Monday, July 03, 2006

"Hey, Fatso" and Political Correctness

I saw in my Columbus Dispatch this morning that doctors are vexed as to how to break it to those that are obese that they are obese. It seems that the government, at least the Center for Disease Control and Prevention (the famous "CDC)," prefer "at risk of being overweight" for fat kids and "overweight" for obese kids. Their concern is that there is a stigma attached to the term "obese." Yo, CDC, there is a stigma attached to looking either fat or obese. I gather that the CDC sees using well-understood terms like "obese" and "morbidly obese" is piling on. There are doctors who are concerned that pussy-footing around the issue by using euphemisms is not medically helpful but are concerned with pissing off the kids and their parents.

Doctors are right to worry about what they say to obese and morbidly obese people. A cousin of mine who is a cardiovascular surgeon who dabbles with veins in other parts of the body once told a patient who was so obese she had to sleep in a chair the truth and this person threatened to sue. I don't think anything came of it but pissing patients off by telling them the truth about their weight issues is something to be concerned about.

Back when I did my research on advertising I ran across a study showing that the more negative the advertising was against cigarette smoking, the less effective it was. I believe this research has real merit for highly negative advertising can evoke people's defenses -- "Hey, I just like the taste of cigarettes" or Hey,I like myself just the way I am (i. e., fat)." The same would be true, I think, of using language with highly negative connotations in describing or characterizing a patient to the patient or his or her parent. I am not fond of political correctness but I am also not fond of overly direct, highly negative, insulting ways of referring to people.

What's the solution to this? I actually have one, learned from years of bing overweight to one degree or another for much if not most of my adult life. Here is what I would suggest doctors say to kids and adults about being overweight. I would not even say that they are overweight. I would say this (the numbers are made up by me and are for illustrative purposes only):
In your present condition at your your age, you have
an 28% chance of contracting sleep apnea
a 35% chance of contracting acid reflux
an 8$ chance of contracting glaucoma
a 65% chance of contracting high blood pressure
a 35% chance of having obstructed blood vessels in your body in some artery
a 32% chance of heart disease
a 40% chance of contracting Type II diabetes
a 6% chance of having spinal issues that could affect your ability to walk with ease
etc. Of course, should this condition persist, the odds will increase that you will contract these diseases, some of which seem to come in clusters.
I do not have heart disease or diabetes but I do have somewhat occluded carotid arteries. I do have all the other conditions or am being treated prophylactically (no glaucoma but have been treated for it prphylactically for probably 25-30 years). I would also say, "Here is a list of the names of these diseases. I want you to go home and search the internet for them at verybadthings.com and come back to me in one week for a discussion of how we can work together to avoid these things."

If the person doesn't immediately ask, "Why might I get these things?" don't worry. They already know. If they don't come back then they aren't ready to be helped.

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Blogger Full Metal Attorney said...

For once, I have nothing to really add to this discussion, as you have laid the issue and the conclusion out perfectly. Well done!

Of course, the drawback to doing everything right is that you won't have much of a discussion. :)

3:48 PM

Blogger Larry Kollar said...

You forgot "% chance of contracting Type II diabetes." My son was badly overweight, wound up diabetic, has lost a bunch of weight (by moving out and not having enough $$$ for regular meals, primarily) and has fewer problems with it. Now if he could get over his ego issues, move back home, and finish high school....

4:52 PM

Blogger The Language Guy said...

I have added diabetes to the list because this is an important one.

The ego damage would be curable by a course of dieting, weightlifting, and going forth fearlessly to attract and bed the other sex (or same sex, for that matter). Or so I believe. You might send your kid over to my blog "How to lose weight" at http://www.mlgeis.com/.

5:05 PM

Anonymous Anonymous said...

It seems to me there is a class of expressions we use that are what I would like to call "second order facts". What I mean is words that summarize more concrete facts. Obese is a word of this type.

The corresponding "first order facts" are the corresponding concrete facts being summarized. For example it might be a person's actual weight, the comparative weight of a (statistical) healthy individual with a similar frame, and the statistical likelihood(s) of contracting various health problems given the difference. (Just as you mentioned above, LG.)

We use these second order facts constantly in our speech, which is perfectly normal--if we had to refer back to the first order facts they reference each and every time we speak, it would take forever to say anything. But, I think, we often forget that they are facts of the second order, not the first.

At the same time that such terms are summary words, they are also judgement words: if we accept the fact of somebody being obese, then that carries with it certain judgements--they should do something to lose weight, they might have a psychological issues leading to obesity, etc.

The fact that such words tend to convey judgement is not in itself a bad thing. It is generally a good thing when the judgement is really just a consequence of encapsulatiing the facts. For example, if a doctor tells a patient they are obese, I expect the doctor is probably advising him or her, in a summarized way, that they are at risk and they would need to change their behavior in order to get healthy.

