New Study: Weighing and Blood Pressure Part 2 - Limitations, Recommendations, and Conclusions
“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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In part 1 we began discussing the study ““Please step on the scale”: The experience of being weighed promotes sustained systolic blood pressure level” by Incollingo Rodriguez, Nunes, & Kirschner, published in 2026 in the Stigma and Health Journal.
The study sought to determine the impact of weighing in a medical appointments on blood pressure, cortisol, and perceived stress. In part 1 we looked at the participants, the intervention, and the baseline findings. In part 2 we’ll consider the limitations, recommendations, and conclusions.
Limitations
They note that the sample was predominantly “emerging adult college students” most of whom were white and “generally came from higher socioeconomic backgrounds” though they point out that younger people “tend to be especially vulnerable to weight stigma, including in health care.”
They repeat the limitation of the participants predominantly not being higher-weight, but point out that if their weight/BMI made them low-risk for previous weight stigma, then this was actually a more stringent test of the study’s hypothesis.
They note that the idea of testing this hypothesis on higher-weight patients can create “ethical quandaries” because while weighing might generally be characterized as low-risk for study participants, there may still be an ethical issue with exposing higher-weight people to a phenomenon that is known to be stressful to them.
They suggest that “A potential compromise might be replicating these findings with low-risk community participants in naturalistic health care settings”
I would like to hear more about this. My gut feeling is that this research is important and that ethical issues can be overcome and that, even in higher-weight populations where this is a known stressor, research around this does not raise to the level of unethical.
The authors also “acknowledge that our research team comprises individuals who do not identify as living in larger bodies. While we certainly can relate to strong discomfort throughout our lives being weighed in health care, we do not have lived experience to inform this work.”
I appreciate the acknowledgment but, not just in this study but in weight and health research in general I think including fat-positive/weight-inclusive higher-weight people is an important thing to do proactively.
Recommendations
We therefore suggest that, should these findings be replicated, especially in samples representing other groups, that health care systems might consider any number of variations to the standard protocol for health care visits.
One option would be eliminating weighing all together whenever it is not deemed medically necessary by the clinical care team. Moving away from routine weighing also aligns with weight-inclusive care guidelines, which have been linked to favorable health outcomes.
This is, as you might imagine, what I favor. As I said at the beginning of this series I think there is significant downside risk to routine clinical weigh-ins with very little, if any, benefit.
When weighing is medically necessary for monitoring and achieving a particular patient’s health goals, health care offices might opt to measure blood pressure prior to weighing or move weighing to the latest possible timepoint before the physician arrives or to the end of the visit entirely.
This may result in harm reduction if there is an actual medical reason for the weigh-in, like medication dosing or monitoring edema in heart failure. For general health goals, I think weight-inclusive options (where body size manipulation is not a target for intervention and thus routine weigh-ins are not necessary) are likely to provide better outcomes with less risk.
Other variations to weighing procedures that should be investigated in future research include:
Allowing patients to self-report a rough estimate of their last known weight without using a scale.
I disagree with this one - I don’t see the point. If the number is actually medically relevant then I would argue that what amounts to a guess by the patient is not helpful. I can’t think of a situation where this would be more beneficial than just not weighing the patient since, if this number is actually necessary for care the correct number would be needed.
Or ensuring weighing happens in private spaces and as sensitively as possible, for instance, by first giving the patient the option to face away from the scale.
If getting the patient’s weight is actually medically necessary then I think this is a reasonable harm reduction technique.
I want to note that in any situation where weight is being taken because it’s medically necessary, any discussion of reducing weight stigma must be paired with a discussion of documentation. There is no point to having the patient face away from the scale if their after visit summary shows their weight in big, bold font or if their weight/BMI leads to them received unsolicited, unwanted, weight loss information and advice from their provider, other connected providers, their insurance etc.
Another option the authors don’t mention explicitly but that I think is worthy of future study and that can be a harm reduction option is making the weigh-in clearly optional. Of course this still has the potential to increase the stress experienced by the patient - especially if after declining weigh-in the patient is still asked to guess their weight.
All these modifications could promote more compassionate health care while likely avoiding inadvertently increasing patients’ stress and should be investigated through health care intervention paradigms.
