Is the word 'obese' a slur?

[justalittlestar]

I'm not trolling. I saw this very topic brought up on social media with someone describing the term obese as a slur even if it is a medical term. I'm looking for input perhaps from some docs who have had to have difficult discussions with patients about weight. Did you use the term obese? Is there any other way to address someone that is considerably large in size?

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[deleted480308]

Obese is a term that is appropriate. I use it or sometimes I use overweight. Some people get mad no matter how you say things, that’s on them. If you use it with an appropriate tone in the context of trying to help people after exhibiting some humanity and building a connection it is usually fine

 

[AMEHigh]

Obese is totally arbitrary. Unfortunately since the EMR essentially requires it then I have to use it in notes when clinically relevant.

I use the word fat socially, but not professionally. I don’t really address weight unless it is absolutely relevant/necessary and most of the time it isn’t. There certainly is tons of data about discrimination against fat people so I absolutely try to be aware of it and biases.

I’m obese based on BMI, have been most of my life, even being a D1 athlete in college. I still workout multiple times a week, eat a mostly plant based diet, yep still obese. The history behind BMI is good for doctor’s to read about.

I think it’s a good shift for doctor’s offices to be more aware of these biases. Not weighing all patients is a good first step that some offices have moved toward.

 

[SurfingDoctor]

Better than saying or documenting “fat”... maybe. Saying “metabolically challenged” though would be a downright lie.

Just for the record, pediatric drug dosing is weight based and true endocrinopathies can be diagnosed by height/weight discrepancies, so if you don’t weigh the patient, you are setting yourself up for malpractice.

 

[DrNotaDr]

Better than saying or documenting “fat”... maybe. Saying “metabolically challenged” though would be a downright lie.

Just for the record, pediatric drug dosing is weight based and true endocrinopathies can be diagnosed by height/weight discrepancies, so if you don’t weigh the patient, you are setting yourself up for malpractice.

Body habitus limits abdominal assessment

 

[FutureInternist]

Obese is totally arbitrary. Unfortunately since the EMR essentially requires it then I have to use it in notes when clinically relevant.

I use the word fat socially, but not professionally. I don’t really address weight unless it is absolutely relevant/necessary and most of the time it isn’t. There certainly is tons of data about discrimination against fat people so I absolutely try to be aware of it and biases.

I’m obese based on BMI, have been most of my life, even being a D1 athlete in college. I still workout multiple times a week, eat a mostly plant based diet, yep still obese. The history behind BMI is good for doctor’s to read about.

I think it’s a good shift for doctor’s offices to be more aware of these biases. Not weighing all patients is a good first step that some offices have moved toward.

Based on the average trip to WalMart, you being in the obese category yet being healthy is likely an uncommon occurrence. (much like how soooo many folks who don’t do well on exams are “poor test takers” rather than not as smart, hardworking, etc).

Catering to the whims of the populace is not our job, although I concede that in a model that is ever increasing towards patient satisfaction and other BS metrics, docs may have to start to cater more if they are in private practice, to keep afloat.

One can advocate for changing the criteria that is used to calculate a BMI, but until then it’s in everybody’s interest to use the same definitions and not omit info that can be helpful.

 

[VA Hopeful Dr]

Based on the average trip to WalMart, you being in the obese category yet being healthy is likely an uncommon occurrence. (much like how soooo many folks who don’t do well on exams are “poor test takers” rather than not as smart, hardworking, etc).

Catering to the whims of the populace is not our job, although I concede that in a model that is ever increasing towards patient satisfaction and other BS metrics, docs may have to start to cater more if they are in private practice, to keep afloat.

One can advocate for changing the criteria that is used to calculate a BMI, but until then it’s in everybody’s interest to use the same definitions and not omit info that can be helpful.

Using common sense can help as well.

I have a patient similar to my colleague above - obese by BMI but dude is actually just huge with muscle. At the first visit I even said "the EMR is going to call you obese but you and I both know that's not accurate so just ignore it".

 

[Impromptu]

My first time being "written up" was for receiving a bad review from a patient was during a pre-anesthesia interview. The patient's BMI was 37. At the end of my interview I thought I summarized their health history well and complimented them at the same time by saying, "great job, aside from being a little overweight, you appear to be very, very healthy. I think you are a low risk patient for this procedure."

Nope. A month later I found out that I had totally offended them. I was introduced to the hospital's physician punishment system of "write-ups", which remain in the permanent record so that they can use them against the offending physician should they ever need a reason to get rid of you.

