The number of severely obese people is growing across the world. This also means that nursing homes, hospitals and the like are seeing an increase in obese patients. But what is the most appropriate terminology to use when dealing with this group of patients in everyday care?
By Occupational Therapist Pia Beck
Through my many years of teaching in topics related to bariatric patients, I regularly find that people use many different ways of describing bariatric clients. Some use professional designations such as 'obese' or 'bariatric'. Others have not yet adopted the professional terminology and may use derogatory names. In my experience, this is due to uncertainty about what the different expressions really mean.
Uncertainty about the terms can lead to a lower quality of care for bariatric clients. This is because we do not agree exactly what we are talking about when coordinating tasks about bariatric patients. This means that we will have different expectations for the task in hand, which might lead to insufficient preparation for a task such as moving and handling of bariatric patients.
That is why it is important to get the correct terms in place!
To classify the degree to which a person is obese, body mass index (BMI) is used as an indicator.
BMI is calculated from the individual's height and weight, using the following formula: BMI = body weight in kg / (height in meters)2.
However, it is important to note that BMI does not provide a nuanced representation of the patients' body. Deviations from the normal weight range are not necessarily due to too much body fat but may also be due to high muscle mass or fluids.
Thus, a pregnant woman, a muscular bodybuilder, or a person with fluid retention in the body may mistakenly be classified as obese using BMI.
This uncertainty makes it preferable to use the relationship between waist and hip measurements as an indicator of whether the extra fatty tissue is a health threat to the individual.
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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|
Ideally, it is the combination of the two measurement methods that in the end will indicate whether the client is overweight, obese, or bariatric.
By applying these standards, it is also possible to get a better understanding of whether patients with a BMI that classifies them as 'normal' are in fact obese. This might be the case with patients where all the adipose tissue sits right on the stomach may well have a normal BMI, even if they have a lot of the dangerous fat around the stomach.
The WHO (World Health Organisation) defines overweight and obesity as "abnormal or excessive fat accumulation that presents a risk to health". Poor fitness, shortness of breath, high blood pressure, osteoarthritis, cardiovascular disease, and several other complications are often associated with obesity.
Obese clients have a BMI of over 30 and might experience health issues because of their weight.
Bariatric is the overall term for the medical field dealing with causes, as well as prevention and treatment of severe obesity. A bariatric client or patient has a BMI greater than 40, with obesity-related diseases, such as cardiovascular disease, diabetes, and osteoarthritis.
As seen, there are some differences between whether a client is obese or bariatric. However, many times we do not know the exact figures and some patients might fluctuate between the two groups. In practice we are more likely to use the terminology interchangeably.
However, obesity is probably the best-known word for people with large amounts of adipose tissue but has developed a negative connotation over the years. This means that terms such as plus-size, large, adipose, or fat are increasingly being used in everyday speech.
Bariatric is a more precise and neutral term that can also encompass the many physical, mental, social, and practical aspects related to obese patients.
My belief is that this slightly newer term is the most comprehensive and most neutral word to use when referring to citizens or patients who are overweight or obese and should be the term primarily used when speaking of obese or bariatric patients to ensure a neutral way of referring to bariatric patients, which does not have derogatory connotations. It describes both the emotional or psychological state the bariatric patient can experience, and the existing methods of treatment. As such, it also provides health care workers with a clearer image of the task ahead.
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