The obsession with not upsetting patients can mean that the message will fail to be delivered. Obesity is a very real problem but not always recognised by the patient , particularly when suggesting the offspring are obese ,overweight or even fat. I doubt whether there are many patients who like to hear they have cancer but using medspeak such as "mitotic lesion" may fail to deliver the message. Of course communication takes time and there is no place for brutality but patients who have been upset may well show gratitude for openness at follow-up. We have had a generation of being less than truthful with the obese. Perhaps instead of a "not your fault" approach we should have emphasised the risks of a number of cancers and diabetes. Obesity is not just a cosmetic issue but is a real threat to the health of the individual - and is costing the NHS billions of pounds.

Competing interests: None declared