 

[docB]

In healthcare we require a term to apply to patients who have additional health risk from being overweight. Right now that term is obese. That may indeed have some stigma attached to it but if we abandon it in favor of a new word it will share the same problems soon.

I think we need a better nomenclature within healthcare. I suggest obese for patients whose excess weight places them at increase risk of health problems, morbidly obese for patients who have already developed weight related health problems and ultra morbidly obese for patients whose size creates physical barriers to caring for them. Ultra morbidly obese patients are those who require bariatric ambulances and beds, can not be imaged in CTs or MRIs or have poor quality pain films due to habitus, or are difficult to gain IV access, intubate, examine or do CPR because of their size.

 

[AMEHigh]

My first time being "written up" was for receiving a bad review from a patient was during a pre-anesthesia interview. The patient's BMI was 37. At the end of my interview I thought I summarized their health history well and complimented them at the same time by saying, "great job, aside from being a little overweight, you appear to be very, very healthy. I think you are a low risk patient for this procedure."

Nope. A month later I found out that I had totally offended them. I was introduced to the hospital's physician punishment system of "write-ups", which remain in the permanent record so that they can use them against the offending physician should they ever need a reason to get rid of you.

While I don’t think this deserves a permanent write up, can you understand how that phrasing was unnecessary? A person can absolutely be categorized as obese and be healthy. Which it sounds like based on what you describe this patient did not have pulmonary disease, cardiovascular disease, etc. They could work out 5 days a week and eat a plant based diet and be more healthy than someone with a BMI of 25. So I guess my point is in regards to your short interaction with the patient why was calling them healthy outside of being obese necessary?

 

[VA Hopeful Dr]

While I don’t think this deserves a permanent write up, can you understand how that phrasing was unnecessary? A person can absolutely be categorized as obese and be healthy. Which it sounds like based on what you describe this patient did not have pulmonary disease, cardiovascular disease, etc. They could work out 5 days a week and eat a plant based diet and be more healthy than someone with a BMI of 25. So I guess my point is in regards to your short interaction with the patient why was calling them healthy outside of being obese necessary?

First, the quote was "a little overweight". The poster didn't mention the word obese at all.

Second, do you know that the patient in question had merely an elevated BMI and wasn't actually overweight/obese? Most of us know enough to be able to tell the difference between a BMI of 37 in a body builder and a BMI of 37 in someone who needs to lose weight.

 

[Detective SnowBucket]

First, the quote was "a little overweight". The poster didn't mention the word obese at all.

Second, do you know that the patient in question had merely an elevated BMI and wasn't actually overweight/obese? Most of us know enough to be able to tell the difference between a BMI of 37 in a body builder and a BMI of 37 in someone who needs to lose weight.

I have actually been thinking about this recently too.
Further question though. Although you can look and tell if someone's a BMI of 37 as a body builder or not, like you said, was the number of 25 for overweight and 30+ for obese chosen esoterically? Is that when you start to have cascading health problems? I can't even find anything in the literature. (Yea, obviously 25+ is less than healthy, but why is 29.9 the cutoff, why not 28.7)

 

[AMEHigh]

First, the quote was "a little overweight". The poster didn't mention the word obese at all.

Second, do you know that the patient in question had merely an elevated BMI and wasn't actually overweight/obese? Most of us know enough to be able to tell the difference between a BMI of 37 in a body builder and a BMI of 37 in someone who needs to lose weight.

Yes sorry, OP said overweight and not obese.

My point is as I said above BMI is arbitrary. The history behind it is crap.
In this specific instance, the OP said the patient is HEALTHY, yet a little bit overweight. So I presume that means the patient has no cardiac or pulmonary problems, no uncontrolled diabetes, etc so they are healthy, end of story. There's no need to bring up the fact that they are apparently healthy AND a little bit overweight. And I'm pretty sure the OP is an anesthesiologist who met the patient just for a few minutes and doesn't have a long standing relationship with them like a pcp might to know the intricacies of their lifestyle, eating habits, exercise, daily schedule, stressors, etc to have a meaningful conversation about overall health and wellness.

So like I said I don't think OP should've been written up and permanently scolded for this, but I think it's a good reminder for us physicians that bringing up weight is very very often unnecessary and stigmatizing and our words do matter. OP said the patient is healthy, so why the need to bring up their weight?

And no you can't look at someone and tell their overall health and wellness. I'm fat/obese/overweight whatever you want to call it, but I eat a plant based diet most days (other days I eat chicken and fish), run marathons, do triathlons, lift weights, do yoga and have a normal blood pressure, blood sugar, and lipid panel. Most people don't fall in to the super skinny category or the body builder category....most people are somewhere in between so no you can't look at them and tell if they ate salad all week and went to the gym this morning or if they can't even run a half mile.

