What Words Should We Use When Discussing Excess Weight?

The words you use when discussing weight lose can impact your patients’ success….

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. 

This study was effective in determining the best words to include in your discussion and the words that you should avoid.

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.”

There was considerable overlap in patients’ ratings of the desirability of different words. “Weight” (mean ± SD) was rated by patients as the most desirable choice for physicians to use (1.13 ± 1.10) and was the only word rated in the range of “desirable” to “very desirable.” However, it did not differ significantly from 5 other words that were rated in the range of “desirable” to “neutral,” including “BMI” (0.70 ± 1.26), “unhealthy body weight” (0.46 ± 1.35), “unhealthy BMI” (0.42 ± 1.30), “weight problem” (0.28 ± 1.33), and “excess weight” (0.20 ± 1.31). The term “fatness” (–1.30 ± 1.22) was rated by patients as least desirable, although this rating was not significantly different from patients’ ratings of “excess fat” (–1.06 ± 1.28), “large size” (–0.99 ± 1.28), “obesity” (–0.85 ± 1.35), or “heaviness” (–0.69 ± 1.24). Comparisons of patient ratings for all 12 terms are summarized in Figure 2. In the figure, terms associated with the same letter (a, b, c, etc…) do not differ from each other, whereas different letters represent significantly different ratings for those terms.

Physicians were most likely to use the term “weight” in discussions with overweight or obese patients, and this term was clearly preferred by physicians when compared with all of the other words offered. In contrast, “fatness,” “excess fat,” “heaviness,” and “large size” were least likely to be used by physicians during clinical encounters. It is encouraging to note that physicians’ use of the term “weight” was consistent with patient preferences, and the avoidance of terms such as “excess fat” and “fatness” was also congruent with patients’ negative reactions to these terms. Similar to comparisons of overweight and obese patients, the weight status of physicians did not influence their reported likelihood of using different weight-related terms with patients.

This topic is particularly worthwhile because physicians can play an important role in the prevention and treatment of obesity, and patients report a desire for greater involvement of their physician in their weight loss efforts. However, this collaborative approach to treatment can only take place after an initiation of the conversation about the patient’s need and desire for weight loss. Physicians generally reported that they use terminology that patients had rated more favorably, and they tend to avoid terms that patients may find undesirable. In fact, preliminary research indicates that the manner in which physicians broach this potentially sensitive topic may influence how patients react emotionally and cognitively to the discussion and advice. 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.