Nonetheless, while such second order facts do convey judgements neutrally, they are also capable of being used with pejorative connotations to convey judgements that don't actually follow from the first order facts. An example would be when calling somebody obese is used to convey the judgement that they are lazy slobs, or that they lack self-discipline.

Problems tend to arise because the message intended almost never is identical to the message perceived. The sender of a message may know that his or her intent was for the judgement to neutrally encompass the facts being summarized. But the receiver of the message can not be 100% sure of the sender's intent, so they may tend to perceive a more pejorative intent.

When such a discrepancy arises between the message sent and the message received, the use of second order facts may prove to be an ineffective method of communication. For that matter, it may even have negative consequences, as you mentioned LG, such as a doctor being sued by patients who object to being subjected to such judgemental terms.

So, seeing that our original method of communication is breaking down, we naturally cast about for alternative approaches.

One habitual approach, in this society, is to soften the words, and be more diplomatic. Such approachs often do help (I believe) and if they are effective, then we should not abandon them. Dr. Marcus Welby would probably have said this is a matter of having good "bedside manners".

Unfortunately, we often encounter a tendency to keep softening things to the point where they simply become molly-coddling drivel. Things are softened up so much that they original array of facts is simply lost in the muddle. The person who needs to know, ends up not getting the message. (And let's not forget that there are probably cases whether the intended recipient of the message is complicit in keeping the message muddled.)

Equally unfortunately, some people have become so annoyed with the use of euphemisms that they start to treat all diplomacy and message softening the same as the extreme use of euphemisms. Such people may tend to overlook the value of effective instances of message softening.

If we were more aware of the distinction between first order facts and second order facts, and the way in which they convey judgement, we would, I think, be more likely to see what you saw, LG--that when the use of second order facts--like the word 'obese' are proving ineffective, there is another mode of communication available that may work when message softening strategies won't--simply refer to the first order facts.

I guess I am taking a very long way around just to say that you are right, LG--your solution is an excellent alternative to the use of second order facts and message softening. It is just a matter of figuring which option is likely to be most effective.

7:21 PM

Blogger The Language Guy said...

ptarmigan, perhaps not surprisingly, I associate myself with your remarks. You hit on a key issue and that needs blogging on itself and that is the distinction between what is meant by the speaker and what is heard by the hearer, where the presuppositions each brings to the discourse are significantly different. A simple case is a doctor's using "obese" as a technical medical term and the patient hearing it as a judgement about the person -- that he or she is defective in some way. More generally, in the medical setting, not just doctors but also patients have medical theories that they bring to the interaction and they will normally be quite different. Doctors tend not to be aware of this and that is a bit unfortunate for a patient might couch his or her "complaint" in language that fits his or her theory but conflicts with the doctor's medical knowledge and the doctor ends up being unintentionally mislead.

8:14 PM

Blogger Ripple said...

I like to think of myself as "gravitationally challenged".

12:16 AM

Blogger concerned citizen said...

I think you are absolutely right about the doctors should approach the obese patient.

What I don't understand is why education about obesity isn't working to keep people from getting fat in the first place.
Why are the American people getting so obese? Is it because people are weak-willed when it comes to food or is it advertising pressure from the food industry? Is it because we spend so much time sitting around? Or is it a combination of things? I can't decide whether it's a complicated issue or a really simple one.

I mean, even i knew better then to have a bunch of snacks laying about the house when my kids were small. we turned the TV off in the summer. It's not that hard to figure out, as far as I can see

7:40 PM

Blogger The Language Guy said...

Some reasons, L>T.

The food pyramid the FDA advocated was probably dictated by the grain and dairy industries. It promotes the eating of bread and dairy products contiatning fats. It does not distinguish good and bad carb-contributing foods. We have big potato and wheat and corn growing farms and all of these carbs contibute to obesity, in contrast to many other vegetables -- cauliflower, broccoli, green beans, lettuces, etc.

Second, when I was a kid, there were many fewer prepared foods in grocery stores. Early on they were often high in fats. When the low fat craze hit, they took out the fats and added sugar in various forms with no real net loss in calories.

Third, there were many fewer fast food joints. McDonald's hadn't be created. So hit and run attacks at McDonald's, Wendy's, Burger King, etc. weren't possible.

And, as you note, advertising fits into the picture. If people bought no fast food and no prepared products they have not carefully examined the labels off, selected berries rather than banans and selected no-fat milk (which still has sugars in it), and avoided the "bad" (high glycemic) carbs and ate gobs of "good" carbs, we sould not likely have this problem. I seem to be losing weight doing just this though I have a dangerous tendency to cheat.

