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.

Chiclette teeth, to be clear, I do not view fatness as a moral weakness, but it seems plenty of people use those sort of tactics as an excuse to insult fat people.

lots of people do things which could be considered self indulgent & weak, often they are vices which we can indulge in private so no-one can call us on them.

Unfortunately the 'vice' of eating more food than is required for maintaining a 'healthy' body weight (combined with the misfortune to be predisposed to storing fat) cant be hidden.

Interesting that those defending the use of the word fat are either not fat or, to quote the op, a size 14-16. I can tell you that to be a size 22 and called fat is a different kettle of fish.

I've only ever had one general anaesthetic, this year for an erpc. In the midst of all the upset and me being terrified that I wouldn't wake up from the GA, I knew how the staff would be discussing me once I was out. Seems I was right.

Chiclette teeth - thanks for making my point more elequently than perhaps I have. Fat as an adjective can be used to describe someone overweight, obese or morbidly obese according to their BMI which as some posters said is a blunt tool (many health sportspeople are classified obese). In this sense the patient had a high body fat percentage and the distribution of fat was centred around the area to be operated on. I didn't really have the time at the point the question was asked to go into a detailed answer.
Yes I did need to make a judgement about the patient's body composition to plan my operation, predict length of surgery and risk of complication - as doctors we do look at bodies all the time and make judgements and no - my conclusion was not that she was a weak or bad person or said in a sneery way.
I'm interested in the different opinions and it does seem that for many people fat is a politically incorrect word now and weight should not be discussed. Whatever term we use I don't think that we should shy away from considering obesity in health. It is a symptom of how bad the problem is that so many HCPs themselves are morbidly obese and despite being educated are poor role models in this respect.

I'm a size 30 and see my post above.

The largest I have weighed was 36 stone.

And see my post above.

GML - yes we do often discuss patients weight - not in a nasty way but we might say that we need to get 2 or 4 more members or staff or extra equipment to help transfer the patient safely. And we might need deeper instruments or an extra assistant to make the work manageable. There may be additional risks too - e.g may need to be strapped on table to prevent body parts slipping off or even a bigger table, and the anaesthetist will often need to adjust for additional airway or breathing risks.
And yes sometimes we comment on someone's size to acknowledge that the procedure will be long, difficult and tiring for the surgical team - I do wish sometimes patients could see the problems that their weight causes. I worry about my lovely size 20 mother having surgery.

Oh, meant to say (but had to pop off to see to the children) re operation - I had one a couple of years ago and died a thousand deaths when I came round and saw that they'd put a catheter in. The thought of them all manhandling my 'bollock' (as I call my pendulous mons ) was awful.

But I still say call fat - fat. When I whispered 'heavy', or 'big, or 'large' or demanded it be (pun intended) the elephant in the room, that was an excuse to not do anything about it. Nobody mention my weight cos it hurts me. Well, you just can't carry on like that. You have to turn and face something head on in order to deal with it. And that means embracing and accepting that you're fat.

None of that bothers me, well it does of course but YKWIM. My bmi has been discussed during this pregnancy and before that op I mentioned. I'm not thick, I know that it presents problems. But it has always been discussed matter-of-factly, not sneeringly or insultingly. What concerns me more is the amount of people saying it doesn't matter how you talk about someone as long as they're unconscious and can't hear you. Call them a whale etc, fine as long as they can't hear you. It's not fine, no one is unconscious for fun. People are at their most vulnerable then, a little bot of respect is not too much to ask, surely.

I was looking for your post and was interested to see that you were more upset by the word obese than fat. I have just twigged that my nickname is a bit ironic here - I'm definitely partial to chocolate biscuits and am no saint!

Also as an aside, is it true to say most patients are given prophylactic antibiotics during major surgery? If so maybe a more a detailed explanation was merited. If the next generation of surgeons are to stop (excuse my assumption you are a surgeon op) making comments about patients (and their other health care colleagues) whilst they are unconcious which are non clinical and unprofessional, don't make them yourself whilst teaching them.

Oh no, that's a totally different matter. But I didn't get from the OP that she sneered - just that she used the word 'fat'. If she had loomed over the patient and said "god, look at this tub of lard, I'm going in..if I'm not out in an hour, send in a st bernard" and then started humming 'abide with me', then that would be totally different. But to simply say that she is doing X because the patient is fat - I don't see that that is insulting in any way. If she'd said, "we'd better give tub-o-guts the elephant dose" I'd agree with you.

• When I had my operation I spent a lot of time imagining the sorts of things they might have been saying as you can see.

Oh, and I just realised you mean the other people on the thread who say that it doesn't matter because the patient can't hear and you mean their attitude, not what the OP actually said. sorry

I have to stop beginning my posts with 'oh'

not upset by it, choc. I mean, can't really justify being upset by words that describe how I look when it's my own fault that I look like the michelin man and within my control to change . If it is so upsetting, I have the choice to do something about it (which I am doing now), no point getting upset about it - do something about it.

