For many struggling with body image, heading to the doctor for a specific health issue or even just a routine checkup is more stressful than it needs to be.
Weigh-ins are a standard practice before you see your doctor, but if you’ve experienced an eating disorder or are self-conscious about your weight, jumping on a scale in the middle of a busy hallway is a tall order.
But here’s an underdiscussed secret: You really don’t have to be weighed every time you go to the doctor.
“It is entirely correct that after age 18, most people do not need to be weighed at the doctor’s office,” Jennifer Gaudiani, a Denver-based physician who treats patients with eating disorders, told HuffPost.
Of course, there are a handful of exceptions: Weight understandably needs to be tracked when a patient with an eating disorder has specific weight needs in order to treat the disease.
If someone comes in and is concerned about unexplained weight loss, that needs to be measured and watched, too.
“And young children need to have weight and height monitored to make sure growth is proceeding properly,” Gaudiani said. “Pregnant people also need to have weights followed ― although they don’t need to have the weights revealed or discussed ― to be sure baby is getting what baby needs.”
But outside of exceptions like these, Gaudiani said she’s confident that “90%” of weigh-ins taken at medical offices are entirely unnecessary.
“What that means is someone coming in to talk about their depression, digestion, substance use or twisted ankle can find themselves on the other end of a lecture about weight and weight loss,” she said.
That sometimes results in weight-conscious patients avoiding health checkups altogether.
“Unnecessary weigh-ins chill patients’ willingness to see medical providers, waste everyone’s time, fail to address the most important concerns of the patient, and may push individuals into cycles of dieting, maybe some weight loss, then regaining even more,” she said.
Given Gaudiani’s thoughts on weigh-ins, she was thrilled last month when she saw these “Please Don’t Weigh Me” cards trending on Twitter:
The cards, created by eating disorder recovery site More-Love.org, read: “Please don’t weigh me unless it’s (really) medically necessary,” adding: “If you really need my weight, please tell me why so that I can give you my informed consent.”
The cards were initially free for individuals but now cost $1 (73p) each due to demand. There’s an option for health care providers to purchase a batch, at $35 (£25.67) per 100 cards. The site also offers “please don’t talk about my child’s weight” cards to parents, to kick off important conversations with kids about the often unfair conflation of weight with good health in advance of a checkup. (Children need to be weighed but the card says, “If you have any questions, ask me when my child is not present.”)
“I’m a fan of these cards because it’s a starting point where the patient or parent doesn’t have to come up with all the words and reasons themselves, but rather has the support of the card as a neutral object to try and advocate for their bodies,” Gaudiani said.
Ginny Jones, the founder of More-Love.org, created the initial batch of cards back in 2019. In recovery from her eating disorder, Jones had begun asking not to be weighed at doctor’s appointments. She soon realised not everyone knew that was an option.
Getting health care providers on board with the cards has been great ― 200 providers have ordered anywhere from 100 to 500 cards for their offices, Jones said ― but the responses she’s received from individuals has been the most heartening.
“The best feedback I hear from patients is, ‘I made my first appointment in years!’” Jones said. “I’m shocked to hear personally from so many people who are delaying health care because they hate stepping on the scale. I love that these cards give them the confidence to walk back into a health care provider’s office.”
“Under no circumstances can I know my weight. If it’s more than I expect, I amp up my eating disorder behaviours. If it’s less, it becomes a weird game where I decide to see how much lower I can go.”
- Gregory Walters, an educator who was diagnosed with anorexia in his 50s
Gregory Walters, a writer and educator from Vancouver, British Columbia, who was diagnosed with anorexia in his 50s, sees the card as a simple but effective tool to empower patients to advocate for themselves.
Being weighed triggers Walters, but in the past, he struggled to discuss it with health care providers.
“Under no circumstances can I know my weight,” he told HuffPost. “If it’s more than I expect, I amp up my eating disorder behaviors. If it’s less, it becomes a weird game where I decide to see how much lower I can go.”
Walters hasn’t weighed himself in more than 10 years. When he spent six weeks in the hospital in 2019 for eating disorder treatment, they did blind weigh-ins around 6 am every Monday.
“We always stood on the scale, facing away from it, which as a method of weighing me was affirming,” he said. “It told me the doctors and staff understood how traumatising a number related to one’s weight can be.”
