What Words Should We Use When Discussing Excess Weight?
What Words Should We Use When Discussing Excess Weight?
Background: There is limited research on how patients prefer physicians to communicate about the topic of obesity, and there is even less understanding of which terms physicians most commonly use.
Methods: In this cross-sectional, nonrandom sampling study, patients who were seeking treatment for weight loss rated the desirability of 12 terms to describe excess weight, and physicians rated the likelihood with which they would use those terms during clinical encounters. Participants rated terms on a 5-point scale, with –2 representing "very undesirable" or "definitely would not use" and +2 representing "very desirable" or "definitely would use."
Results: Patients (n = 143; mean age, 46.8 years; mean body mass index, 36.9 kg/m) rated "weight" (mean ± SD) as the most desirable term (1.13 ± 1.10), although it did not significantly differ from 5 other terms provided. They rated "fatness" (–1.30 ± 1.22) as the most undesirable term, although this rating did not differ significantly from 4 other terms. Physicians affiliated with a community-based medical school (n = 108; mean age, 48.8 years; 79.6% primary care specialty) were most likely to use "weight" (1.42 ± 0.89), which was significantly different from ratings for all other terms. They were least likely to use "fatness" (–1.74 ± 0.59), although this rating did not differ significantly from 3 other terms.
Conclusion: Physicians generally reported that they use terminology that patients had rated more favorably, and they tend to avoid terms that patients may find undesirable. Understanding the preferences and terminology used by patients and physicians is an important initial step to ensure that communications related to obesity and weight loss are efficient and effective.
The provision of weight loss counseling by physicians in primary care settings offers a potentially effective approach to combating the problem of overweight and obesity. However, physicians often neglect broaching the topics of obesity and weight loss during primary care encounters. Barriers that may hinder physicians' provision of weight-loss counseling include time constraints, lack of reimbursement, and perceptions that treatment will be ineffective. In addition, physicians may feel ill-equipped to address these issues.
Despite these barriers, overweight and obese patients may desire greater involvement of their primary care physician in weight-loss counseling and treatment efforts. Until recently, however, few studies have examined how patients would prefer their physicians to discuss the topic of obesity. In one study, obese patients rated the term "weight" as significantly more desirable than a variety of terms physicians could use to describe excess weight; they rated "obesity," "excess fat," and "fatness" as the most undesirable terms physicians could use. The parents of pediatric patients overwhelmingly preferred that physicians use the phrase "gaining too much weight" as compared with other options, including "overweight," when discussing their child's weight. Use of shared terminology that is agreeable and understandable for both patients and physicians is important for ensuring that effective communication occurs during the clinical encounter.
Although previous work suggests that patients prefer some terms used by physicians over others, there is less information available regarding what terms physicians use during clinical encounters. Among a small sample (n = 19) of general practitioners, Tailor and Ogden found that physicians were more likely to use a euphemism with patients (eg, "Your weight may be damaging your health.") than the term "obesity." Understanding what terms physicians use may be particularly helpful because these word choices may influence patients' responses. For instance, patients with a body mass index (BMI) <30 kg/m found physicians' use of the term "obesity" more emotionally distressing, whereas obese patients (ie, BMI >30 kg/m) found the euphemism "your weight may be damaging your health" more distressing.
In addition, research indicates that physicians are not immune to the negative, implicit biases held against overweight and obese individuals. Also, physicians may spend less time with obese patients than with normal weight patients. Given these findings, it is worthwhile to explore whether physicians explicitly endorse the use of potentially derogatory terms to describe excess weight. Furthermore, previous research on patient preferences only included obese and severely obese individuals; there is a lack of information about the preferences of overweight patients (ie, those with a BMI between 25 and 29.9 kg/m). There is also limited research about physician preferences for communication about excess weight. Therefore, the purpose of this study was to compare which terms overweight and obese patients prefer to describe excess weight. We also investigated the reported practices of primary care physicians when addressing this topic with patients.