There's plenty of information out there about fat shaming and fat phobia and how the medical community treats fat people differently than not fat people (I've seen some pretty horrific comments on this board for example), so to think that it doesn't matter is incorrect.

 

[VA Hopeful Dr]

Yes sorry, OP said overweight and not obese.

My point is as I said above BMI is arbitrary. The history behind it is crap.
In this specific instance, the OP said the patient is HEALTHY, yet a little bit overweight. So I presume that means the patient has no cardiac or pulmonary problems, no uncontrolled diabetes, etc so they are healthy, end of story. There's no need to bring up the fact that they are apparently healthy AND a little bit overweight. And I'm pretty sure the OP is an anesthesiologist who met the patient just for a few minutes and doesn't have a long standing relationship with them like a pcp might to know the intricacies of their lifestyle, eating habits, exercise, daily schedule, stressors, etc to have a meaningful conversation about overall health and wellness.

So like I said I don't think OP should've been written up and permanently scolded for this, but I think it's a good reminder for us physicians that bringing up weight is very very often unnecessary and stigmatizing and our words do matter. OP said the patient is healthy, so why the need to bring up their weight?

And no you can't look at someone and tell their overall health and wellness. I'm fat/obese/overweight whatever you want to call it, but I eat a plant based diet most days (other days I eat chicken and fish), run marathons, do triathlons, lift weights, do yoga and have a normal blood pressure, blood sugar, and lipid panel. Most people don't fall in to the super skinny category or the body builder category....most people are somewhere in between so no you can't look at them and tell if they ate salad all week and went to the gym this morning or if they can't even run a half mile.

There's plenty of information out there about fat shaming and fat phobia and how the medical community treats fat people differently than not fat people (I've seen some pretty horrific comments on this board for example), so to think that it doesn't matter is incorrect.

Part of the problem, as you correctly point out, is that BMI is a very imperfect measure. We really should be using BMI with body fat percent. If your BMI is 35 but you have 10% body fat, you'll be fine. Conversely, if your BMI is 25 but you have 40% body fat that's less fine.

That being said, the data is pretty clear that a BMI in the obese range generally speaking is a bad thing:

Metabolically Healthy Obese and Incident Cardiovascular Disease Events Among 3.5 Million Men and Women - PubMed

Metabolically healthy obese individuals had a higher risk of coronary heart disease, cerebrovascular disease, and heart failure than normal weight metabolically healthy individuals. Even individuals who are normal weight can have metabolic abnormalities and similar risks for cardiovascular...

www.ncbi.nlm.nih.gov

Its also not that hard to address weight in a non-judgmental way. Plus, that gives the patient a chance, as you just did, to explain that they lead a very healthy life and so their BMI might be misleading. I had a patient last week like that. BMI of around 33 or so. His shirt was about the explode off of his biceps when he reached out to shake my hand. I didn't bring up his BMI.

 

[AMEHigh]

Part of the problem, as you correctly point out, is that BMI is a very imperfect measure. We really should be using BMI with body fat percent. If your BMI is 35 but you have 10% body fat, you'll be fine. Conversely, if your BMI is 25 but you have 40% body fat that's less fine.

That being said, the data is pretty clear that a BMI in the obese range generally speaking is a bad thing:

Metabolically Healthy Obese and Incident Cardiovascular Disease Events Among 3.5 Million Men and Women - PubMed

Metabolically healthy obese individuals had a higher risk of coronary heart disease, cerebrovascular disease, and heart failure than normal weight metabolically healthy individuals. Even individuals who are normal weight can have metabolic abnormalities and similar risks for cardiovascular...

www.ncbi.nlm.nih.gov

Its also not that hard to address weight in a non-judgmental way. Plus, that gives the patient a chance, as you just did, to explain that they lead a very healthy life and so their BMI might be misleading. I had a patient last week like that. BMI of around 33 or so. His shirt was about the explode off of his biceps when he reached out to shake my hand. I didn't bring up his BMI.

Yes I understand that.
But again you quoted me after I essentially said I disagree with OP mentioning the patient being healthy yet overweight in a pre-anesthesia interview. I stand by my stance. There seems to be zero reason to bring up that person being overweight in such a setting, which was my entire point. OP said the patient was healthy, end of story.

