Original article
Bad words: why language counts in our work with bariatric patients

https://doi.org/10.1016/j.soard.2018.01.013Get rights and content

Abstract

Language is powerful. Our words convey our impressions, attitudes, and worldview. Language not only reflects, but also shapes, the way that we think. In the field of bariatric-metabolic surgery, it is critical for clinicians to choose our language thoughtfully. In this paper, we demonstrate the importance of language choices in our clinical work and our professional communications; explore the potential pitfalls of words and phrases commonly used in the field of obesity; and encourage the use of more productive language choices in our communications with patients and professional colleagues, both within and outside of our field.

Introduction

If a group of obesity treatment providers was asked to list the tools that are available to help patients manage their weight, resources such as medications, surgical instruments and devices, activity monitors, exercise equipment, dietary counseling, or behavioral treatment might first come to mind. What may be less obvious to these providers is the one tool they all have at their disposal, a simple but powerful tool that is often overlooked: human language.

Merriam-Webster defines “language” as a way of “communicating ideas or feelings by the use of signs, sounds, gestures or marks having understood meanings” (retrieval AND update date 1/28/18) [1]. Our words convey our impressions, our feelings, and the attitudes we hold. They also provide insight into how we see the world—including our judgment of our patients and the way we make sense of their struggles. However, the words we use do not just reflect our worldview; they powerfully shape it as well. We think in words, and thus the words we choose shape the way we think. For instance, in languages that assign a gender to the words for neutral objects like a bridge or a key, the adjectives that speakers choose to describe these objects will vary depending on the gender of that object. In German, the word for “key” is masculine, while in Spanish, it is feminine. Consequently, when asked to describe a key, German speakers tend to choose descriptors like “jagged” and “hard,” while Spanish speakers choose descriptors like “tiny” and “delicate,” despite the fact that they are describing the very same object [2].

Language choices have been found to influence what details we attend to during communication and the type of information we remember. Language choices also shape the attributions we assign to the phenomena we observe, and they play a role in the approaches we choose to solve problems [3], [4]. These findings have important implications in domains such as policy and healthcare. For instance, when crime is metaphorically described as a “beast,” individuals are more likely to support the implementation of aggressive tactics, such as increasing the size of the police force. However, when crime is described as a “virus,” respondents are more likely to favor tactics such as increasing social programs [5]. This finding suggests that language choice has an impact on the narrative to which one subscribes when explaining a phenomenon. Perhaps unsurprisingly, the narrative around the etiology of obesity has been shown to impact attitudes toward policy. In a recent study, people who agreed with a narrative that blamed individuals for their weight were more likely to support the use of penalties, while those who understood obesity in terms of environmental contributors were more inclined to support polices designed to protect people with obesity [4].

It is especially important to acknowledge that many of the topics relevant to the fields of obesity and bariatric-metabolic surgery often carry considerable “emotional baggage” due to the social stigma associated with obesity, which makes it particularly critical for clinicians in this field to choose our language thoughtfully. In short, of all the tools we have at our disposal for patients who have obesity, language is among the most crucial.

The aims of this paper are to demonstrate the importance of language choices in our clinical work and our professional communications; to increase awareness of the potential pitfalls of words and phrases commonly used in the field of obesity; and to encourage the use of more productive language choices in our communications with patients and professional colleagues, both within and outside of the obesity field.

Section snippets

The power of language in our work with our patients

The outcomes of our interventions with patients will depend a great deal upon our language in a number of different ways. One important determinant of treatment outcomes is the strength of the working alliance between the clinician and the patient [6], [7]. Consultation and advice from even the most brilliant surgeon, nurse, physician, dietician, or behavioral health provider is unlikely to be effective—or even heard—if the patient does not trust that the provider understands his or her

Language and stigma

Perhaps one of the most powerful ways that language can affect our relationship with our patients is the extent to which our words suggest, accurately or not, that we hold stigmatizing beliefs and negative biases that characterize people with obesity as lazy and lacking self-discipline, among other negative and blaming stereotypes. It is well established that weight-related stigma is pervasive in our culture [8], [9], [10]. Regrettably, this stigma is present among healthcare providers [11],

Language and treatment

Within the patient-provider relationship, the words we use have the power to shape patients’ attitudes about treatment choices, behavior change, and even about themselves. To achieve and maintain an optimal outcome from weight loss treatment, patients must feel motivated to make and sustain changes and be confident in their ability to do so. There are many ways providers can choose language that helps the patient take a cognitive approach that is most conducive to lasting behavior change. What

The role of language in communications with our colleagues

At times, providers may use different types of language when talking to patients than when they are talking to professional colleagues, both within and outside the specialty of obesity treatment. When talking to colleagues, providers might have less concern about causing offense or having their words be misconstrued. However, given the power that words have to shape attitudes and behaviors, we argue that our words should be chosen carefully in all professional contexts, not solely when

Special consideration: the role of language in discussing bariatric-metabolic surgery

It has been well established that bariatric-metabolic surgery saves lives, with relatively low operative morbidity and mortality, excellent efficacy and co-morbidity improvement, improved patient-reported outcomes, and cost effectiveness shown in multiple studies, including randomized trials [39], [40], [41]. However, despite this high-quality, convincing evidence, the acceptance of surgery is poor and uptake is not increasing substantially [42].

We seem to be suffering from “clinical inertia”;

Words and phrases that generate mixed messages

Surgeons and their teams can make statements about themselves or surgery that can be interpreted in several ways by patients, colleagues, and the community at large. Being more precise about our language can minimize the risk of untoward interpretations by our patients and our colleagues. Examples of potentially misleading or unclear language are presented below.

Conclusions

In this article, we have highlighted many examples of ways in which language can be used that are counterproductive for ourselves, our patients, and our specialty of BMS. Because language so strongly determines perceptions and ways of thinking, those of us in the field of BMS must be vigilant, and work hard to make sure that we and our colleagues are using the power of language to promote, rather than hinder, better understanding and patient care, reduction in stigma, and more widespread

Disclosures

The authors have no commercial associations that might be a conflict of interest in relation to this article.

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