I'm just saying that obese seems a fatter word than just fat. It feels fatter than fat. There's fat, and then there's obese

GML they'd be discussing you regardless of your weight. And so they should be if you are under a general and under their care.

If good clinical practice dictates that you should be treated a certain way clinically because you are "fat", would you rather this wasn't discussed? What if you needed to be treated a certain way because you were way too thin; is this ok?

I don't get it why everybody is so offended and judging the OP.

You'd be shocked as shit if you heard what some medics said about patients. But I'm afraid, referring to someone as fat (when they are) is not an insult.

FWIW, I work with a lot of very fat people; both as colleagues and as patients and I judge them no differently than I would anybody else simply because of this.

This is a non-event in the grand scheme of things, and OP in this setting YANBU.

Lewis, medically speaking, fat is not a colloquial word for anything. It is a perfectly reasonable way to describe a patient.

Calling them a beached whale or a bloater (which an eminent colleague of mine once did in an invited take, and who I corrected for his insulting, inflammatory language) is not.

invited talk

Wow. If "obese" is considered to be sugar-coating the scenario, then maybe we should wipe out all references of SN to students at school and just go back to referring to them as "thick" and "slow."

Using a word like "fat" to refer to a patient is tactless and unprofessional. There are more appropriate and clinical terms. YABU, seriously unreasonable.

Halbanoo what has the hell have SN students got to do with this? Really, read the thread and educate yourself a little. Just out of curiousity, are you a doctor and if so, to which more appropriate clinical terms do you refer?
And go to Oxford dictionary online as well as any medical textbook and look up the definition of fat.

You will find it's not an insult.

Well I'm a fat anaesthetist.

I could detail for you in great detail how my obesity prejudices my health and increases my risk of poor outcome generally, during anaesthesia and during pregnancy.

Does that information alone make me lose weight - no.

Fixing obesity is not quite so simple as eat less, exercise more. There are frequently significant psychological issues and well established behavioural patterns to contend with. If it was straightforward I can assure you that I would be the size 12 I should be not someone with a BMI of approaching 35.

I would love to lose weight on a long term basis but it is really hard work and my stressful high pressured job with an erratic working pattern doesn't really help much. I did drop my BMI two years ago to < 30 but have since regained the weight with very little effort.

I would not generally refer to a patient as 'fat'. I would use obese or overweight. Sometimes it is very awkward eg. when you have to explain to a patient that they can't have their operation in the usual operating theatre as they are too heavy for the table. Or that the reason why their epidural took more than an hour to site was because their BMI was 50.

Most patients are very embarrassed to be in that situation.

No, of course I don't expect to not be discussed, that's ridiculous. But it's this You'd be shocked as shit if you heard what some medics said about patients. that annoys me. The fact that the person in question is lying in front of you at their most vulnerable while "medics" are taking the piss really disgusts me. And yes, I've spoken to enough people in the profession, close family members included to know that piss-taking is very very common. Discussion is necessary, piss-taking isn't.

I am a HCP and wouldn't use fat but would use overweight or the term 'habitus' which is a non judgemental, non specific term to desribe difficulties encountered due to a person's physique.

For all of those who say being overweight does not affect health....it bloody does!!! A large % of patients in my practice have health problems directly caused by their weight, some cannot have life saving surgery or surgery to resolve longstanding painful conditions (OA knees caused by their weight) and all of them cause problems for HCP because examining them is far more difficult because of their weight. Many diagnostic tools are limited because of their 'physique'. Manhandling an incapacitated patient is risky and often threatening to the well being of all concerned.

I have a BMI above normal however it does not affect my health and I am very fit. We are talking about physiques which might be described as obese. I agree with the OP's point about obesity being a major health risk and pretending it isn't to 'save feelings' being immoral. My job is to promote health not ignore risky behaviour. However I don't think ridicule/disgust/sneering is helpful. I do think honest sensitive discussion is useful and often welcomed. When it is not welcomed- I back off, accepting the patient has made an informed choice to accept the risks of obesity

Rabbit fat is not a pejorative term at all. It can be levied as an insult, but it doesn't have to be.

My own patients call themselves fat (ie. they will say "is it because I'm fat"). Really, this is getting silly. If somebody is insulting their patients, then that is clearly not on, regardless of the insult they use.

Out of curiousity, what if the patient wasn't obese, but merely overweight? My guess is being called obese (if you're not) is worse than being referred to as fat, if you are.

I agree GML, but the OP wasn't taking the piss.
I have corrected (and will continue to do so) people every time they mock a patient; it's not on and it bothers me immensely