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If you're 'fat', why not throw away the chocolate bar?


Curmudgeonly. It’s not how I think of myself to be honest. Much as I loathe hippies I suspect I am a bit of a “flowers in my hair” type of guy at heart. Or at least I would be if I had hair. Or flowers.

Yet recently I had to phone a few wards for various reasons and I found myself becoming one of those outraged types who wanted to write to The Daily Telegraph demanding that someone bring back the birch. All because many of the people answering the telephone exhibited the social skills of Simon Cowell with a hangover.

Whatever happened to greeting, ward name, nurse name, how can I help you? Four people in a row answered the phone by saying “ello”, “yeah”, “hello” and - my personal favourite - “yo”, giving the impression that they had in fact been listening to gangster rap and waiting for puberty rather than working on a hospital ward and being aware that it was possible that a patient’s relative might be on the other end of the line.

Now, of course, I know that busy wards can make for distracted staff and perhaps mean they become so locked into the day that anything outside the immediate environment feels like an intrusion, but should callers have to ask if they have the right ward? Or even the right hospital?

‘If I put on a few pounds I don’t wobble around a bit in front of the mirror and suggest in hushed tones I may have caught “obesity”’

Anyway, maybe it’s me. Maybe I am a grump. It’s true I cannot stand bad manners. I think politeness is an expression of self respect. It reminds us - along with flip flops - that we are not monkeys.

Of course it may be that in my middle age I am drifting ever rightwards, becoming a curmudgeon because - and forgive me if this is turning into some sort of confession - the other day I found myself agreeing with something someone in the coalition said.

No, of course it isn’t any of this “big society” nonsense. I find that terribly sinister suggesting, as it does, that the most useful activities in the social world - healthcare, education, policing - can be handed over to volunteers. Rather it is the suggestion by health minister Ann Milton that we might replace the word “obese” with the word “fat”. I have long felt the word “obese” medicalises a largely unmedical body shape that has medical consequences; it may also patronise people in its attempts to avoid either being rude or the health promotion nightmare of “blaming” the patient.

Frankly if I put on a few pounds I don’t wobble around a bit in front of the mirror and suggest in hushed tones I may have caught “obesity”; I point out the fat and throw away the KitKat.

Given the complexities of self image and empowerment that underpin changing unhealthy lifestyle choices, might it not make sense to assume a language of honesty and clarity from the beginning? Perhaps the word “fat” feels rude. Perhaps it feels like an insult and so we opt for something with less history, more neutrality. But perhaps using understandable and accurate words that may genuinely empower just demand more adept communication skills? And perhaps we are too busy to apply them?


Readers' comments (39)

  • Ah but Mark, when you look at yourself in the mirror, say you are putting on a bit of fat and throw away the Kit Kat, or maybe even decide to go for a run, I fear that you are in the minority.

    I think the majority of people out there would rather think that of course it is not there own fault they are fat! It has got nothing to do with the 15 chocolate bars and triple helpings at the all you can eat buffet, it certainly isn't down to the fact that they might sit on their backsides all day watching Jeremy Kyle! So what do they do? They waddle down to their local health provider and demand a medicalisation of their chubbiness! They want an excuse. They want to blame 'obesity' on a glandular problem, or the ever present oversized bones.

    Now I agree with you on the communication front, as I have argued on other posts using a clear, honest style of language is not about dancing round the patient, laughing and pointing and shouting fatty fatty fat fat at them (as some other posters seem to think anyone who speaks plainly is apt to do).

    We can incorporate our language skills, our education skills, into the format of plain speaking and honesty. For example I can speak plainly to an 'obese' patient, saying to them that they are obviously too fat and need to lose weight before it causes a lot of health problems (if it hasn't already). They are often not stupid and know this already. The so called 'nightmare' of blaming the patient is perhaps exactly what we should do in some circumstances. In many many cases it IS their fault they are fat! Then it becomes a matter of education, of stating plainly that the only way to lose that fat is to put down the Kit Kats and excercise. What is wrong with saying it is your lifetyle that has caused this, it is your fault you are fat, only YOU can make that lifestyle change and do something to lose the weight? To skirt around the issue with medicalised terms, calling them obese etc, does noone any favours at all.

