Is "obese" a bad word?
Some parents seem to think so, and doctors – and their kid patients – are learning that the hard way.
A recent study appearing in Pediatric Obesity found that parents believe it's a physician's job to spearhead any conversations surrounding their child's weight, particularly when there are health concerns.
But the way they discuss the issue is crucial: Parents don't like to hear "fat" or "chubby" – understandable, given the fact that those words are most often used pejoratively. But the study also says that parents don't like the words "obese" or "overweight," both of which are medical terms.
Instead, say researchers, doctors ought to use terms like "large or "gaining too much weight" to describe kids who are on the path to being overweight or obese.
Dr. Wendy Slusser, who directs the Fit for Healthy Weight program at Mattel Children's Hospital UCLA, says the article "really rings true" regarding physician-patient communication.
"I think that, just like a parent, we want to communicate with a child carefully," said Slusser. "I think we need to be very cognizant of how powerful we can be in a positive or negative way."
Residents in UCLA's pediatrics program are trained to communicate with patients via "motivational interviewing," said Slusser, a patient-centered method in which open-ended questions, affirmation, reflection and summarizing are central.
"You go through this in a very systematic way with families to identify their interests and motivations," she said. "Picking those words initially where you're actually opening up the subject is critical in terms of having them be open to taking a next step, which would be to make some commitments for change."
A doctor's choice of words can have a profound effect, said the study. Parents may feel blamed for a child's weight issues, depending on how a physician phrases things, or may even feel like a doctor is being rude or judgmental.
Doctors, on the other hand, may be reluctant to bring up the issue of a kid's weight at all, because they don't want to risk offending families or jeopardizing the physician-patient relationship. That holds particularly true when it comes to bringing up weight during appointments for children regarding an unrelated medical issue.
The line between cautious communication and sugar-coating important truths about a child's health can be a fine one, said Slusser.
"As a physician, I'm reading where my patients are in terms of what are they thinking," she said. "And so by utilizing the whole concept of open-ended questions you can say, 'So what do you think about your child's weight and nutritional habits?' And then you can get them to tell you what they're thinking."
Slusser explained that the expert working group that most recently defined "obese" and "overweight" suggested that doctors don't use those words when communicating with a patient. It's more for internal use among physicians, so they know where they are in terms of taking action.
"I'm a big believer in a patient-centered approach to care," she said. "It's sort of the same concept – rather than the word 'culturally-sensitive', I think you have to be culturally open to where they are and then work with them to move them a little further along the spectrum to have a healthier lifestyle."
In the end, it's the child who's most negatively affected by ineffective or poor communication, as the study found that parents who feel ostracized by physicians – whether it's because they feel like their doctors are holding back information or appear to be "judgmental" – are less likely to comply with doctor's recommendations. That only exacerbates the problem in a place like South Los Angeles, where the child obesity rate is among the county's highest at nearly 30 percent.
When it comes to child obesity, Slusser said the most important things are early detection, early intervention, prevention and patient-centered communication. Regarding the latter, the study concluded that doctors need more training on how to address sensitive issues like weight, and that more feedback from parents is needed.
"We are trained to tell a patient what to do," said Slusser. "But nine out of 10 times, they will come back and won't have done anything." So she's taken to asking patients for permission to offer an idea on how to combat a given health problem.
"I've never had a patient say no," she said. "And suddenly they're relaxed."