Almost every visit to the doctor’s office starts the same way: You’re asked to step on the scale. This practice has become so common that we begin to think, If a doctor is asking me to do it, it must be necessary, right? What many of us don’t know is that in the majority of cases, you don’t actually need to be weighed at the doctor’s office at all. If you find weighing yourself at home negatively impacts your mental health—studies have confirmed this is often the case—then it may be worth it for you to skip the weigh-in at the doctor, too. If this sounds appealing to you, here’s what to keep in mind.
Why would someone choose not to be weighed at the doctor?
Not only does research show that patients labeled as “obese” receive a lower quality of care—with additional biases experienced by queer and Black people—but also, because they wish not to be is enough of a reason (informed consent is and should be a thing in your doctor’s office). Experts acknowledge that weight stigma extends beyond the doctor’s office and into the workplace and educational settings, among others, and have called for education to begin at both the healthcare and policy level with the goal of eventually eliminating the current weight bias. For the majority of us, our healthcare education begins in the doctor’s office, where the number on the scale is often oversimplified and seen as a direct reflection of how much we are eating, how much we are moving and how healthy we are (and again, we must mention racial and ethnic disparities that further impact this). While your weight isn’t a choice, your decision to be weighed at the doctor’s office—or at least to know the number on the scale—is. “While there may be rare instances when your weight is needed to determine appropriate dosage amounts of medications, you under no circumstances need to know what your weight is at a doctor’s visit,” shares decolonized wellness coach Dalia Kinsey, RD, LD. “If you do not wish to engage with this information simply inform your provider and it should be no problem for the provider to obtain your weight without discussing it.”
When is it medically necessary to be weighed at a doctor’s appointment?
As a family medicine doctor at Blue Mountain Clinic in Missoula, Dr. Caitlin Blau, DO, notes that if a patient comes in with a cold or mental health consult, their weight is “almost never relevant to the conversation.” As Kinsey notes, medication dosage may necessitate a weigh-in (for example, Dr. Blau notes that emergency contraception pills can be less effective over certain weights and may require a higher dose or more effective form, such as an intrauterine device), but you can elect to not be informed of the number. There are a few other cases where a doctor may need to know a patient’s weight to provide proper treatment. Dr. Blau notes that these include:
Children who need to gain weight to grow and developPatients with severe eating disordersElderly patients with dementia who have a hard time remembering to eatPatients with heart or kidney disease that affects fluid retention
“I do gently suggest that patients be weighed at least once per year,” adds Dr. Blau, “as there are dangerous health conditions that can cause sudden weight loss or gain (cancer and endocrine diseases come to mind).”
How can you set a boundary and decline being weighed by your doctor?
As Kinsey suggests, should you have to be weighed, you can ask that your doctor and their staff not report the number to you. This will involve setting a boundary, whether you voice your concerns or carry a card with you—such as the free ‘Don’t Weigh Me’ cards created by More-Love.org—to help make your limit clear. “Your consent does not cease to matter when you enter a physician’s office,” affirms Kinsey. “You always have the right to decline a procedure or any type of care you don’t want. Learning to set boundaries can be difficult for anyone but tends to be especially challenging for people socialized female with multiple marginalized identities (yes, being in a larger body in a fatphobic society counts as a marginalized identity). That said, it is crucial to find a physician that both values patient consent and is aware that the skewed power dynamics in healthcare settings make boundary setting very difficult for some patients.” Kinsey adds that setting boundaries with people in authority can be draining (especially if you are alone and navigating illness). In this case, you may want to rely on a friend or partner who can serve as a patient advocate for you. This way your boundary can be set and respected, and you can protect your energy while navigating doctor’s appointments and treatment.
How to find a “Healthy At Every Size”-friendly doctor
One way to help ensure that your boundary of not being weighed or not knowing your weight is to find a doctor that is Healthy At Every Size (HAES)-friendly. This approach to health recognizes that one’s health and weight are not mutually exclusive; it serves to promote inclusive care and acceptance for all, no matter their size. Dr. Blau recommends as a first step, asking the front desk staff if they are HAES-friendly in their approach. It should be noted, however, that just because a doctor’s office uses this label, that all bias has been removed. There are some additional steps that Kinsey adds, including red flags to watch out for. “There are many providers who are vaguely body positive that haven’t done any work to make their offices accessible to patients of size or remove weight bias from their practices in general,” Kinsey reveals. “So, simply because someone uses that label doesn’t mean they’ve created a safe environment for patients seeking HAES-aligned care. Beyond using referrals to find a provider, I recommend reviewing their website [and] online presence for red flags, like offering medical weight loss services or using imagery that isn’t size inclusive.” Finding referrals for doctors may seem daunting, but there are people out there doing the work to assist, such as Aubrey Gordon, a writer and co-host of the Maintenance Phase podcast. On Instagram, Gordon has crowdsourced for “fat-friendly doctors” and the post is a great place to start to see if there are suggestions in your city. Ultimately, you are looking for a doctor that you trust. “If you are working with a physician that isn’t making it easy for you to decline procedures you do not want, that physician may not be the provider for you,” shares Kinsey. Next up, read up on how and why diet culture may be dying.
Sources
American Medical Association. Informed Consent. Accessed 3/29/22.Association for Size Diversity and Health. The Healthy at Every Size (HAES) Approach. Accessed 3/29/22.Caitlin Blau, DO, a family medicine specialist at Blue Mountain Clinic in Missoula, MTDalia Kinsey, RD, LD, a decolonized wellness coach based in GeorgiaDuke Today. HOW SEGREGATION AND DISCRIMINATION RACIALIZED THE OBESITY EPIDEMIC. Accessed 3/29/22.Pacanowski CR, Linde JA, Neumark-Sztainer D. Self-Weighing: Helpful or Harmful for Psychological Well-Being? A Review of the Literature. Curr Obes Rep. 2015 Mar;4(1):65-72.Phelan SM, Burgess DJ, Yeazel MW, Hellerstedt WL, Griffin JM, van Ryn M. Impact of weight bias and stigma on quality of care and outcomes for patients with obesity. Obes Rev. 2015 Apr;16(4):319-26.Rubino, F., Puhl, R.M., Cummings, D.E. et al. Joint international consensus statement for ending stigma of obesity. Nat Med 26, 485–497 (2020).