8:33 AM

Blogger concerned citizen said...

yes, & of course the general lack of exercise, by this I also mean children not playing outside as much & lack of physical labor by most of us because of modern conveniences, etc. quite the lethal combination, huh?

Can you think of any new ways to combat the problem, since the old ways don't seem to be working, anymore.

I don't mean on a personal level. i mean on the national health problem level.

Like A "Fighting the War on Fat" campaign that acually works.

Personally, i don't like the idea of molly-coddling fat people. prob. cause I'm not, but, why 'feed' someones denial?

9:50 AM

Blogger concerned citizen said...

Of course you've already done your bit by doing a great post about obesity & making good points in a nice way.

I wonder if i could do it in a funny way, make a few good points & not piss anyone off or alienate my 'fatso' friends?

10:10 AM

Anonymous Anonymous said...

Having read many of your entries with interest, I'm wondering if you have heard anything about the recent appropriation by youth of the word "gay" or if it is just a regional thing?

I teach English on the North Coast of Australia and I am in the midst of a (losing) battle against its usage, although my students now apologise if it slips out for fear of my haranguing them at length :). The connotation is negative - as in "An essay for homework? That is so gay!"

I'm interested in how widespread this new usage is and would appreciate your thoughts.

8:03 PM

Blogger The Language Guy said...

http://archive.salon.com/people/featSalon.com has an article on this. As the article says, this use of "gay" brings it back to the original meaning of being wrong-headed or lame. I don't know how widespread it is.

7:32 AM

Blogger Full Metal Attorney said...

It might be recent, as you called it, in Australia, but it's been around in my part of the US at least since the mid-90's.

2:25 PM

Blogger Theo Clark said...

Too much beating around the bush never did anyone any good. When someone's obese they know it, so a doctor need not shy away from labelling them so - but in the pro-active and constructive fashion you advocate. This is better than a euphemistic label such as "spatially challenged" or the dysphemistic "fatty boom boom" or "fatty boomba". However, giving them a research project for "homework", as admirable as the intention is, isn't particularly realistic.

Doctors could always propose an extreme make-over - Kim Beazley is considering one.

3:41 AM

Blogger concerned citizen said...

My government solution;
Make it illegal to have more then a certain percentage of body-fat.
Think of the revenue this could generate.
Make the fattys pay a 'hefty' fine. Take a court ordered class, & if they didn't slim down throw them in jail so they could sit around, eat nutritious jail food & think about it.
all the laws that would spawn off of it, too.
Enterprising entrepenoirs(?) could live off the fat of the land.

9:14 AM

Blogger Ripple said...

I like that idea, LT. The "Fat Tax". Think about it...fat people really are a nuisance.They usually take up more than their fair share of plane seat, they are harder to walk around in a crowded area, they are an eyesore at the beach (no doubt about that), they eat more than their fair share at the church potlucks, and they irritate the thin people who have to walk with them because they are always lagging behind due to their limited capabilities of forward mobility.

I'd say segregation is necessary too. If you want to keep the fat folks out of your restaurant, just have booth tables only and keep them closer to the fixed table. Also, serve only healthy foods. For instance, if I go to Hometown Buffet, I'll see a massive amount of all-you-can eat unhealthy, low quality food. I will also see a massive amount of huge people. Huge people flock to places like that. But if I go to Soup Plantation, where they serve massive amounts of healthy foods, I usually only see one other huge person besides myself.

The thing is, the solution seems simple. Eat less, exercise more, lose weight. I understand how thin people perceive us. But understand that for a few of us, it is just heredity to be fat. It takes twice as much exercise and twice as much food control as a normal person. I nearly have to be perfect to lose weight.

1:52 PM

Blogger concerned citizen said...

paul f; I HOPE you realize i was being sarcastic. :) I'm just warming up for a post on vices.

4:22 PM

Anonymous Anonymous said...

Oh, that's cool. You didn't offend me. sorry I couldn't tell you sooner.

3:22 PM

Blogger Unknown said...

I think the use of the term "obese" is appropriate in a medical setting. The term is a standard diagnosis. It is direct and descriptive. People don't like the terms "cancer" or "AIDS" either, but a good doctor doesn't weaken the language (appropriate terminology being a foundation of the practice of medicine) to soften its effect.

Also, the term "obese"--in the evening news, for instance--is used primarily in reference to its negative medical implications; it is not a schoolyard or comic insult. Its negative connotations probably have more to do with one's being reminded of having a medical condition that can, in other contexts, bring insult or embarrassment. "Acne," "hemorrhoids," and "incontinence" are potentially embarrassing terms as well, but it's not worth it to put doctors on the path of not calling something what it is in order to make someone feel better--particularly when diminishing the seriousness of the condition will actually make them feel worse in the end.

1:26 AM


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