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Who are you calling fat?

Tony Delamothe, deputy editor, BMJ
tdelamothe@bmj.com
As England’s adults and children are plumping up (doi:10.1136/bmj.e2332) doctors are tying themselves up in knots over the right words to use with their podgy patients. It’s a minefield out there. On a ward round Ian Seetho wondered aloud whether a patient was too heavy for the hospital’s CT table—only to see his patient’s demeanour rapidly deteriorate (doi:10.1136/bmj.e1370). Apparently, studies show that patients prefer terms like "body mass index" and "excess weight" to "fat," "obese," and "extremely obese." Seetho’s bottom line: "When describing a diagnosis or talking to patients, it is important to be ever so mindful of our choice of words in relation to how they feel about their condition."
I wonder. Operations, pregnancies, and yes, even some investigations are riskier in obese people. Shouldn’t doctors be able to speak these simple truths in simple words? Seetho worries that the use of potentially pejorative terms may be interpreted as moral judgments. Perhaps, but I’m reminded of Robert Hughes’s lament at the heart of his Culture of Complaint: "It’s as though all human encounter were one big sore spot, inflamed with opportunities to unwittingly give, and truculently receive, offence."
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Des Spence believes that medicine’s challenge this century is to fight the pandemic of iatrogenic harm, and general health screening checkups are firmly in his sights. They lack any scientific basis and lead to more investigations, anxiety, and profit—although not for patients. He blames these checks for the overtreatment of breast and prostate cancer (doi:10.1136/bmj.e2346).
Nevertheless, screening retains its allure. As part of his plan to make the UK a world leader in dementia care, the prime minister announced this week that everyone aged 65 to 74 will be screened for early signs of dementia (doi:10.1136/bmj.e2347). Does such a programme satisfy the UKNSC’s criteria for introducing a new screening test (www.screening.nhs.uk/criteria)? I don’t think so.
Cite this as: BMJ 2012;344:e2363