- David P. Selzer, MD, David P. Selzer, MD, is an internal medicine doctor at NYU Langone.
- Sammy Previte, RDN, PT, Sammy Previte, RDN, PT, is a registered dietitian, certified intuitive eating counselor, personal trainer, owner of Find Food Freedom, and podcaster.
- Susan Zilberman, Susan Zilberman, is a certified mind-body eating coach at Mindful Eating Associates.
Weight is an outdated indicator of health
For most patients, doctor visits include stepping on the scale and recording body mass index (BMI). BMI is calculated using weight and height—and no other information. Using this measurement, patients are categorized as "underweight," "healthy weight," "overweight," and "obese." However, in the last couple of years, it's become clear that BMI is not the best indicator of health. For example, large, muscular people like Dwayne "The Rock" Johnson have a BMI that classifies them as overweight or obese.
Additionally, BMI can contribute to weight stigma within healthcare settings, impacting the quality of care patients receive. A 2018 paper published in BMC Medicine, posits that weight stigma in healthcare settings (unequal or unfair treatment of fat patients) is related to heightened mortality and other chronic diseases and conditions. As a result, fat patients are often less likely to seek medical attention—they might intuit that the treatment they're receiving is unhelpful.
Ultimately, there are better ways to determine health. "A total blood panel tells us so much more of what is going on inside the body. Blood pressure, Hemoglobin A1C (3 month average of your blood sugar), total lipid panel, etc. These are the numbers I want to see if someone wants to improve their physical health," says Sammy Previte, RDN, PT, a registered dietitian, certified intuitive eating counselor, personal trainer, owner of Find Food Freedom, and podcaster. There are much more important metrics than the number on the scale.
How to talk to your doctor about not being weighed
Since your doctor may weigh you as a default and might have done so in past appointments, you may need to explain why you don't want to be weighed. Let's be clear: Like any medical procedure, you have the right to refuse. Previte says, "Let them know...that it can be harmful or triggering if you see (your weight). Most doctors or nurses will respect this boundary and won't think twice." Honesty is a good policy with your healthcare providers.
Previte also suggests "working with a treatment team (dietitian, physician, therapist, counselor, etc.)" to help monitor changes in your body and reference the information you gather when talking to your doctor. "Explain that you are no longer using weight as a way to measure your health, and you would like to focus on your health independent from weight," says Susan Zilberman, a certified mind-body eating coach at Mindful Eating Associates.
Even doctors who might prefer to look at your weight need to keep your overall health, including your mental health, in mind. "Given the anxiety that patients often go through when being weighed, having a full metabolic panel is often an acceptable substitute," says David P. Selzer, MD, an internal medicine doctor at NYU Langone. "Rather than focusing on one data point, our top priority is to ensure that each patient is comfortable during their appointment."
The cases when you should probably be weighed
There are occasions when you may need to be weighed. Previte says dosing for anesthesia is an example. Many medications, including birth control and some emergency contraception, have weight thresholds and do not work well in some patients. However, unless you have had a significant fluctuation or are near the threshold for medications' effectiveness, you don't need to be weighed at every visit. You can speak with your doctor about whether or not your medication may be affected by weight.
If you have to be weighed, Previte suggests "a blind weigh-in, where you step on the scale backward and ask the nurse to write the number down and not say it out loud or show you. This way, the office gets the weight, you stay safe, and they respect your boundaries." You can also close your eyes.
What to do if you get pushback from your provider
If your healthcare provider gives you a hard time about not being weighed, Previte says, "My gut reaction is to get a new doctor." There are resources from Health at Every Size, an organization geared toward fat acceptance in the medical community, to help you find a practitioner who won't reduce your health to a number. Zilberman says, "The more you feel heard and understood by your doctor, the more comfortable you will be with the care you are receiving." Make sure you trust your healthcare provider. Pushback from your doctor about any medical treatment or procedure does not mean you have to submit.
What happened when I opted-out
After listening to Maintenance Phase and talking to my therapist about it, I decided to opt-out. At my appointment with my primary care doctor, the nurse came to get me, and, I said, "I don't want to be weighed today" (calmly, like my heart wasn't in my throat). The nurse didn't miss a beat. She diverted me away from the scale and to the exam room. She took my blood pressure, which was normal, my doctor came in, and we went over my health history and most recent blood work, all of which showed that I was healthy. It was simple—I was lucky, but I was also prepared if I had needed to stand up for myself.
I was in my doctor's office for a checkup, but there will be many times you'll visit your provider because something is wrong. A good doctor, one who values the whole patient and is willing to learn and listen, will use many more important pieces of information other than your weight to determine what's going on and how to help you return to and maintain health at any and every size.
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