to expect health care professionals to be realistic about obesity

[chocolatehobnobs]

I have just seen a male student nurse walk past my flat window with DP and 2 sweet young DDs. He works on a ward and is 30 stone plus ie morbidly obese. I was horrified to see him carrying a family bucket of KFC.
Last week in the operating theatre a colleague asked me why I had prescribed antibiotics for a patient when another patient having the same operation had not been given them. I replied 'because she is fat' ( longer surgery and obesity mean higher risk of wound complications and infection). She then challenged me in front of our other colleagues saying that she didn't think I should have used the word fat about a patient. I replied that we are all health professionals and all understand that fat is a plain term for raised body mass index or obese and that the patient was not upset as unconscious. She replied that as the patient's advocate she did not want the patient to be referred to as fat or have their weight discussed. I think she was upset as a morbidly obese person herself.
Honestly, I just think that if health professionals cannot accept that obesity is a major health risk and discuss it openly then what chance have we got to improve things.

There was a drive fairly recently to encourage HCPs to use the "F" word with patients when discussing weight rather than "Obesity".

One is a condition that happens to someone over which they have no control, the other may seem (to an outsider/eavesdropper for eg) to be pointing a blaming finger, but the theory was that it empowers the patient to put into place lifestyle adjustments to become a healthier weight themselves; those who do so tend to see a more longterm weight loss and more reliable health benefits. Those who are led to believe fatness/obesity is a disease in its own right that has happened to them are more often than not the group who struggle to lose any weight then put it straight back on again.

COI: I work in the NHS. Lost 6 stone last year now size 10-12 and still "overweight/obese border" on BMI (blunt instrument, I lost the weight with a lot of gym work and remain 5'3"), not really "fat" anymore though . Drink sometimes. Don't smoke. Usually sort most of the recycling. Occasionally wear odd socks, and have been known to drive too fast. Do as I say, but only sometimes what I do - the socks thing is pretty liberating!

good going Jenniec!
i'm guessing that you'll have done some resistance training in the gym and thats why your bmi is borderline despite you being much reduced in body volume.

I agree BMI is a blunt instrument since it takes no account of the amount of adipose tissue vs lean tissue and muscle is almost twice as dense as fat!

"but was answering a juniors question with a straightforward answer"

No you wasn't, you gave the answer in your post at 20:37 that you should have given to the junior. You did not give a clinical reason for your decision.

"I was taking extra care to make sure she did not have a complication due to her obesity",
You shouldn't be asking anyone outside of the profession their opinion and taking it on board, there are probably lots of terms that they use that are not acceptable to use within social care. If in doubt take it to your senior.

You should also know that there are complex reasons as to why people are obese and overweight that are not that easily rectified.

I'm still slightly amazed that anyone thinks calling someone "obese" is allowing themto remain in denial. If you are a size 30 you are not in any way unaware of the fact. Beleive me.

Big fan of calling a spade a spade. Calling it a "bloody shovel" probably not hugely helpful.

But I'm confused about what your point is OP. Is it that you were told off for calling someone fat? In which case YANBU, who cares what you call it as log as its not rude and I wouldn;t consider calling someone fat rude (without hearing the tone you said it in - which may be the real problme). Is it that HCP who are obese/fat/overweight are employed by the health service - in which case YABU because it doesn;t mean they can't be good at their job and "role model" aside I'd rather like someone competent regardless of their size. If its "health professionals cannot accept that obesity is a major health risk" then I'm amazed that your fellow hcp's don't appear to be living in the same universe as me but YANBU - it is and they should.

Whilst it may not apply to the patients in your care I have been surprised recently to find quite a few situations where being overweight increases the patients' chance of survival. We are all in danger of becoming judgemental, rather than objective, when weight is the issue.

It is our job to help patients (and sometimes our fellow professionals) find a healthy lifestyle that they can enjoy and maintain but let's not be judgemental about it. We're slowly overcoming those attitudes with addictions, mental health, etc and should do the same with weight.