Abstract and Introduction
Abstract
Background: There is limited research on how patients prefer physicians to communicate about the topic of obesity, and there is even less understanding of which terms physicians most commonly use.
Methods: In this cross-sectional, nonrandom sampling study, patients who were seeking treatment for weight loss rated the desirability of 12 terms to describe excess weight, and physicians rated the likelihood with which they would use those terms during clinical encounters. Participants rated terms on a 5-point scale, with –2 representing "very undesirable" or "definitely would not use" and +2 representing "very desirable" or "definitely would use."
Results: Patients (n = 143; mean age, 46.8 years; mean body mass index, 36.9 kg/m) rated "weight" (mean ± SD) as the most desirable term (1.13 ± 1.10), although it did not significantly differ from 5 other terms provided. They rated "fatness" (–1.30 ± 1.22) as the most undesirable term, although this rating did not differ significantly from 4 other terms. Physicians affiliated with a community-based medical school (n = 108; mean age, 48.8 years; 79.6% primary care specialty) were most likely to use "weight" (1.42 ± 0.89), which was significantly different from ratings for all other terms. They were least likely to use "fatness" (–1.74 ± 0.59), although this rating did not differ significantly from 3 other terms.
Conclusion: Physicians generally reported that they use terminology that patients had rated more favorably, and they tend to avoid terms that patients may find undesirable. Understanding the preferences and terminology used by patients and physicians is an important initial step to ensure that communications related to obesity and weight loss are efficient and effective.
Introduction
The provision of weight loss counseling by physicians in primary care settings offers a potentially effective approach to combating the problem of overweight and obesity. However, physicians often neglect broaching the topics of obesity and weight loss during primary care encounters. Barriers that may hinder physicians' provision of weight-loss counseling include time constraints, lack of reimbursement, and perceptions that treatment will be ineffective. In addition, physicians may feel ill-equipped to address these issues.
Despite these barriers, overweight and obese patients may desire greater involvement of their primary care physician in weight-loss counseling and treatment efforts. Until recently, however, few studies have examined how patients would prefer their physicians to discuss the topic of obesity. In one study, obese patients rated the term "weight" as significantly more desirable than a variety of terms physicians could use to describe excess weight; they rated "obesity," "excess fat," and "fatness" as the most undesirable terms physicians could use. The parents of pediatric patients overwhelmingly preferred that physicians use the phrase "gaining too much weight" as compared with other options, including "overweight," when discussing their child's weight. Use of shared terminology that is agreeable and understandable for both patients and physicians is important for ensuring that effective communication occurs during the clinical encounter.
Although previous work suggests that patients prefer some terms used by physicians over others, there is less information available regarding what terms physicians use during clinical encounters. Among a small sample (n = 19) of general practitioners, Tailor and Ogden found that physicians were more likely to use a euphemism with patients (eg, "Your weight may be damaging your health.") than the term "obesity." Understanding what terms physicians use may be particularly helpful because these word choices may influence patients' responses. For instance, patients with a body mass index (BMI) <30 kg/m found physicians' use of the term "obesity" more emotionally distressing, whereas obese patients (ie, BMI >30 kg/m) found the euphemism "your weight may be damaging your health" more distressing.
In addition, research indicates that physicians are not immune to the negative, implicit biases held against overweight and obese individuals. Also, physicians may spend less time with obese patients than with normal weight patients. Given these findings, it is worthwhile to explore whether physicians explicitly endorse the use of potentially derogatory terms to describe excess weight. Furthermore, previous research on patient preferences only included obese and severely obese individuals; there is a lack of information about the preferences of overweight patients (ie, those with a BMI between 25 and 29.9 kg/m). There is also limited research about physician preferences for communication about excess weight. Therefore, the purpose of this study was to compare which terms overweight and obese patients prefer to describe excess weight. We also investigated the reported practices of primary care physicians when addressing this topic with patients.
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