The Impact of Language in a Healthcare Consultation

SPEAKER 1: The language we use when talking about overweight and obesity has powerful impact. It’s really important that we are aware of the impact of the language we use as clinicians.

Consider this first statement. The evidence tells us that one of the best things you can do to reduce your blood pressure is to lose some weight. What do you think about using this in a clinical consultation?

Translating research evidence for patients is part of our role as a clinician. However, in this statement, telling someone that they should lose weight means that a judgement has been cast about their weight. And depending on the context, this judgement may have been made based on appearance. Depending on the context and timing of the statement in the clinical care pathway, it presumes that the patient is comfortable to discuss weight and also that they’re comfortable to discuss it with you. Providing the information in this way also doesn’t provide the other options for treatment.

An alternative approach could look like this. The evidence tells us that there are a number of options that are effective in managing and reducing your blood pressure. There are drugs available which are very effective for controlling your blood pressure, and for some people losing some weight can also be effective, and could reduce the amount of medication, you would otherwise need. It’s important when dealing with a patient’s chronic disease to acknowledge a range of treatment options, and within that to describe the benefits of weight loss on their condition.

What about this statement? All you need to do is eat a bit less and move a bit more.

Obviously, tokenistic advice is absolutely not helpful in the discussion about obesity. Weight loss cannot be reduced to a simplistic equation that doesn’t take into consideration the physiological changes happening in the body and the social context in which someone lives. Taking a tokenistic, simplistic approach reduces the credibility of the clinician and can have significant impact on rapport. It is also stigmatising.

Consider this next statement. Your back pain is definitely, probably, possibly due to you carrying extra weight over the years.

Agreeing with patients who pose this kind of statement, or taking such an approach yourself, is not helpful and places blame onto the patient. Firstly, it may not necessarily be true, as a number of factors can contribute to back pain. And indeed the majority of chronic diseases have complex, multifaceted etiologies. It’s also stigmatising, and we know that guilt is not a useful motivator. What the patient needs is realistic support without judgement.

So as clinicians, whilst we always have the best intentions, it is important to remember that our language and words can have unintended impact. Using language that is free from judgement, constructive, and positive is important, particularly around weight management.