To The Editor

The article titled 'Words Do Matter' was helpful in reminding us to choose our words correctly lest they convey the wrong tone and that improperly chosen words or phrases can lead to present and future bias in health practitioners.  But some of the examples given, especially the suggestion that obesity and obese are stigmatizing, is open to argument.

Obesity is a legitimate medical term, found in the index of every medical text. Bariatric surgeons operate on obese patients; the recent federal government travel warning referred to increased risk in obesity; newspapers regularly advise of the increased incidence of obesity in children and the New England Journal of Medicine had 4 articles in September in which obesity appeared in the title or within the first paragraph.

The descriptor ‘morbid’ obesity is likely a form of fat shaming because we don’t use that term in other contexts — for example, we never say ‘morbid hypertension.’

Some underweight people don’t like the term skinny. Can we no longer use this term or ‘cachectic’ in the appropriate settings?

— Howard Bargman MD, FRCPC

The CPSO responds:

We thank Dr. Bargman for his letter. It is a timely note as the cover story for this issue of eDialogue focuses on the recent Canadian guideline for the Management of Obesity and weight bias, in particular. 

To avoid the perpetuation of weight stigma in research, health-care practice and policy, international obesity associations, including Obesity Canada, have adopted the use of person-first language in all written and verbal communications. Person-first language is the standard for respectfully addressing people with chronic diseases, rather than labelling them by their illness. 

For example, having a chronic disease such as cancer does not make a person identify as a cancerous person. Therefore, it is recommended that we stop using the name of a chronic disease (e.g., obesity, cancer, hypertension, diabetes) as an adjective. So rather than saying “obese people” or “diabetic person” or “hypertensive patient,” the societies suggest we rephrase these terms as “people with obesity” or “person with diabetes” or “patient living with hypertension.”

Thank you, Dr. Bargman, for presenting an opportunity to elaborate.