Little Johnny is Obese: Political Correctness Interfering with Medicine

Political correctness and “sensitivity training” are interfering with medicine and healthcare. In a recent article published in the journal, Pediatrics, a group of researchers published their findings regarding parental perceptions of the terminology that doctors use to describe childhood obesity (ages 2 to 18). The researchers found that it was undesirable to use the term “fat,” "obese" or “morbidly obese” because they were stigmatizing, blaming, and the least motivating to lead one to lose weight. What should be used instead? The term “weight” and “unhealthy weight” were rated as the most desirable. The term “overweight” fell in the middle of the pack.

When I write reports for patients and other healthcare providers, I always try to avoid use of casual terminology and stick to medical terminology. It looks more professional that way because the terms have a scientific basis. While the word “fat” is a colloquial term, the words “obese” and “obesity” are not. They have specific scientific meanings in the medical community. Don’t believe me? Grab a medical dictionary. I just looked up the terms “fat” and “obese/obesity” in the two most popular medical dictionaries: Mosby’s and Stedman’s. Mosby’s does not even have an entry for the word “fat’ as a descriptive term and Stedman’s only briefly noted that it is a common (i.e., colloquial) term for obese. However, both dictionaries contain extensively detailed scientific entries on obesity. Neither dictionary contains the term “unhealthy weight” which is vague since it can also apply to people who are underweight.

So, while I agree that we should avoid using colloquial terms that can feel degrading, we should not abandon the use of scientific terminology because someone does not like the stigma attached to it. The problem that emerges when we start to substitute euphemistic phrases for scientific terminology is that we start to de-emphasize the seriousness of the problems. For example, for people who do not like the stigma of being called “anorexic” should we just say that they are “too skinny.” Some people do not like the stigma of being a cancer patient. Should we just say they just have “really bad cells?” What about people who don’t like the stigma of major depressive disorder? Should we just say the have “the blues?” Should we tell patients they have “unhealthy sugar” instead of telling them they have diabetes mellitus? Where does it stop?

The terminology is becoming so diluted that I have even heard that some overweight people are being referred to as “persons of size.” That term means absolutely nothing since everyone is technically a person of size.

I do not doubt that the parents in the study feel the way they reported, but I would like to see some evidence that less stigmatizing terminology makes a difference in terms of the actions people take to reduce weight, as there was no such evidence of this cited in the above study. A good study would be to divide patients into two groups, call one “obese” and say that the other has “unhealthy weight” during appointments, prescribe a weight loss routine, and see who loses the most weight after controlling for other variables between the two groups that could contribute cause difference between the two groups. If the obese group loses more weight than the unhealthy weight group, then that is what really matters in the end. Sometimes, people need to feel that something bothers them in order to be motivated to really make a change.