The Clinical Importance of Using People-First Language in Obesity ManagementSaturday, November 3, 2018
Regular readers should by now be well aware of the importance of using people-first language when referring to people living with obesity (as in “patient with obesity” not “obese patient”).
As I have noted in previous posts, living with a condition is not the same as being defined by that condition – this is why we do not refer to people living with dementia or cancer as being “demented” or “cancerous”.
As elegantly pointed out by Lee Kaplan in a presentation he delivered at the Harvard Medical School Center For Global Health Delivery consultation on obesity, currently being held in Dubai, there is also a pressing clinical argument for speaking of obesity as a disease rather than a descriptor of a “state”.
Take for e.g. the case of a patient with hypertension, who, thanks to effective on-g0ing anti-hypertensive treatment has managed to control his blood pressure levels over the past 10 years. In fact, at no time in the past 10 years has the patient ever presented with elevated blood pressure. Any clinician would agree that this patient would still be declared to have “hypertension” despite currently not being “hypertensive”.
Similarly, a patient whose depression is well-controlled with an anti-depressant is still a patient living with “depression”, although they are not currently “depressed”.
Likewise, we can probably all agree that a patient who has undergone coronary bypass surgery, is still someone living with coronary artery disease, even if they have not experienced a single angina pectoris attack since their surgery.
In all of these cases, hypertension, depression, and coronary artery disease would continue to appear on their medical problem list.
When applied to obesity, this means that even if someone has successfully managed to lose their weight to a level that they are no longer clinically “obese”, they are still someone living with “obesity”. Even if their BMI (not a good measure of obesity) should drop to below 25, they are still someone living with obesity (albeit, as in the case of the above examples, living with “controlled” or “treated” obesity).
Thus, they continue to have “obesity” even if they are currently not “obese” – ergo, the diagnosis “obesity” should remain on their problem list.
Furthermore, given the high rates of recidivism, keeping obesity on the problem list serves as an important reminder to the clinician to continue supporting and reinforcing ongoing obesity treatment (even if this treatment is only behavioural).
It should be evident from this analogy that although the use of people-first language may seem like semantics, it does have very real consequences for long-term clinical management.