Though it is assumed by most that checking the number on the scale is necessary for our medical care, it’s time to question this assumption. Dr. Metz shares research based information supporting skipping the scale.
I am an Internal Medicine physician and the owner of Mosaic Comprehensive Care, a primary care medical practice in Chapel Hill. Our practice offers a unique approach to health and wellness that breaks the mold of typical medical care. One of the biggest differences between our practice and others is that our patients are not asked to get on a scale as part of a standard medical visit.
As most of you know, a weigh-in is typically the first thing that happens at a medical appointment, typically in a public area of the office with others around. Then, during the visit with the provider, weight loss and dieting are often the focus of the appointment no matter the reason for the visit.
Though it is assumed by most that checking the number on the scale is necessary for our medical care, it’s time to question this assumption. You may be surprised to learn that the research does not back up the routine weight check at the doctor’s office.
Have you ever wondered where the BMI scale came from?
The Body Mass Index (BMI) measurement was created by a Belgian astronomer and mathematician in the 1800s to define a normal distribution of body sizes in men, not to define health.
The BMI categories that are currently used were created later without adequate research to support the definitions of “normal”, “overweight”, or “obese” as being measures of health. In fact, studies looking at the BMI and health show that people with a body size in the “overweight” category actually live the longest, and that people with a “normal” weight and “obese” weight have the same life expectancy.
In reality, there is a normal variation of body sizes, and recognizing this size diversity is important in separating weight from health rather than pathologizing body size.
Most people who have gone on diets in their lifetime are well aware that they are highly ineffective at achieving their intended goal of sustained weight loss.
People are often led to believe that their diet wasn’t successful because they didn’t try hard enough or that there must be a new or better diet out there that would work for them. However, many research studies have confirmed that almost all people (at least 95%) who lose weight on a diet will regain the weight within 5 years, and that many of those people will regain more weight than they lost.
This very common fluctuation in body size with dieting, known as yo-yo dieting or weight cycling, has been shown in many studies to lead to health risks, including high blood pressure, diabetes, heart disease, and a shorter lifespan.
The research makes it clear that dieting as a medical treatment is ineffective and carries health risks. Is there any other treatment we would be willing to accept that is guaranteed to fail in 95% of cases and could also be harmful to our health?
Weight stigma refers to internalized negative attitudes about weight. All of us carry some degree of weight bias living in this society.
When this stigma based on body size is internalized, it causes a stress on the body that can lead to an increase in health risks, including diabetes, high blood pressure, heart disease, metabolic syndrome, high cholesterol, and eating disorders. Therefore, when there is a focus on weight within medical care, healthcare providers may actually be causing an increase in the risk of the very health conditions they are intending to prevent.
So, should a weight ever be checked at a medical visit? The answer is rarely, but there are a few medical indications for checking weights:
For the vast majority of medical visits, checking a weight is not necessary or helpful.
When there is an indication for a weight to be checked, it can be done “blindly” so that the individual does not see the weight and it can just be used for the specific clinical indication by the healthcare provider in their treatment.
When we take the focus away from weight in medical care, there is so much more that we can focus on for our health and wellness. This paradigm of care is called weight-inclusive care, or the Health at Every Size® approach.
The most important aspects of this approach are recognizing size diversity and acknowledging that all people can pursue health irrespective of body size.
We know that in addition to genetics and social determinants of health, behaviors can be important for promoting health and wellness. This includes engaging in enjoyable physical movement, stopping the cycle of dieting, and learning intuitive eating principles. Weight-inclusive care also frees up time for providers to focus on preventive care, and to ask about social factors, life stressors, and mental illness, which can negatively affect long term health.
The possibilities become expansive without the obligation of both provider and patient to center their care on weight.
Despite this clear scientific support for avoiding weights at healthcare visits, we know that it is still part of the routine at most medical practices. However, it is your choice to decline to be weighed. It may seem daunting to decline a weight at a medical visit, but it can be done!
Here are some practical tips for avoiding weight checks at medical visits:
Health and wellness goals can be pursued by all without a focus on weight. Skipping the scale at the doctor’s office is evidence-based, health-promoting, and most importantly, your choice to make.
O’Hara and Taylor. What’s Wrong With the ‘War on Obesity?’ A Narrative Review of the Weight-Centered Health Paradigm and Development of the 3C Framework to Build Critical Competency for a Paradigm Shift. Sage Open. April-June 2018. 1-28.
Linda Bacon. Health at Every Size. 2008.
Linda Bacon and Lucy Aphramour. Body Respect: What Conventional Health Books Get Wrong, Leave Out, and Just Plain Fail to Understand about Weight. 2014.
Letter for Healthcare providers about weight-inclusive care from Mosaic Comprehensive Care and Lutz and Alexander.
Do Not Weigh Me cards from More-love.org
Cards with Helpful phrases for the doctor’s office, created by Ragen Chastain.
Dr. Louise Metz is an Internal Medicine Physician who has expertise in the medical
management of eating disorders and gender-related medical care. She is the owner and
founder of Mosaic Comprehensive Care, a medical practice in Chapel Hill that offers
weight-inclusive primary care and gynecologic care for adolescents and adults of all genders. She is committed to increasing access to inclusive and affirming medical care for all individuals, and is
passionate about changing the paradigm around weight and health in medical care.