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  • Good point Mike, but how many will be compliant if you just point out they need to do something? It is their fault, which they already are aware of. If for years these 'obese' people have sat infront of the telly all day and overeat, how are they going to change their patterns? I would think it would be best not to blame them but to ask about what their lifestyle is like now, what do they eat, how much exercise do they take and take small steps at changing their lifestyle, or else they will just rebel and being reminded it's their fault might just make them get worse.
    I am currently a student nurse and I have an autistic child of 15, which I must admit has taught me a lot about behaviour and behaviour patterns.
    People who are overweight are overweight for a reason, but unlike drug abuse, alcohol abuse or cigarette smoking which in some cases do not present themselves physically, 'obesity' is plainly obvious. So yes, I agree education is a big part but stating the obvious may just not be the obvious way to deal with it. I could point the obvious to my son, but without any explanation he will only do how he sees it should be done. Small steps are better than big ones and will in the long term create better results.

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  • Excuse me? You "loathe" hippies?? What did these generally peace loving, kind and giving, chilled types do to deserve your loathing? Surely there are much, much worse things in life than having flowers and hair? I am disappointed.

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  • Yum

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  • That kitkat was lovely

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  • We frequently use medical terminology to soften the blow. We should use the right language to engage with a particular patient. I agree, we should be straightforward but not to be underhandedly insulting. Obesity is largely lifestyle but it is also complicated and leads to serious medical problems.

    Not quite sure why the hippies got dig either.

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  • Yes yes yes, do away with the politically correct terminology and call a spade a spade. Fat is good , it describes what is happening to the person. Five young boys got into the same swimming pool as I was in and they all had bigger breasts than me , 38 c........ so we do have a problem. Is it down to terminology or our fast food , eat on the hoof , take away society? I like most of you have heard the immortal phrases " I eat like a bird " and " I only pick at food " from large people about to undergo bariatric surgery. Education , parents , children , school cooks, the ruddy food industry which loads our plates with unwanted trans fatty acids , salt , sugar and rubbish. We all need to take a stance on this issue to get any results and save children from the teasing and torments of their school mates over their fatness.

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  • May I be so bold as to suggest that the current dietary advice expounded by the government is flawed?? It certainly flies in the face of the diet which sustained mankind for millions of years - the hunter gatherer "diet" which consisted of anything they could forage during the day - fruits, nuts, edible vegetation with the hope of a feast at night if the hunter was able to slay a beast, giving them the protein their bodies needed. No processed foods, no bread, rice, oats, white pasta NO FAT PEOPLE!!! The restricted diet during the war years of rationing also meant hardly anybody was fat. Since then, the food industry has burgeoned, introducing delicacies processed to within an inch of their life and advertised at prime times on T.V., enticing parents with the promise of quick, "healthy", tasty meals for their family - what they don't tell is the hidden salts, sugars and fats in each concoction.

    Yes, I am currently overweight by about two stones. Yes I have dieted in the past (for the greater part of 32 years but can never quite keep it off). I am NOT out of control, I enjoy a bar of chocolate now and again, I don't overeat at mealtimes, I eat a "healthy" diet with plenty of fresh fruit and vegetables, I am well educated and reasonably fit and healthy but still have a weight problem.

    People, especially those on a limited budget need taught how to cook meals from scratch, not depend on processed meals that are continually advertised on TV. Time we got back to basics with big pots of homemade broth, mince and tatties with carrot turnip and onion, good wholesome, filling food.

    Unfortunately, many people do not know HOW to cook, having been brought up themselves on a diet of processed foods and takeaways (I'm not one of the by the way). So......back to basics in our schools - teach our kids how to cook from scratch, make it part of the national curriculum, let them taste these meals and how good they can be. God I sound like Jamie Oliver but the guy HAS got a point.

    Anyhow Mark, I'm with you on your comments about telephone manners, nothing more infuriating. I make sure my team always answer the phone properly, giving our location and their name, enquiring how they may be of help. Up the workers!

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  • Pardon me, but is it not the patients own fault generally for becoming obese... for ending up on the larger end of the scale. Regardless as to what excuses, (yes, excuses) these fat/obese people may use to explain their label.... it is down to them to make a change for the benefit of their own health. Is it not our role as nurses to promote health and well being... surely by being honest with the patient about their probably self-induced state of poor health and any further complications they are bringing upon themselves, this is the only thing that will make them want to do anything positive to loose the weight. As i stated earlier, it is the "label" that allows them to live with themselves and sit about binge eating and depriving themselves from any real quality of life. All we can do is educate our patients, and the life choice is theirs.

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  • I apologise to any hippies I may have inadvertently offended in the making of this clearly disposable and light hearted reflection on the world.
    Of course I don't imagine most of them care, given they are probably hanging out with some wagon wheels and joss sticks listening to Emerson Lake and Palmer but nonetheless loathe is too strong a word Anonymous you are right.

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