Health is multi-factorial. Telling a patient to "just lose weight" is condescending and misses the point often. I don't want to turn this in to a whole political conversation, but lets just think about all the things that affect weight from living in a food desert to stress from being sexually harassed to not getting enough sleep because you had to return to work 2 weeks after having a baby because your company doesn't offer any maternity leave...and the list goes on.

Obviously doctors can't solve all of society's problems, so that's why I think it's super important to recognize the discrimination that fat people receive and recognize that telling a patient to "just lose weight" is likely not helpful and can certainly be harmful. Take the time to talk about any mental health concerns, stressors, movement, access to food, etc. Improvements in all of those can lead to more healthy behavior and weight loss. I'm going to go out on a limb and say that OP didn't have such a comprehensive conversation with the patient as they just met the patient and it wasn't relevant at the time since OP said the patient was healthy.

 

[VA Hopeful Dr]

Yes I understand that.
But again you quoted me after I essentially said I disagree with OP mentioning the patient being healthy yet overweight in a pre-anesthesia interview. I stand by my stance. There seems to be zero reason to bring up that person being overweight in such a setting, which was my entire point. OP said the patient was healthy, end of story.

Health is multi-factorial. Telling a patient to "just lose weight" is condescending and misses the point often. I don't want to turn this in to a whole political conversation, but lets just think about all the things that affect weight from living in a food desert to stress from being sexually harassed to not getting enough sleep because you had to return to work 2 weeks after having a baby because your company doesn't offer any maternity leave...and the list goes on.

Obviously doctors can't solve all of society's problems, so that's why I think it's super important to recognize the discrimination that fat people receive and recognize that telling a patient to "just lose weight" is likely not helpful and can certainly be harmful. Take the time to talk about any mental health concerns, stressors, movement, access to food, etc. Improvements in all of those can lead to more healthy behavior and weight loss. I'm going to go out on a limb and say that OP didn't have such a comprehensive conversation with the patient as they just met the patient and it wasn't relevant at the time since OP said the patient was healthy.

Except that the evidence says that even very brief encounters where problems like this, tobacco use, alcohol use, are mentioned can make a difference.

 

[AMEHigh]

Except that the evidence says that even very brief encounters where problems like this, tobacco use, alcohol use, are mentioned can make a difference.

I guess we'll have to agree to disagree.
I would like to see the evidence that says that an anesthesiologist telling a patient they are healthy but overweight makes a positive difference for their physical and mental well-being. The evidence I've read in the past about behavioral modification for weight-loss shows that the best results occur with frequent sessions over a time period.
If I go get my eyes checked and my eyes are healthy and my vision is 20/20 I would not be happy if the optometrist said, well your eyes are healthy, but you're a little overweight.
There's also plenty of evidence in regards to how horribly fat people are treated by the medical community so it's rather frustrating that people continuously ignore that evidence and keep saying but but but let me just tell this person they're fat and all will be good in the world.
It really is ok to look at things differently and listen to patients and recognize ways to improve.
Again I commented to the OP that I don't think it should be on their permanent record, but I do think the patient has the right to bring it to the doctor's attention when something isn't appropriate to their care. I've certainly messed up and have tried to learn to improve things when they've been brought to my attention. I could be wrong but OP seemed to post about this because they don't agree with what the patient said so I assume they haven't learned anything from it or looked in to the biases that fat people face in medical settings.

 

[VA Hopeful Dr]

I guess we'll have to agree to disagree.
I would like to see the evidence that says that an anesthesiologist telling a patient they are healthy but overweight makes a positive difference for their physical and mental well-being. The evidence I've read in the past about behavioral modification for weight-loss shows that the best results occur with frequent sessions over a time period.
If I go get my eyes checked and my eyes are healthy and my vision is 20/20 I would not be happy if the optometrist said, well your eyes are healthy, but you're a little overweight.
There's also plenty of evidence in regards to how horribly fat people are treated by the medical community so it's rather frustrating that people continuously ignore that evidence and keep saying but but but let me just tell this person they're fat and all will be good in the world.
It really is ok to look at things differently and listen to patients and recognize ways to improve.
Again I commented to the OP that I don't think it should be on their permanent record, but I do think the patient has the right to bring it to the doctor's attention when something isn't appropriate to their care. I've certainly messed up and have tried to learn to improve things when they've been brought to my attention. I could be wrong but OP seemed to post about this because they don't agree with what the patient said so I assume they haven't learned anything from it or looked in to the biases that fat people face in medical settings.

I'm not aware of anesthesia specific data, but having multiple people mention something does matter.

