Using Words Wisely in Diabetes & Obesity

By Laura Andromalos

Using Words Wisely in Diabetes & Obesity

There is a call to action for health care professionals working in the fields of obesity and diabetes: Use your words wisely!

Our language choices impact quality of care for our patients. People with obesity and diabetes are often faced with stigma in their personal and professional lives. Even healthcare professionals are guilty of demonstrating bias towards their patients. This stigma is dangerous. People who experience bias are less likely to seek medical care and are more likely to have psychological stress.

Since bias can be demonstrated through language, several organizations are taking action to encourage healthcare professionals to be more mindful of their word choices. In 2017, a task force of representatives from the American Diabetes Association (ADA) and the American Association of Diabetes Educators (AADE) developed language guidelines for diabetes care and education. Similar guidelines have been published in the field of obesity by the Obesity Action Coalition and the Rudd Center for Food Policy & Obesity.

The ADA/AADE guidelines include five recommendations for spoken or written language:

Language that is neutral, nonjudgmental, and based on facts, actions, or physiology/biology

The words “good” and “bad,” such as a “good weight” or “bad blood sugar,” are not neutral. They pass judgment upon the person. We can be more accurate by using the actual numbers without attaching a judgment to them.

Instead of talking with patients about “controlling” their weight or blood sugars, we can talk about “managing” these components of their disease. In the state of obesity or diabetes, the body is not functioning properly. Asking somebody to “control” those factors in an active disease state is a nearly impossible task.

Language that is free from stigma

While “non-compliant” and “non-adherent” are commonly used in the healthcare field, they are ugly words that imply that the patient is not submissive to our will. This concept does not align with patient-centered care. When we label patients as “non-compliant,” we may be less likely to invest time trying to support them.

Instead of using these stigma-infused words, we can investigate the barriers to care and describe them with fact-based language. “The patient takes their medication 4 days per week.” “They only buy glucose strips when they can afford them.” “They cannot attend appointments monthly due to lack of reliable transportation.”

Language that is strengths-based, respectful, inclusive, and imparts hope

This is exemplified by adopting an empowering style of communication and counseling. Empowerment allows the patient to have ownership in identifying their challenges, their health goals, and how to achieve them.

Building self-efficacy by reminding patients of their previous accomplishments acknowledges their strengths. “You told me that you lost 30 pounds in the past. How did you achieve that?”

Messages of hope and reassurance can have a lasting effect on a patient’s ability to manage their disease. “The risk of complications from diabetes is greatly reduced when we work together to manage it well. I’m here to support you.”

Language that fosters collaboration between patients and providers

People with obesity or diabetes may think poorly of themselves, especially when they have internalized stigma that they have faced. They might refer to themselves as “bad” or “lazy." This can play into a power differential with the patient expecting to be disciplined by the provider for their behavior. We can use this opportunity to help patients reframe their negative thoughts and self-blame. “It doesn’t sound like you are lazy. You have a busy lifestyle and you value foods that are convenient.”

The patient is an expert in their own diabetes or obesity. They know what has and has not worked well for them in the past. Encourage patients to share this valuable insight for more productive outcomes when developing interventions.

Language that is person-centered

A person is not defined by their disease; it is one part of their life experience. We’re encouraged to use person-first language, such as “person with obesity” or “person who has diabetes”. When we describe a person as “obese” or “diabetic,” we are labeling them by a disease and implying they are a passive recipient.

While habits can be hard to change, it’s important for healthcare professionals to embrace this language movement to improve quality of care. It starts with awareness and a willingness to progress. Leverage resources from the organizations listed above for training purposes. Have discussions in team meetings. Encourage staff to politely remind each other to use empowering language. Support people with obesity and diabetes by using your words wisely.

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Orignially published on April 16, 2019, updated on April 18, 2019

Topic: Improving Health Outcomes

Laura Andromalos

About Laura Andromalos

Laura Andromalos, MS, RD, CSOWM, CDE, is a bilingual CDE Coach for Cecelia Health and the Nutrition Program Manager at Northwest Weight & Wellness Center in Everett, WA. She is an internationally recognized expert on metabolic & bariatric surgery nutrition practices. Follow her on Twitter at @LAndromalos.