New Study: Weighing and Blood Pressure Part 1 - Study Basics

“Please step on the scale”: The experience of being weighed promotes sustained systolic blood pressure level by Incollingo Rodriguez et al.

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I recently spoke at the Association for Weight and Size Inclusive Medicine’s Spring Scientific Assembly. Speakers were grouped into blocks and this study was presented by the lead author, Angela C. Icollingo Rodriguez in the same block as me and I think it’s an important area of study.

An incredibly common sequence of events at any healthcare visit occurs when they call the patient’s name, they put the patient on a scale to record their weight, then they take the patient’s blood pressure.

I’ve previously made a case for ending routine weigh-ins (which is to say weigh-ins that aren’t medically necessary, like for a medication that needs to be dosed by weight, monitoring edema as a side effect of heart failure etc.) because I believe there is significant downside (for example, patients delaying or disengaging from care due to the stress of the weigh-in including past harm, like healthcare providers making unsolicited comments about a patient’s body/size, body shaming the patients, and/or ignoring the patient’s concerns and instead delivering an unsolicited weight loss lecture,) with basically no upside. I wrote about all of this in detail here.

This new study is beginning to build data for another possible reason to skip routine weigh-ins - it may create artificially elevated blood pressure.

The study is called “Please step on the scale”: The experience of being weighed promotes sustained systolic blood pressure level” by Incollingo Rodriguez, Nunes, & Kirschner. It was published in 2026 in the Stigma and Health Journal.

Summary

Researchers created mock healthcare visits for 190 undergraduate students, most of whom were not higher weight. They divided the students into three groups: one group was not weighed at all, one group weighed themselves and entered the information into the computer, and one group was weighed using the standard protocol for healthcare visits. The researches took a baseline blood pressure and saliva sample, and then took one additional blood pressure and saliva sample, and then a final saliva sample, each 20 minutes apart. They found that baseline systolic blood pressure was slightly elevated and that for those who weighed, either self or standard, systolic blood pressure remained at that level. For those who weren’t weighed at all, systolic blood pressure dropped. There were no other statistically significant differences including in diastolic blood pressure and cortisol. This suggests that weighing patients prior to taking blood pressure could impact the blood pressure reading. In part 2 we’ll discuss the study’s limitations, recommendations, and conclusions.

Deeper Dive

The authors declared no conflicts of interest.

The researchers hypothesized that “merely being weighed in a health care setting may be weight-stigmatizing and promote downstream stress reactivity.”

To test this hypothesis the researchers put 190 undergraduate students (43% male and 51% female with an average BMI of 24.29) through a randomized experiment set around a mock healthcare visit.

Participants were randomized into one of three groups.

Researchers took baseline blood pressure and a saliva sample and then each group proceeded:

Group 1 (non weigh) were placed in a room alone to fill out questionnaires on a computer. Twenty minutes after taking the saliva sample the researchers came back and took their blood pressure for the second time along with a second saliva sample. There was another 20 minutes of questionnaires and then the third and final saliva sample. The researchers noted that the reason for the 20 minute intervals is because that is how long past research has demonstrated that it takes for changes in circulating cortisol levels to show up in saliva. After all measures were collected the participants were moved to a difference room to have weight and height measured and BMI was calculated. It was a deliberate choice to collect these measurements last so they did not affect any of the study measurements or questionnaire answers.

Group 2 (self-weigh) were placed into a room and told that they would be taking their own weight and after a tutorial on how to use the scale they were left alone to take their weight, then moved back into a room where they self-reported the weight into an electronic form. Then they used the same computer to fill out questionnaires. Researchers took the second saliva and blood pressure 20 minutes after the self-weighing and the third saliva sample 20 minutes later. Finally, height was measured.

Group 3 (standard weigh-in) This group had both weight and height measured immediately after the first saliva and blood pressure were taken, as would typically happen in a standard healthcare appointment. Then questionnaires were completed and saliva and BP were taken as in the other two groups.

After everything was done, the participants were debriefed and told that the purpose of the study was actually “about whether patients find being weighed during medical visits to be stigmatizing and whether the experience is less stigmatizing if a patient weighs themselves. We are also interested in how the experience of stigma might affect our feelings of stress and our body’s physiological stress hormones, which is why you provided those saliva samples.” Participants were given the option to withdraw their information but none did. Participants were compensated for their participation.

Psychosocial Measures

Self-reported demographics

“age, sex assigned at birth, gender, year in school, ethnicity, socioeconomic status (indexed by total household income and homeownership status of their parents/guardians).”

Self-Perceived Body Weight

Subjects answered the question “which of the following best describes how you see your own body” using a 7 point scale from “very thin” to “very heavy”

Perceived Stress

They responded to a series of a statements using the 14-item Perceived Stress Scale indicating a frequency using a 5-point scale from “never” to “very often”.

