Use Patient-Centered Language in Discussions About Weight

Medscape

14-05-2025

Pediatric primary care providers need more training and support in respectfully addressing weight issues with families while avoiding inadvertently stigmatizing terms, suggest findings from a qualitative study presented at Pediatric Academic Societies (PAS) 2025 Meeting.
An estimated 1 in 3 US children aged 2-18 years have overweight or obesity, so this issue is one that all primary care pediatricians inevitably must address on a regular basis with their patients and their caregivers. At the same time, extensive research has revealed the harms of fat bias in healthcare and the ways in which weight stigma increases unhealthy behaviors and even the risk for mortality. The American Academy of Pediatrics therefore recommends non-stigmatizing and person-first language (eg, person with obesity) in discussing weight.
While many of the providers interviewed for the study were aware of the importance of using respectful, responsive language, the research also revealed more work needs to be done to support pediatric providers 'in delivering patient-centered, non-stigmatizing care for overweight and obesity,' concluded Katrina B. Dietsche, Yale School of Medicine, Yale University, New Haven, Connecticut, and her colleagues in their poster.
Dietsche told Medscape Medical News she was impressed with how often providers used preferred terms, but she was also a little surprised at how little person-first language was used, perhaps because it's a newer recommendation.
'While this study explored how clinicians talk to researchers about weight, I think it's very possible the way we talk about weight when we're not talking to patients reveals some of the biases we all have. I also think it's easy to slip up and accidentally use stigmatizing language with patients if it's not something we're consistent about outside of visits.'
But she said it was very clear that clinicians want well-defined language to use with patients in these discussions, and Dietsche hopes that one result of her research will be to design scripts to help better prepare clinicians for these conversations.
'This study highlights a crucial, often overlooked aspect of obesity care — how we talk to patients and families about what it means to live in a larger body,' Alaina Vidmar, MD, the medical director of the Obesity Medicine and Bariatric Surgery Program at Children's Hospital Los Angeles, Los Angeles, told Medscape Medical News .
'Communication has a profound impact on trust, engagement, and outcomes. As we work to address the obesity epidemic in children, aligning our language with empathy and evidence-based guidance is just as important as the treatment itself,' said Vidmar, who was not involved in the research.
The researchers conducted a qualitative study with primary care practices in three US health systems in the Northeast, Midwest, and South. Through semi-structured interviews, the researchers explored how primary care providers manage overweight and obesity in their clinical practice.
Before the interviews, a content analysis of words from a literature review in PubMed identified preferred and stigmatizing terms related to weight. Preferred terms included body mass index (BMI), weight, and overweight, while potentially stigmatizing terms included obesity, large, heavy, and morbidly obese.
The 21 interviewees were mostly female (81%) attending physicians (90%) who had been in practice more than 10 years (86%). When discussing weight, 29% used a mix of nonperson first ('obese patient') and person-first ('patient with obesity') language, while 33% used person-first language only and 33% used nonperson first language only.
The most used terms by providers were BMI and weight, each used by 20 of the interviewees, and obesity, used by 19 of them. Overweight was used by 14, while three or fewer used large, heavy, or morbidly obese.
'There was a wide spectrum as to how primary care clinicians discussed weight, but it was mainly along a spectrum of 'weight focused' or 'lifestyle/health focused,'' Dietsche said. 'A common way to introduce the conversation about weight was to use the growth chart, which then helped give patients a visual.'
One physician who used the growth chart strategy would then say something such as ''Your 6-year-old weighs like a 12-year-old' because I think that opens their eyes a little bit more.'
Overall, four strategies emerged for how the providers discuss weight. One focuses specifically on the weight/BMI itself, such as drawing attention to where a child falls on the growth chart or comparing them with children of other ages. A second strategy avoids discussion of weight and focuses on health and lifestyle, such as how patients are eating and how much exercise they're getting.
'I'll say, 'I'm not so much interested in the total number of the weight. I'm interested in how healthy your body is,'' one provider said. That approach 'is instructive for identifying weight as a problem and linking it to health,' Dietsche said.
'One clinician used a very poetic metaphor about patients' growing bodies like growing a garden,' Dietsche said. 'They talked about how important nourishing foods were to grow a garden and related it to how we need to feed, water, and exercise our own bodies.'
A third approach centers on respect for patient values, preferences, and context, including asking permission from the family to discuss it. The fourth strategy involves being attuned to emotions and cues from the patient and family and following their lead. 'Then the discussion is very sensitive to whatever signals you're getting as feedback from what you're saying,' one physician who uses this approach said.
Mahnoosh Sharifi, MD, MPH, an associate professor of pediatrics at Yale and the senior author on the study, noted that they intentionally used the term 'potentially stigmatizing' when assessing the terms used 'to avoid placing a definitive value judgement on whether it is appropriate or not to use terms like 'obesity.''
What's key, Sharifi said, is preserving trust with patients and remaining patient-centered in communication.
'It is important to balance a focus on health and well-being with communication that obesity is a chronic disease that is not a patient's fault,' Sharifi told Medscape Medical News .
'Using the word 'obesity' may not be helpful and could be unnecessarily experienced as stigmatizing in counseling a parent of a toddler whose BMI is just over the threshold of obesity, but discussing the diagnosis of obesity and using the term may be very helpful in communicating about the condition and treatment options such as medication and bariatric surgery for an adolescent with severe obesity and early-onset diabetes and high blood pressure,' she said.
So while using the term 'obesity' has a role in describing a medical condition with patients, 'we should take care to center the patient's and family's needs, values, and preferences,' she said.
The research was funded by the National Institute on Minority Health and Health Disparities. The authors reported having no disclosures. Vidmar reported having no disclosures.