by Barbara Berkeley, MD
A few days ago, I wrote about the excessively blunt language and targeting of obese kids in an anti-fat campaign in Georgia. On the other end of the spectrum, doctors are being cautioned about using straightforward words like "obesity" when counseling patients about weight loss.
A survey from the University of Pennsylvania asked overweight people to rate words that described their condition and to assign them negative, neutral or positive values. Words like "obese" and "fat" were given low marks, while words like "weight" were considered acceptable. Based on these responses, doctors in Canada are being cautioned about turning off patients with words that offend them. But in reality, it's not the words themselves that are the problem. It's the sentences that surround the words and their perceived subtext. Changing individual words is silly in my opinion. Often attempts at political correctness lead us even further astray from our objective, as our beliefs remain the same while the words that describe those belefs simple become euphemisms.
Some time ago, I wrote about the lack of effective words in English to describe exercise. Prior to becoming a doc, I was an aspiring writer and English major (gee, can you tell?) and someone who respected the power of words to create reality. Here's an example: if we had lots of better words for types of exercise, these descriptive words might entice many more people to try it. The single word that we DO have--exercise-- is so devoid of depth and so connected to negative perceptions that it limits our ability to motivate.
Similarly, we have very few words to describe the state of having too much fat. Here are the main choices: "overweight", "fat", "heavy" and "obese". If we start eliminating these, we get into some pretty labor-intensive options: "scale-istically challenged"?, ""metabolically weight-accumulative"?, "lipidophilic"? Or we might move even further into safe territory by developing acronyms like "PAL" (prone to accumulating lipids) or "FAD" (fat accumulation disorder). Feel free to make some up, perhaps one of yours will enter the lexicon.
As many as 78% of physicians currrently give no counsel to overweight patients about losing weight. In some odd jump of logic, the U of P survey leads some to conclude that asking doctors to limit their ability to level with patients will make it easier for them to provide this guidance. I would submit that the reason that doctors don't counsel patients is exactly because they don't want to risk riling them up or offending them. Will politically correct language solve this problem?
I have a novel idea. Suppose we learn how to sympathize with obese patients and speak to them in a way that shows that we not only support them, but understand them and aim to help? Here's the approach that I take:
"Mrs. Jones, according to our BMI charts you are considered medically obese. That's a term that doctor's use and it just means that you are more than about 30 pounds overweight. So I want to tell you a couple of things. First of all, if you're strugging with weight loss, I don't think that's your fault. What I believe is that most people haven't gotten good guidance about how to lose weight and keep it off. What you think you may know about eating healthy may actually not be correct for you, so I hope you will listen to what I propose and consider it. Second, It's very, very worthwhile to lose weight. Extra fat is simply not good for you. With every pound you lose, you'll take a strain off your heart and your joints. You'll also correct your diabetes, high blood pressure, reflux and cholesterol to a large degree. You'll be amazed that once you start eating a diet that is harmonious with your body instead of oppositional to it, that you'll also feel much more energetic and less anxious. You'll probably be interested in doing some physical activity for the first time in a very long while. I've done this with lots of people and I'll be here to help you the whole way. But here's the most important part: many people can't make these changes on their first try. Getting closer to eating well can be a life's work. Lots of people who've done it permanently have had missed attempts. So don't blame yourself if it doesn't "take" right away. Just keep tryng. So, here's the plan. If you agree, let's get to work and give this a try."
No fancy words, no acronyms. On the other hand, a doctor might say this:
"Mrs Jones, your BMI shows that you are obese. (subtext: that's your fault). You really need to lose about 50 pounds (subtext: I don't know how to tell you to do it, that's your problem). This is important, you're going to have lots of problems down the road unless you take care of this. (Subtext: I'll be annoyed if you haven't lost anything by the next time you come in)."
It's not about the single words, is it?
