Language matters when talking about weight

Language and communication are incredibly important in health care. ‘Good’ communication supports ‘good’ patient care. But there are some areas where clinicians may be unsure what ‘good’ communication looks like. In 2018, the NHS England guideline ‘Language Matters: Diabetes’ aimed to share the details of good communication between doctors and people living with diabetes. Importantly, the document drew on a range of evidence, was developed by a group of experts which included people living with diabetes. This guideline was incredibly well received, so much so that in May 2019 development started on a guideline, for another condition for which clinicians and patients have reported difficulty with ‘good communication’…Language Matters: Obesity.

My SPCR- funded DPhil, and subsequent BHF funded research, focus on audio recorded interactions between doctors and patients with obesity. I used an in-depth qualitative method called ‘conversation analysis’ to identify conversational patterns used by clinicians and patients when talking about obesity, and associate these patterns with post-consultation data regarding the actions that patients took on their weight after the consultation, and patient-reported scores for how ‘appropriate’ and ‘helpful’ the discussion was. Because of my experience in this area I was invited to take part in the development of the new ‘Language matters: Obesity’ guidelines.

Myself and Dr David Strain, from the University of Exeter, led an expert panel. This included stakeholders from Obesity UK, doctors, dieticians, clinical psychologists, obesity researchers, nurses and representatives from NHS England Diabetes and Obesity. The finished guideline busts some myths about obesity, including its causation, and encourages clinicians to communicate differently. We highlight conversational alternatives to things that clinicians might think are good ways of communicating but, in practice, may inadvertently contribute to the stigmatisation of people with obesity.

Specific results from my SPCR-funded work are used in the guidelines, one thing my research identified was a conversational technique called ‘paraphrasing’ (eg “you said x “ or “you were saying y”). I found that, if doctors paraphrased something a patient had previously said, when talking about weight, patients were more receptive to subsequent advice. Resultingly, one of the things the guidelines state is that doctors should try to mention what patients have previously said.

Working with a group with such a range of experience, meant that my knowledge from my SPCR-funded primary care research, has contributed to broader guidelines which can be used in primary care, but also by clinicians working across all other fields of health.

This guideline is published by Obesity UK, and will be launched later this Spring.

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