What if they tell you that you have to weigh-in?

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Before we get into today’s topic, I’ve had a ton of requests to write about Serena Williams decision to talk about getting on GLP-1s for weight loss through the company RO, which her husband is an investor in and on the board of. I want to point you (specifically for this topic and generally for her incredible work) to Chrissy King’s Substack The Liberation Collective.

On to today’s topic of compulsory weigh-ins. This came up during a monthly Subscriber Ask Me Anything. Many patients, of all sizes, choose to opt-out of routine weigh-ins for a lot of reasons. For some it can be a trigger for disordered eating/eating disorders, for others getting a weight and/or BMI calculation can lead to provider weight distraction that compromises the care they came to the doctor for, still others decline as a way to push back against a weight-centric paradigm that hyperfocuses on patient weight over actual health and leads to be getting weighed before they see the dermatologist for a rash. In the past I’ve written about why I think we should put an end to routine clinical weigh-ins, options for dealing with weigh-ins while they are still happening, and how healthcare providers should (and should absolutely NOT) handle these weigh-ins.

But what happens when you decline a routine clinical weigh-in (again, not a medically necessary weigh-in that has a specific medical purpose like dosing medication,) but one that is just being done because you are at a doctor’s office) and they tell you that you aren’t allowed to decline. There are two reasons that I’m typically asked about:

1. Insurance requires you to be weighed in

2. The software requires that I enter a weight

Let’s look at options for each in turn. I want to say that in each of these situations, you get to decide what you want to do based on how you are feeling, the situation, what you need, how emergent the issue is etc. If you decide to just get weighed in because you aren’t in a place to deal with the hassle or because you need something from the provider, or for any other reason, that is always a valid option. You can ask to stand with your back to the scale, and you can ask that it not be charted, but do know that there is no guarantee that it won’t be charted and that you won’t see it on your after-visit summary or that it won’t be brought up in your appointment.

I will also say that I feel for the people who are in charge of taking vitals - they are often overworked, underpaid, may be at the bottom of the chain of command and have likely been told that it is very important that they get a weight from each patient (in some cases, particularly Medicare or Medicaid patients, it might impact provider reimbursement amount, thought it doesn’t have to.) That said, my first obligation is always going to be to the patient because it is their healthcare that is getting compromised by a weight-centric paradigm.

Finally, as always, feel free to modify these scripts to work for you. The parts in bold are parts that I would suggest keeping.

Insurance Requires You Be Weighed In

I’ve checked this a number of times with different insurance companies and it has never been true. There may be certain procedures or situations in which insurance requires what they consider to be a medically necessary weigh-in, but in terms of a routine clinical weigh-in I have, again, never once found it to be true. Maybe this is just a persistent myth, or maybe it’s an intentional method of getting the patient to do what the provider wants. but either way it’s a problem.

Some options for handling this are:

You can ask for proof. “I’ve never heard of that/I’ve refused weigh-in previously with no problem, can you show me where you got that information so I can understand?”

Go ahead and call your insurance and ask if they require that you be weighed in every time you go to the doctor, then you can confidently reply “this is a surprisingly common myth, but I checked with my insurance and it’s not true.”

Say “I’m going to exercise my right of informed refusal of this weigh-in, I’ll deal with my insurance company if it becomes an issue for them.”

I have heard people say that they put it off by saying “I’d like to talk to the doctor to see if this is medically necessary.” This may lead to everyone forgetting about it, but be aware that it may also lead to the precious time you spend with your doctor being spent talking about this.

Software requires that I enter a weight

I would recommend that you first ask:

“Can you clarify – are you saying that the software will not let you move forward without putting a weight in and there is no way to indicate that I declined the weigh-in?”

If they say yes:

“I’m so sorry – the software is creating a really frustrating situation for both of us! I am exercising my right to informed refusal of this weigh-in, and of course I don’t want to falsify my medical records by using a random number. Can you try entering the number 1 and see if that satisfies the software?”

You can also just skip to “If you are required to put in a weight, please try to put in the number 1”

If it doesn’t satisfy the software:

“Thanks for trying. I’ll just decline/give my informed refusal to the rest of the intake at this point and I can talk about it with the doctor.”

If you have bandwidth/desire, when you check out ask at the front desk who you can talk to in order to solve this situation and/or file a complaint. Software does not have the right to bully patients into giving up their right to informed consent/refusal or forcing them to do something that’s harmful for them.

As always, the difficulty here becomes our problem, but it is absolutely not our fault. This shouldn’t be difficult at all. In a weight-neutral/Weight-Inclusive paradigm healthcare would be focused on our actual health rather than obsessed with thinness, and weigh-ins would be conducted only when necessary to monitor actual health.

Editor’s note - this piece originally used a phrase that has since been replaced with chain of command that was inappropriate and offensive. I don’t wish to repeat the phrase and cause further harm, but it is explained here in point number 5. Thank you to the reader who pointed out the mistake. I make no excuses or justifications, I was wrong and I apologize.

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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.