Opinion: Doctors, Think Twice About Using This Term

by Kevin Wineinger MD

Stop saying ‘morbid obesity.’ Stop coding it, remove it from your problem lists, and if you hear someone describe a patient using the phrase, politely correct them.

What’s wrong with saying a patient is morbidly obese, you ask? For starters, it is an outdated adjective for patients who have a BMI ³ of more than 40 that’s no longer used by those in the field of obesity research and clinical medicine. They would use people-first language and refer to patients in this category as “A patient with obesity Class III” or “A patient with obesity,” or even “Mr. or Mrs. Last Name.”

The use of BMI-based classifications has added a great deal to our understanding of population health in regards to weight, but the classifications have significant limitations for individual patients because they lack the additional context of co-morbid conditions. Additionally, in some individuals, BMI-based classifications provide a poor estimate of a patient’s total body fat.

Obesity Classifications: 
Class I Obesity: BMI 30.0 – 34.9
Class II Obesity: 35.0 – 39.9
Class III Obesity: ³ 40.0

More importantly, continuing to use the term “morbid obesity” potentially contributes to a bias against our very own patients. The presence of weight bias in health care providers has been shown in numerous studies of physicians, nurse practitioners, nurses, and medical students.1,2,3

Our patients are impacted by this bias and their care suffers accordingly. In a study of nearly 2,500 women who were overweight or obese, 53% reported receiving inappropriate comments from a doctor about their weight.4

In a 2003 study of primary care physician’s attitudes toward patients with obesity they were far more likely to be described as “awkward”, “unattractive”, “ugly” or “non-compliant” than “graceful”, “attractive”, “handsome” or “compliant.”5

Even more substantial and concerning, especially in light of increased risk of certain cancers in patients with obesity, is a trend in research studies showing patients delaying or forgoing cancer screening with mammography, pap smears and/or colonoscopy.6-14

I will close my arguments with a quotation from the 1970 article that introduced the phrase morbid obesity,15

“When an obese individual attains the gargantuan level of the fat man or fat woman in the circus and maintains this degree of massive obesity for many years, we believe the adjective morbid should be added to emphasize the serious health implications and severe, life-shortening hazards of such grotesque accumulations of fat.”

If I have convinced you to drop the phrase, “morbid obesity,” then I would like ask for a small favor. Spread the word. Share this article. If you are supervising a medical student who presents the case of a “43-year-old morbidly obese male”, take a couple seconds to teach them about weight stigma and improve their presentation skills. This type of change will be driven by a small group of people that convince their larger healthcare family that “morbid” is a useless, stigmatizing adjective.

At OurHealth we are committed to using people-first language throughout our organization and strive to treat all of our patients as valued people instead of a collection of biometric statistics and diseases.

About Opinions at OurHealth: 

OurHealth celebrates diversity of viewpoints and encourages debate among its healthcare providers. Medical research and practice is full of differing perspectives and controversies that contribute to the evolution of conventional wisdom. While this opinion does not necessarily reflect that of OurHealth’s as an organization, we wholeheartedly support and encourage providers taking the time to speak about important topics like these.

About the Author: 

Kevin Wineinger is a board-certified family medicine physician with experience including traditional outpatient primary care, immediate care, and inpatient medicine. Additionally, he is an entrepreneur and the founder of a home visit practice.

Prior to his career as a physician, Dr. Wineinger was a mechanical engineer. He received his undergraduate degree in mechanical engineering from Purdue University, and he later earned his Doctor of Medicine  from Indiana University School of Medicine.

Follow Dr. Wineinger on Twitter @kevinwineinger


SOURCES:

  1.        Harvey EL, Hill AJ. Health professionals’ views of overweight people and smokers. Int J Obes 2001;25:1253–1261.
  2.        Brown I. Nurses’ attitudes towards adult patients who are obese: literature review. J Adv Nurs 2006;53:221–232.
  3.        Wigton RS, McGaghie WC. The effect of obesity on medical students’ approach to patients with abdominal pain. J Gen Intern Med 2001;16:262–265.
  4.        Puhl RM, Brownell KD. Confronting and coping with weight stigma: an investigation of overweight and obese adults. Obesity (Silver Spring) 2006;14:1802–1815.
  5.        Foster GD, Wadden TA, Makris AP et al. Primary care physicians’ attitudes about obesity and its treatment. Obes Res 2003;11: 1168–1177.
  6.        Ferrante JM, Ohman-Strickland P,Hudson SV et al. Colorectal cancer screening among obese versus non-obese patients in primary care practices. Cancer Detect Prev 2006;30:459–465.
  7.        Heo M, Allison DB, Fontaine KR. Overweight, obesity, and colorectal cancer screening: disparity between men and women. BMC Public Health 2004;4:53.
  8.        Meisinger C, Heier M, Loewel H. The relationship between body weight and health care among German women. Obes Res 2004;23:1473–1480.
  9.        Ostbye T, Taylor DH, Yancy WS, Krause KM. Associations between obesity and receiptof screening mammography, Papanicolaou tests, and influenza vaccination: results from the Health and Retirement Study (HRS) and the Asset and Health Dynamics Among the Oldest Old (AHEAD) Study. Am J Public Health 2005;95:1623–1630.
  10. Rosen AB, Schneider EC. Colorectal cancer screening disparities related to obesity and gender. J Gen Intern Med 2004;19:332–338.
  11. Wee CC, McCarthy EP, Davis RB, Phillips RS. Screening for cervical and breast cancer: is obesity an unrecognized barrier to preventive care? Ann Intern Med 2000;132:699–704.
  12. Wee CC, McCarthy EP, Davis RB, Phillips RS. Obesity and breast cancer screening: the influence of race, illness burden, and other factors. J Gen Intern Med 2004;19:324–331.
  13. Wee CC, Phillips RS, McCarthy EP. BMI and cervical cancer screening among White, African American, and Hispanic women in the United States. Obes Res 2005;13:1275–1280.
  14. Mitchell JE, Padwal RS, Chuck AW, Klarenbach SW. Cancer screening among the overweight and obese in Canada. Am J Prev Med 2008;35:127–132.
  15.     Scott HW, Law DH, Sandstead HH, Lanier VC, Younger RK. Jejunoileal shunt in surgical treatment of morbid obesity. Ann Surg 1970; 171: 770–782.