Before that, he would just close his eyes when stepping on a scale at a doctor’s office and say emphatically, “I don’t want to know.”
These days, Walters’ family doctor has learned about his triggers, but he knows how hard it can be to speak up for yourself.
“It can be challenging for anyone to talk with doctors,” he said. “Their time can feel limited. As a patient you can feel intimidated due to a perceived imbalance in terms of education and knowledge.”
The card “allows a patient to quickly get a message across without having to stumble and bumble through an extremely uncomfortable conversation,” he said.
In an ideal world, it wouldn’t be such an uncomfortable conversation. Asking not to be weighed should be as simple as stating, “I’d prefer not to be weighed today.”
Unfortunately, it’s not always that easy, according to Gaudiani.
If you say you don’t want to be weighed and are challenged, Gaudiani said to tell the nurse, “Thanks for letting me know it’s standard, but this is my body, and I’m electing not to be weighed. You may write ‘declined’ on my note for insurance purposes. I’m happy to discuss it further with my doctor.”
If the doctor challenges you, bring up the medical issue that brought you into their office in the first place.
“That might sound like, ‘I have a short amount of time with you, and I really need to discuss my back pain, my constipation and my asthma today. Let’s focus on that, please,’” Gaudiani said.
How the cards could also help combat pervasive fatphobia in the medical community
Since going viral, the cards have received some criticism from people online who think the cards are enabling or will do damage to public health given the obesity epidemic in America.
Shana Spence, a registered dietitian nutritionist based in New York, said she thinks weight stigma and a larger trend of fatphobia in the medical field does greater damage to the quality of health care and health outcomes than any card could ever do.
“Fatphobia in the medical field often translates into a lack of diagnosing for ailments,” she said. “When someone goes in for pain or whatever ailment, it’s extremely discouraging to be told to just lose weight or simply ignored altogether. What are those in thinner bodies told for the same ailments?”
Spence said there are many instances when people in larger bodies are congratulated on weight loss, no matter how unnatural or unhealthy it is.
“Even a thin or straight-sized person is congratulated on weight loss because we as a society are very weight-centric,” Spence said.
A 2012 survey of almost 2,500 US women found that 69% reported feeling stigmatised for their weight by their doctors and 52% endured recurring fat bias.
As Spence pointed out, diagnoses are often missed because providers are fixated on the number on the scale rather than the full picture of health.
A review of studies published in the journal Obesity Reviews in 2015 showed that health care professionals’ negative feelings about fat bodies can lead to misdiagnosis and late or missed diagnoses, negatively impacting patient outcomes. Studies have also shown that this bias makes women and people in larger-sized bodies less likely to seek health care in the first place.
The good news is, more weight- and body-neutral doctors seem to be entering the profession.
Some doctors have adopted a Health at Every Size, or HAES, approach to public health. HAES-aligned health care providers seek to deemphasize weight loss as a health goal while reducing stigma toward larger bodies in the medical field. Most HAES health care providers believe that the current practice of linking weight to health using body mass index standards is not only biased but unhelpful when it comes to weight loss.
(If you’re looking for a HAES-informed health care provider in your area, there’s an online database that you can search by area or specialty.)
A 2017 study out of the University of Pennsylvania found that when people feel shamed because of their weight, they are more likely to avoid exercise and consume more calories to cope with this stress.
Spence noted that healthy solutions include encouraging patients to incorporate more fruits, vegetables and fiber-rich foods into their diets, work on strategies to quit smoking and focus on mental health, since stress can contribute to many health problems, including high blood pressure, heart disease, obesity and diabetes.
“There is no need to concentrate on numbers constantly,” she said.
At the very least, medical professionals should start asking patients if they want to be told their weight. When Gaudiani consults with fellow medical practitioners who aren’t quite on board with radically reduced weight checks, she asks them at least to consider asking for consent.
“A doctor or staff could say, ‘Would you be willing for me to check your weight today? I was worried last month when you said you were feeling low energy and having a harder time getting in your meals, and I’d like to follow up,’” Gaudiani said. “So much of medicine assumes permission to act upon patients’ bodies, when in fact we need to be honoring body autonomy and seeking consent much more.”