A patient asked me a wonderful question the other day – why is our office so “sensitive” about discussion of weight? Why don’t we routinely weigh patients, cover the number on the scale if we do decide to weigh, and leave weights off after visit summaries? Why do we make sure patients feel comfortable in our office by having things like gowns and blood pressure cuffs that fit their body?
Most simply, we have been taught by our society and medicine that the number on the scale is a moral judgement on whether we are “good” or “bad”. The emotional reaction some people feel to knowing the weight at the scale speaks volumes about why we do not show it. That number is not “just” a number. It leads to false conclusions about health, self-criticism and shame, and broken therapeutic relationships with healthcare. In my prior practice I used to hear patients say things in the hallway like “I don’t understand – I’ve been really good” or “let’s see if my doctor is going to yell at me.” For some patients, the discussion of weight in the exam room has long term and traumatizing effects. We feel shame does not belong in the exam room and do what we can to ease it.
There are volumes written about the sketchy science about weight as an independent risk factor – there are many wonderful places that review the science. https://haeshealthsheets.com/resources/ Whether or not someone aligns with this or understands the psychologic effect of weighing in our culture, there are quality of care reasons our practice is weight inclusive. In a visit, having a focus on weight obscures addressing medical problems and health promotion, and in many cases results in harm. As a doctor, if I decide that my patient’s high blood pressure is caused by their weight, I would spend the visit talking about the most efficient and rapid ways to lose weight. Not only is this likely to fail and potentially harm with weight cycling, these are not the most effective and sustainable ways to treat blood pressure. I would make the wrong recommendation for the medical problem at hand.
So, then, how do we utilize our scale? When patients give us permission, we may use weight like we would a lab result. With my patients, I typically do a “blind” weight at their first visit to have a reference if I need it for a prescription dose or test interpretation. If patients are not comfortable with this, we do not weigh. I may talk with them about the frequency that it is helpful. For example, in an elderly patient with decreased appetite, it may be important to follow their trend. For a patient in recovery from an eating disorder or with heart disease, sometimes it is helpful for us to follow their trend at scheduled intervals as part of their treatment plan.
Having our care weight inclusive means we do our best to provide people in any body a patient centered visit. We know that for some, visits to doctors are stressful, shaming, and not health promoting. Patients in diverse bodies comment that they appreciate shifting the focus off that loaded number and toward what will help them live happier, healthier, and longer. We shift focus to finding ways to move that are joyful and that patients can do for the rest of their lives without pain, having good relationships with food and body that lead to nourishing the body, getting quality sleep, having strong relationships and community, and reducing stress.