Physiological and Anthropometric Measurements

Blood Pressure

Systolic and diastolic blood pressure (mmHg) were measured using an iHealth Track Smart upper arm blood pressure monitor. Best practices were followed including participants being “seated with the arm resting on the table, legs uncrossed, and feet on the ground.”

Cortisol

This was measured through the saliva samples.

Height, Weight, and BMI

These were captured using a standard physician balance beam scale with an attached stadiometer without shoes or any heavy outerwear. Weight was measured to the nearest half pound, height to the nearest half inch. BMI was calculated according to the standard formula (weight in pounds time 703 divided by height in inches squared.) Two participants were removed due to data entry errors that created “implausible BMI values” of 2.52 and 4.26.

I understand why this study calculated BMI, it’s a common measure. That said, BMI is also incredibly problematic and I do wish these researchers would have at least mentioned these issues.

Basic Findings

Psychological stress

There was no significant difference in perceived stress among the three groups.

Systolic Blood Pressure (this is the top/first number)

Controlling for BMI, those in the self-weighing and standard weighing groups had sustained systolic bp from baseline to immediately post weighing but those who didn’t get weighed had decreased systolic blood pressure over the same time.

Diastolic Blood Pressure (this is the bottom/second number)

There were no significant differences.

Cortisol

There were no significant differences.

Discussion

The researchers characterized these findings as suggesting that “being weighed can affect autonomic stress activity and have implications for health care. Namely, blood pressure is a primary health assessment tool, one which may be artificially inflated if collected after weighing, as is the norm.”

Said another way, if weighing-in impacts blood pressure then it’s an issue that in a standard healthcare visit the patient is weighed and then blood pressure is taken. The authors note that, in fact, the baseline systolic average was slightly elevated (>120 mmHg) in all groups which the researchers point out may suggest that the idea of a healthcare visit/trip to the lab may be inherently stressful. Only the systolic bp in the group who were not weighed decreased over the experiment.

One potential confounder that the researchers mention is that weighing does require physical movement while the non-weigh group was seated, though the walk to the scale was about 15 feet on level ground they still recommend that future research factor this in.

The researchers note that the finding of no impact on diastolic bp is consistent with past research that finds that the link between social-evaluative stress is strong with systolic bp and that systolic bp is thought to be preferable for indexing stress “given its more proximal link to sympathetic nervous system activation” and that there are arguments made that systolic bp is/should be the primary concern in terms of hypertension.

The authors also point out that the average BMI was below the BMI for “overw*ight” or “ob*se.” Problematically, this study uncritically uses weight loss industry driven, “person first” language for higher-weight people which is, in and of itself, stigmatizing. (Note that if you are being pushed to use this harmful language, I have created a tool to push back.)

Still the authors acknowledge that higher-weight people may experience additional stress in these scenarios. The authors acknowledge the need to replicate this work with those with different lived experience and I fully agree.

The authors also point to the available scales to measure perceived stress as a limitation and recommend larger sample sizes in future studies and, again, I agree.

The authors mentioned that they thought that self-weighing might be less stressful but note that wasn’t the case for systolic blood pressure and the authors wonder if this might be due to the self-weighing group still entering their weight into a form for later viewing or that it may simply be that internalized weight bias makes weighing in stressful regardless of whether it is standard or self weighing.

The researchers note that these findings “suggest that the weighing that happens prior to the blood pressure measurement may perhaps be artificially inflating the subsequent measure of this predominant health indicator [blood pressure].”

Here I want to emphasize that capturing weight (which is not a health measure,) may be impacting capturing something that actually is an important health measure.

The authors point out the possibility, that we’ve discussed here before, that if the process of weighing (and I’ll add, the stress of medical appointments, including based on past experiences of weight stigma) creates higher blood pressure, then the assumption may be that the higher blood pressure is due to the patients body size, and that this may also extend to other populations. The example they use is a pregnant women whose “artificially elevated blood pressure readings may falsely increase concern over preeclampsia and heighten a mother’s anxiety over the health of her pregnancy and child.” (I’ll note that this may be exacerbated in pregnant people with additional marginalized identities.)

The authors note that the study has strengths including the use of an ecologically valid paradigm (mimicking real-world settings,) the use of multiple measurements, and a sample that represented both men and women suggesting that stigma may be felt broadly (and I’ll add that the included expansive gender options, which is far too rare in research, and there was a transgender participant.)

In part 2 we’ll discuss the study limitations, recommendations, and conclusions.

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*Note on language: I use “fat” as a neutral descriptor as used by the fat activist community, I use “ob*se” and “overw*ight” to acknowledge that these are terms that were created to medicalize and pathologize fat bodies, with roots in racism and specifically anti-Blackness. Please read Sabrina Strings’ Fearing the Black Body – the Racial Origins of Fat Phobia and Da’Shaun Harrison’s Belly of the Beast: The Politics of Anti-Fatness as Anti-Blackness for more on this.