I think compassionate healthcare is important and I generally agree with the sentiment here. I also want to point out that the compassion is not a substitute for ending medical weight stigma (and I don’t think these authors are saying it is, I just think that it needs to be stated clearly.) Treating fat* people with “compassion” while continuing to pathologize their existence and considering them to be an epidemic/pandemic/crisis that must be fought and eradicated is not nearly good enough.
Conclusion
I’m going to copy the entire conclusion and then break it down bit by bit.
Our findings suggest that the experience of being weighed may promote sustained stress physiology outputs via systolic blood pressure, regardless of how weight is measured. This supports the assertion that weighing alone may constitute a stigmatizing experience. Standard health care practice may also glean insights from this research. Namely, health care offices might consider reconfiguring the typical order of procedures in health care visits to eliminate a structural driver of stigmatization. Future studies should replicate these results in other populations and, ideally, directly within health care settings to obtain in vivo evidence. The accumulation of this evidence will support health care interventions to develop more compassionate, inclusive care models that allow for the valid collection of important health metrics while, most importantly, avoiding inadvertently harming patients enroute to assessing their health. Overall, this work forwards our understanding of weight stigma as a nonmedical driver of health; the embedding of weight stigma in health care; and the downstream implications of the interplay of these issues.
Let’s break this down:
Our findings suggest that the experience of being weighed may promote sustained stress physiology outputs via systolic blood pressure, regardless of how weight is measured. This supports the assertion that weighing alone may constitute a stigmatizing experience.
To me this is an important takeaway. I also want to take this moment to note that something that sometimes come up with I discuss weight stigma like this in talks that I give to healthcare professionals. It is the claim that weight stigma is solved by weight loss (ie: if the patient feels stigmatized by being weighed then they should change their weight.) This is dead wrong. The world, including the healthcare system, creates weight stigma and the solution to weight stigma is for weight stigma to be ended and for bodies of all sizes to be fully affirmed, welcomed, and accommodated. While individuals get to make their own choices for their bodies, including attempting to manipulate their body size for whatever their reasons or beliefs, the idea that a group of people should have to change themselves to suit their oppressors/stigmatizers is never the answer to stigma of any kind.
Standard health care practice may also glean insights from this research. Namely, health care offices might consider reconfiguring the typical order of procedures in health care visits to eliminate a structural driver of stigmatization.
I would argue that there is absolutely no way that reconfiguring the order of procedures will eliminate this as a structural driver of stigmatization. It may be a harm reduction technique but there is still an impact on blood pressure, whether it is measured immediately after or not. Ending routine (non-medically necessary) weigh-ins would go a lot farther until we can create a world where weight isn’t pathologized/stigmatized.
Future studies should replicate these results in other populations and, ideally, directly within health care settings to obtain in vivo evidence.
I agree that this would be helpful. I also think it would be interesting to add groups who decline weight, especially if they receive pushback when they are exercising their right of informed refusal of a non-medically necessary weigh-in. I’m very curious how that experience would impact blood pressure, cortisol, and stress.
The accumulation of this evidence will support health care interventions to develop more compassionate, inclusive care models that allow for the valid collection of important health metrics while, most importantly, avoiding inadvertently harming patients enroute to assessing their health.
I’m not clear if they are suggesting here if weight is an “important health metric” but just for the record, I would argue that it is not.
Overall, this work forwards our understanding of weight stigma as a nonmedical driver of health; the embedding of weight stigma in health care; and the downstream implications of the interplay of these issues.
I agree with this in general and I think more research around weight stigma in healthcare, including as a source of iatrogenic harm, is absolutely critical.
Patient and Provider resources for weigh-ins:
Patient Resources:
Strategies for dealing with weigh-ins
What to do if you’re told you have to weigh-in
Provider Resources
Do’s and Don’ts for patient weigh-ins
Patient and Provider Resources
Are Medicare Patients Required to Weigh-in?
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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.
Wright stigma is solved by weight loss? Isn't that just another kind of "conversion therapy"?
When you add together this kind of findings with data on how badly blood pressure readings are done in clinics (not following evidence based guidelines for positioning of patient and time seated before beginning) it really paints a picture of how many people could be on BP meds that do not really need them.