patients about weight

July 01, 2012

If you are among the two-thirds of the population estimated to be overweight, you must talk to your doctor about it. If you are a physician, you can make it easier by avoiding such words as “fat” and “obese” that make many patients uncomfortable.

That is the advice of two Yale Medical Group clinicians, Robert Bell, MD, and Geralyn Spollett, APRN, who commented on a new study by the Rudd Center for Food Policy & Obesity at Yale. The study found the language that health care providers use when discussing their patients’ body weight can reinforce stigma, reduce motivation for weight loss, and potentially lead to avoidance of future medical appointments,

The study, which appears in the advance online publication of the International Journal of Obesity, examined adults’ perceptions of, and reactions to, common terms used to describe excess body weight by doctors.

The researchers conducted a national survey of American adults, asking their opinions about 10 common terms used to describe excess body weight. The words “weight” and “unhealthy weight” were rated as the most preferable terminology for doctors to use when discussing excess weight, and “morbidly obese,” “fat” and “obese” were rated as the most stigmatizing and blaming. Additionally, 19 percent of adults reported they would avoid future medical appointments, and 21 percent says they would seek a new health care provider if they felt their doctor had stigmatized.

Some medical words have connotations

“It was an eye opener to see the words patients prefer to hear,” says Spollett. “We know that we’re supposed to talk directly and plainly, not use a lot of jargon, and ask questions to make sure the patient understands. But I think sometimes the kind of language that is used in the medical profession can seem offensive. The word “obese” is a medical word, but it has so many bad connotations that I never use that word with my patients.”

Likewise, Dr. Bell says he would not use the term “morbidly obese” with patients, even though it is an insurance classification. “It’s not politically correct, it’s almost redundant, and I don’t care for the term,” he says.

Dr. Bell says sensitivity in talking to patients about weight is an important enough topic that it should be taught in medical school as part of training for future physicians. “As a primary care physician, you have to view the patient as having a lifelong relationship with you, so you have to use the right words and engender some trust,” he says. Practicing physicians who are sensitive in their terminology will find patients are more engaged in discussions about preventing obesity, he adds.

Patients should speak up

Spollett says patients who find language offensive should “remind the provider that this is a sensitive topic for you. It may be a difficult topic and sometimes the words used to describe weight issues sound unkind, but don’t be afraid to speak up. It is your health that counts.”

Rebecca Puhl, director of research at the Yale Rudd Center, and the study’s lead author, says, “Although health providers face significant challenges in efforts to prevent and treat obesity, their efforts must begin with a non-stigmatizing conversation with patients about weight and health.” The authors assert that using weight-based terminology that is comfortable for patients may help facilitate a positive, productive discussion that communicates support and respect for patients in their efforts to become healthier.

In the meantime, Spollett says, if a patient is worried about how their doctor is discussing their weight issue, they should feel comfortable enough to address the problem with the doctor directly. Nothing should get in the way of addressing weight issues, she adds. “Doctors have difficulty bringing it up, patients have trouble hearing it, but it is a discussion that needs to happen.”

Submitted by Mark Santore on December 16, 2013