Chocolate I am a doctor although I work in clinical research. We work with patients who are diabetics and/or pre-diabetics. 99/100 of these people are fat; either overweight or obese, or morbidly obese, or super-morbidly obese. Whatever category they are in, too much fat is their problem.
We will often use the word fat, in a clinical descriptive sense (rather than an insult) and nobody, but nobody, fat or thin who has ever commented or even intimated being offended.

There is a difference between saying "you fat cow " (clearly meant to be nasty and offend) and saying "the patient is fat"

Brian I had one woman cry when she found out she was rejected from a trial because she was too fat.
She was simply sent a standard letter saying she didn't meet our criteria (which she had seen in advance and which stated that overweight people would be excluded from the study) and she rang up to insist on finding out why.
I quickly looked up her file and told her that her BMI was 29 and that for the purposes of this particular study, she wouldn't be able to join in and she literally started crying down the phone.

I didn't really know what to say to her when she said she couldn't believed she had been called fat (she hadn't, by anyone, but she was a little, and clearly didn't realise). It's amazing how many people are in denial.

My (ex)GP told me that the problems I was having was because I was fat and if I ate less and did more I'd lose weight and be fine. Calling a spade a spade

Hands up all those who knew that dieting cures autism.

Aaargh, deleted a whole sentence

was a little surprised to find out she was not at a healthy weight and clearly didn't realise

I can't judge! People in glass houses shouldn't throw stones and I have as many vices as anyone else! HCP or not

The issue here is surely that somebody is prescribing antibiotics on the basis that they predict the patient will need them due to their weight.

Well, in that case, you should have very good reason to prescribe them based on research into weight and potential healing problems. And that would require a precise explanation to other staff - exactly how high does your BMI need to be before the benefits of these antibiotics outweigh the harm of a possibly unnecessary prescription? Overweight? Obese? Morbidly obese?

Fat has no precise meaning, and so can't possibly be a justification for giving people antibiotics based on a prediction. Very worrying OP.

I would also give a very overweight person prophylactic antibiotics after major surgery.
So would most of my colleagues.

I'm not disagreeing with giving an overweight patient antibiotics. I am disagreeing with giving a 'fat' patient antibiotics, because the word fat does not have any particular meaning in research.

Well obviously it does have a meaning in research, but not as an adjective to describe people's weight.

Yes Milly but if OP uses the word in the sense that I explained it is often used, then the patient may not well have been just overweight. And the woman who made of issue of it, will have been able to see this.

Yes the word fat does have a meaning in research. I'm sorry to burst your bubble, but it does.

Xposts

What does it mean?

Err, yes it does describe people's weight.
There are degrees of "fat" hence; overweight, obese, morbidly-obese etc....

In a conversation I with a colleague, we wouldn't necessarily state the patients BMI (if not to hand you wouldn't make one up and you may well not know/remember a specific number or category) but if it was high, you would say fat.
You wouldn't say overweight, because that is a category of fatness you would just say fat.
It's a generic term; a descriptor of how much energy they have stored. It's not an insult.

Thanks. In that case I think that OP is right. If the antibiotics would generally be prescribed to all people who would be defined as fat, then it is perfectly reasonable for the OP to say so.

The whole fat is unhealthy malarky is a big trojan horse for people to do a bit of sneering at and shaming of other people. Fat is seen as a huge moral weakness now it seems.

OP YABU, I can just imagine how you came across and I'm really glad someone challenged you.

Occasionally, when I worked in theatres, a surgeon (usually one of the more junior ones) would complain about a patient's size. Calling them a body fascist and saying that a truly skillful surgeon operates well on all body shapes would soon shut them up.

Goth what on earth has this got to do with moral weakness?

I don't think it's seen as a 'moral weakness' but fat people have mainly always been viewed as self indulgent and weak. In much the same way smokers and heavy drinkers are.

your colleague was right to correct your use of language.

I was in a meeting the other day with senior management and a colleague (equal to me) and she was picked up on something she said (similar lines - a colloquial term for something given a proper name/definition).

When you're at work, you speak in that register and should do whether patients can hear you or not; when you're at home, using a more relaxed register; call people fat until your heart' content.

describing someone, plainly, as "she's fat" isn't offensive. it's descriptive. If it is said with malice "she's a fat bitch" then obviously it's insulting. But just describing someone as being "fat" surely can't be offensive .