Do you really need to weigh in with a doctor? some doctors say no

by Sumati Reddy | Update 3月 07, 2022 05:30 EST

More doctors are emphasizing weight loss or trying to make the mass move less stressful.

Mandatory stepping on the scale is a dangerous part of doctor visits for many patients. Now, some doctors are letting people opt out of weigh-ins.

More doctors aren’t emphasizing weight as a barometer of health as patients have lobbied for a reduced focus on weight in recent years. Health professionals say they are trying to avoid stigmatizing patients and make sure the trouble with losing weight doesn’t keep people from coming in.

“There is a tendency in healthcare to understand that weight isn’t everything,” says Natasha Bhuyan, a Phoenix-based primary care physician and regional medical director at membership-based Primary One Medical. Care practice with offices across the country. “One’s health is not reflected by a number.”

Many doctors say that weight is still an important indicator of health that shouldn’t be skipped, but they are taking steps to make the routine less stressful.

At One Medical, doctors ask patients if they are comfortable taking their weight at an annual wellness visit. The practice moved away from mandatory weight-recording when it redesigned its wellness visits two years ago, says Dr. Bhuyan. She says doctors look at a variety of metrics to assess patients’ health, such as blood pressure, cholesterol, stress, family history and alcohol consumption.

“We know that checking weights can be a trigger for many different people,” says Dr. Bhuyan.

If patients agree to be weighed, doctors give them the option of not seeing or hearing the actual number. Patients can choose to hide their weight when they access their post-visit summary.

Wet-ins have been the basis of doctor’s visits for years. In medical school, students are taught to record weight as a vital sign, says Sterling Ransone, president of the American Academy of Family Physicians and a family physician in Deltaville, VA.

Many insurers also require the recording of certain vital signs, such as weight, in order to bill them for patient visits, particularly at annual wellness visits, Dr. Ransone says.

For some medical conditions, monitoring the patient’s health requires taking and recording the patient’s weight, he says. This includes monitoring for congestive heart failure, in which weight is so important that Dr. Ransone uses a telemedicine platform that informs them of the patients’ weights every day. A difference of more than 3 pounds can be dangerous and requires attention.

For other issues, such as depression or anxiety, weigh-ins usually aren’t necessary, he says.

For most patients, Dr. Ransone says his office still conducts investigations, but takes steps to make patients less self-conscious. Therapists may let patients carry the mass backwards so that they don’t have to look at numbers, or carry their weight in a different area, to avoid potential embarrassment. He instructs employees to ask, “Is it okay for you to gain weight? Do you feel comfortable doing that?” He says it’s rare for patients to say no, but if they do, their staff will flag them off when they hand them patient paperwork.

“Having an office that is welcoming and accepting of people who are overweight is really important,” says Dr. Ransone. “A lot of people feel that they are judged based on their weight.” During the pandemic, many people have gained weight and may feel more uncomfortable being on the scale.

Doctors’ attitudes toward weight are evolving as more patients lobby to emphasize it and social movements encourage adoption and appreciation of a greater range of body types.

Weighing in at the doctor’s office can also pose particular concern for people who have an eating disorder. In 2019, Ginny Jones, 46, in Santa Monica, Calif., who says she had an eating disorder, began printing cards that read: “Please weigh me until it’s (really) medically not necessary.”

The demand for the cards has grown so much that Ms. Jones began charging for them. She says she has distributed over 73,000 cards since 2019. Most of the cards have been bought by individuals, but dietitians and doctors buy them as well, she says.

The intent behind the card is not to imply that patients should never be overweight, Ms Jones says. But he believes that patients, especially those for whom the experience is stressful, do not need to be weighed at every visit, unless it is medically necessary.

Leslie Williams-Blackwell, a family physician at Mayo Clinic in Phoenix, ordered the cards a few months ago and presented them to patients. She typically weighs patients at most visits, but wants to make sure patients don’t feel that weight is always the main issue.

For patients with eating disorders, she often does “blind waits” where they don’t see the number because they are standing backwards, or there will be a sticky note that blocks the number.

Rebekah Fenton, an adolescent medicine fellow and pediatrician at Lurie Children’s Hospital at Northwestern University Feinberg School of Medicine in Chicago, was recently pleased to see a sign that a nurse had placed above the scale in her clinic. It read: “This scale can only give you a numerical reflection of your relationship with gravity. That’s it. It cannot measure beauty, brilliance, purpose, vitality, potential, power or love.”

She recalls that as a resident, she once started discussing growth charts with a 12-year-old patient and the girl started crying. Dr. Fenton didn’t think he said anything stigmatizing, but the episode made him try harder to “disconnect health from weight”.

Now, she talks more with patients about the quality of their diet and physical activity. She asks if they want to talk about their weight. If they do, she will show them the path of their development. Patients may refuse to lose weight, or may choose to opt out of looking at the numbers.

Most do not refuse. “My patients are still growing. So I think knowing their weight is still helpful,” she says.

Anita Ravi, a primary care doctor in New York City, looks after patients who have survived gender-based violence, such as victims of domestic abuse and human-trafficking. She says she previously worked for a community health center, whose protocol included recording weights at every visit. “Weight hinders the care of some patients,” she says.

When she opened her own practice in November, she decided to take the weigh-in at the end of a visit and explain why she was taking it up. She takes steps like having patients take off their shoes or clothing to reduce pounds to improve accuracy and make them feel better.

“At the end of the day I’m not going to force anybody in a big way,” she says.