No one is arguing that bias doesn't exist, not sure why you keep bringing that up.

 

[deleted859689]

If the patient was having surgery and their bmi is on the high side, being overweight is a risk for surgery no? Is it not normal to assess this risk with a patient before surgery?

 

[AMEHigh]

I'm not aware of anesthesia specific data, but having multiple people mention something does matter.

No one is arguing that bias doesn't exist, not sure why you keep bringing that up.

Ok I haven’t seen the data about just telling a patient they’re overweight multiple times does anything, that’s what I’m saying. I would read those studies.

I brought up about the bias because the OP and now you seem to think it’s "no big deal" to tell someone they’re obese/fat/overweight when in reality it could be harming the patient based on the context.

Maybe the patient has just lost 100 pounds, maybe the patient’s child recently died and they’ve been stress eating for 6 months, etc. In the context of what OP said since they said the person is healthy there was no need to tell them they’re overweight.

OP seemed to think the patient was overreacting by reporting what was said, but I disagree. We can all learn how to interact with our patients better without dismissing it.

 

[VA Hopeful Dr]

Ok I haven’t seen the data about just telling a patient they’re overweight multiple times does anything, that’s what I’m saying. I would read those studies.

I brought up about the bias because the OP and now you seem to think it’s "no big deal" to tell someone they’re obese/fat/overweight when in reality it could be harming the patient based on the context.

Maybe the patient has just lost 100 pounds, maybe the patient’s child recently died and they’ve been stress eating for 6 months, etc. In the context of what OP said since they said the person is healthy there was no need to tell them they’re overweight.

OP seemed to think the patient was overreacting by reporting what was said, but I disagree. We can all learn how to interact with our patients better without dismissing it.

Yes, the patient did overreact. Doctors are supposed to address potential health concerns with patients. If its done rudely, sure that's worthy of a complaint. But merely addressing it is not. If any of the scenarios you mention come up, you drop it, say "keep up the good work", or whatever is appropriate.

Same thing with smoking. If I mention it to a patient and they said "yeah I'm cutting down, I was at 3ppd and now I'm at 1/2ppd" I'll say good job and move on. Or if they say they were doing well but had a kid die and started smoking more, I'll leave it there.

What you're missing is that sometimes no other doctor has brought up weight and the patient really has no idea that their weight is unhealthy. Sometimes all it takes is one person making a remark like the OP to encourage change in lifestyle.

Bottom line: as doctors its our job to address potential health issues. Obesity is one of those.

 

[VA Hopeful Dr]

Also (and I just learned this) obesity by itself is enough to change a patient's ASA classification: ASA Physical Status Classification System | American Society of Anesthesiologists (ASA)

So absolutely appropriate for an anesthesiologist to mention it as it takes a patient from ASA 1 to ASA 2 or 3 depending on BMI.

 

[deleted859689]

Also (and I just learned this) obesity by itself is enough to change a patient's ASA classification: ASA Physical Status Classification System | American Society of Anesthesiologists (ASA)

So absolutely appropriate for an anesthesiologist to mention it as it takes a patient from ASA 1 to ASA 2 or 3 depending on BMI.

Well that answers my question.

 

[tr]

Waist circumference/waist-height ratio is easy to measure, hard to argue with, and a much better predictor of cardiometabolic risk than BMI.

Waist-to-height ratio is a better screening tool than waist circumference and BMI for adult cardiometabolic risk factors: systematic review and meta-analysis - PubMed

Our aim was to differentiate the screening potential of waist-to-height ratio (WHtR) and waist circumference (WC) for adult cardiometabolic risk in people of different nationalities and to compare both with body mass index (BMI). We undertook a systematic review and meta-analysis of studies that...

www.ncbi.nlm.nih.gov

 

[VA Hopeful Dr]

Waist circumference/waist-height ratio is easy to measure, hard to argue with, and a much better predictor of cardiometabolic risk than BMI.

Waist-to-height ratio is a better screening tool than waist circumference and BMI for adult cardiometabolic risk factors: systematic review and meta-analysis - PubMed

Our aim was to differentiate the screening potential of waist-to-height ratio (WHtR) and waist circumference (WC) for adult cardiometabolic risk in people of different nationalities and to compare both with body mass index (BMI). We undertook a systematic review and meta-analysis of studies that...

www.ncbi.nlm.nih.gov

And as soon as CMS changes their quality measure from BMI to that, everyone else will change too.

 

[iwumd07]

I believe “super morbidly obese” is the PC term. No one appreciates being called “fat”, “overweight”, or “hefty”.