What words do obese patients prefer to hear from physicians when referring to their large body size? Not fatness or obesity, despite the common use of the term obesity in news stories about the expanding epidemic in the United States.

"It's common sense that certain terms, like fatness are offensive," said Gareth Dutton, a clinical psychologist at Florida State University College of Medicine and lead author of a recent study on the subject. That the word obesity was considered to be nearly as offensive came as a surprise. Although health care professionals use obesity as a clinical term, "at the personal level, that word carries a different emotional context," said Dutton.

Dutton and his colleagues asked 143 clinically overweight or obese patients (with a body mass index [BMI] higher than 25) to rate 12 terms commonly used to describe weight problems as desirable, neutral, or undesirable. Additionally, 108 family practice and internal medicine physicians reported whether they probably or definitely used the same words when talking with overweight patients. Patients found the word weight to be most desirable (it was also the term most likely to be used by physicians). The other terms patients deemed desirable (or at least neutral) were, in order of diminishing preference, BMI, unhealthy body weight, unhealthy BMI, weight problem, and excess weight. The term patients liked the least (and was least likely to be used by physicians) was fatness, followed, in order of increasing preference, by excess fat, large size, obesity, and heaviness.

The authors believe this to be the first study to assess patients' and physicians' preferences regarding weight-related terms. The results may make it easier for physicians to talk with overweight patients about shedding pounds. "The findings are equally applicable to nurses, who often are the first line of defense in counseling patients about weight loss," said Dutton.

Studies show that clinicians can play an important role in the prevention and treatment of obesity, and patients desire more involvement of their providers in weight-loss efforts. When clinicians initiate a dialogue about weight loss, choosing the right words may influence how patients react to advice. No one knows, however, whether lessening the emotional impact of terms used in such discussions will motivate patients to make the behavioral changes necessary to lose weight. "That's the ideal follow-up study," said Dutton.-Carol Potera