Although I’ve been a practicing physician assistant (PA) for almost 20 years, there are times when I dread engaging with the medical community. Recent discomfort in my ear led me to consult with a nurse practitioner (NP). The NP noticed nothing abnormal with my ear, but suggested I pay a visit to an otolaryngologist.
One of the things that I appreciate about seeing a specialist is that these visits usually skip initial weigh-in and vitals. I always fear stepping on the scale: I know how much I weigh, and I know it is an excess of what is ideal for my health. When I am asked to weigh in in a primary care setting (which I now usually decline), I often experience mild eyebrow raising by the attending clinician.
I was fairly confident that my ear pain had nothing to do with my weight, and therefore, that I would not be weighed in — and I wasn’t. My interaction with the specialist was cordial, and in a few minutes, I was out the door, with a diagnosis of “there’s nothing wrong with your ear.”
The medical institution that I attend has access to after-visit summaries as well as full-text notes. A few days after my appointment with the otolaryngologist, I received a follow-up email that let me know that the note and summary were available. I logged on to the online patient portal and opened the note, curious to see the details of the specialist’s opinion. As I read the note, I was surprised to read his description of me as “an obese gentleman.”
It’s never fun to read that reference to my body in a physician’s medical notes, but it seemed particularly gratuitous in the setting of trying to rule out an ear infection by a specialist.
Recently I underwent radiography of my knee. The radiologist read the image and wrote a brief description, and there it was again, the term “obese man.” I thought to myself, “How did he even know I met criteria for obesity, based only on my knee X-ray?”
There has been a lot written about the stigma against people who are overweight. Much of it discusses the discomfort that patients feel when referred to as obese, fat, plump, and so on. I have known patients who have avoided receiving necessary care because they dread being referred to as obese.
In a report from the 3rd Annual International Weight Stigma Conference, the author noted that no single word exists that overweight people prefer, but it’s pretty clear that “obese” isn’t one of them.1 “Higher-weight” and “full-figured” seem to be more positive terms.
A truly patient-centered world would have providers paying more attention to the terminology that high-weight people prefer, even going so far as to take the time to ask their preferences during visits. It might be awkward, but I can imagine having little difficulty communicating after hearing a provider say to me, “Jim, your weight is higher than it was 10 years ago. I’d like to talk to about that, and maybe discuss ways that you think you might be able to take a look at the impact that your weight may be having in your health. Is there a word that you would prefer my using in how I describe your weight?”
Upon rereading my notes from recent visits, the providers who I like best appeared to have used care in how they described my weight. Either they didn’t mention it at all, or they referred to me as “large,” “heavy-set,” or “heavy.” To me, I think weight should only be mentioned in a medical note if it has some relevance to the condition or conditions being assessed.
In some cases, say, for example, someone being seen by a specialist to rule out an ear infection, I think mention of a patient’s weight is as relevant as what color shirt they were wearing. Certainly, there are many times that noting weight is relevant and appropriate, and I have no problem with that. I personally just prefer that they use anything but “obese,” and I prefer to work with a provider who cares about how I feel about that.
My primary care PA is a wonderful person. He has been trying to get me to do some laboratory testing for conditions that are more common in people with higher weight and was very patient with my deferring for a while. We talked about my dread about the “O word,” and he understood completely. In fact, his patience and support about this issue resulted in my agreeing to do the testing. And, by the way, my lipids, blood sugar, and glycemic index are normal, thank you very much.
Meadows A, Daníelsdóttir S. What’s in a word? On weight stigma and terminology. Front Psychol. 2016;7:1527.