By occupational therapist Pia Beck
There often is some hesitation among caregivers when they mention a patient with increased bodyweight for whom they need to provide care. On several occasions, I have experienced it to be a barrier when meeting the overweight patient. This often result in an ethical dilemma for the caregivers.
In connection with my teaching in bariatrics, I often experience that the participants mention this group of patients with many different phrases. Some use professional terms such as “The patient I visit is fat” or “The patient is overweight, actually severely overweight”, or “There are two bariatric patients on my route”. Others have not embraced the professional terms and use descriptions such as “We had a big teddy bear” or “The patient was as big as a horse”.
When describing or mentioning people with an increased amount of body fat many terms are used, some are more considerate than others. This could be due to an insecurity about what the words actually mean.
BMI and classification
|Weight Class||BMI (kg/m2)||Risk of complications|
|Underweight||< 18.5||Depends on cause|
|Normal||18.5 - 24.9||Medium|
|Overweight||25.0 - 29.9||Lightly increased|
|Obesity I||30.0 - 34.9||Somewhat increased|
|Obesity II||35.0 - 39.9||Severely increased|
|Extreme obesity III||> 40||Extremely increased|
BMI calculations are based on the individual’s height and weight and the following formula is used: BMI = bodyweight in kilograms / (height in meters)2.
However, it is important to remember that calculating BMI does not always give you a balanced picture of reality. Deviations from a normal weight is not necessarily due to the amount of fat in the body. It can also be due to a change in muscle mass and fluids. This means that a pregnant woman, a muscular bodybuilder or a person with edemas wrongfully could score as obese when using BMI.
This insecurity means that it is increasingly more common to use the waste line to hipline ratio as an indicator of how health threatening the overweight is. When using these measurements it is also possible to uncover if people with a normal BMI in reality is overweight. For example, people with an apple shape, whit all the fat centered on the stomach, can have a normal BMI even though they are in the risk group.
The Danish Health and Medicine Authority defines obesity as a state where the amount of fat in the body has health consequences. Poor physical fitness, shortness of breath, hypertension, arthritis, cardiovascular diseases and other complications is often associated with obesity.
Obesity is probably the best-known term for people with a high amount of body fat. However, through the years the term obesity or being fat has obtained negative associations. Instead, words such as adipose, bariatric, overweight, severely overweight, plus size, the heavy patient or XXL patient are increasingly used. Actually, the question is if it is less offensive to call a person plus size or XXL instead of obese or overweight.
This large registry of words all describing the same term, is in my opinion contributing to the inappropriate processes in the care for this group of people. It will be of great value if everyone used the same term when describing the situation in which these people are. Imagine you the first day are described as fat, the next day heavy and the third obese. For most people this constant change in terminology is an unnecessary worry. I believe that is desirable to implement and integrate the term bariatrics when mentioning people categorized as obese.
In Denmark, the term bariatrics was introduced in 2005. Bariatrics or bariatric is a more precise and neutral description which can accommodate the many physical, psychological, social and practical aspects related to obese people. Bariatrics is the Greek definition of heavy weight. It is a combined description of the medical area which deals with reasons for as well as prevention and treatment of severe overweight, a BMI above 35 with the symptoms of obesity related illness. For example cardiovascular diseases, diabetes and arthritis, or a BMI above 40 but not necessarily with obesity related illness.
It is my conviction that the term bariatrics is the most comprehensive and most neutral word. It describes both the state a bariatric patient is in and the possibilities of treatment there exists for people with high amounts of body fat.
Read the next article about bariatrics: The difficult encounter