Why We Should End Routine Weigh-Ins

Weigh-Ins Part 1

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Typically before they even make it to the examination room for a doctor’s appointment fat* patients find themselves being asked to step on the scale and give their height to calculate Body Mass Index (BMI - a ratio of weight and height.)

Too often the results of these weigh-ins create a situation where the healthcare provider becomes so hyper-focused on the patient’s body size (and on manipulating it) that they fail to address the actual health concerns the patient came to them for. This does untold harm to fat patients (with the most harm being done to those at the highest weights and those with multiple marginalized identities, especially considering the racist basis of BMI*). Sometimes, as in the case of patients like Ellen Maude Bennett, healthcare provider’s weight obsession is fatal.

These routine weigh-ins can also harm people of all sizes who are dealing with eating disorders/disordered eating. The end result can be that people avoid going to the doctor, which causes missed screenings, late diagnoses and more.

Unfortunately, this sometimes gets shrugged off by healthcare professionals with a “they need to get over it” eyeroll, but it needs to be taken seriously because it’s driving both provider weight distraction and patient disengagement, and that matters.

In a fatphobic society (like the one we live in,) being weighed and/or negatively judged by a person of authority – including and especially a healthcare practitioner – can create harm that interferes with the patient’s ability to engage with their own healthcare in the future. That needs to be taken seriously, and solutions need to be offered (and let’s all be clear that “how about you just stop being harmed” is NOT a solution.)

Unfortunately, it can also be tied to compensation, as insurance providers can have specific codes for “ob*sity counseling” (which, sadly, is not counseling to help doctors stop pathologizing bodies based on their height/weight ratio, but rather counseling patients to engage in an intervention that fails the vast majority of the time and has the opposite of the intended effect up to 66% of the time.) Some facilities/insurance providers actually judge and rate practitioners based on how often they measure BMI and/or provide/refer to this counseling. Which is another good reason to do away with standard weigh-ins - again, we don’t have any ethical, evidence-based interventions to change weight and so these weigh-ins drive advice whose most common outcome is harm. (The reimbursement process around BMI and so-called weight loss counseling is a complicated one that I’ll discuss in part there of this series.) For our purposes today, it’s important to understand that how an insurance provider does or does not compensate doctors has nothing to do with the patients’ right to informed consent/refusal of a weigh-in.

In good news, getting someone’s weight is almost never actually necessary – only in a few specific cases (like medications that are dosed by weight, situations where water retention is being measured, some anesthesia etc.) The need to actually tell patients their weight, or discuss it in any way, is even more rare.

In even better news, treatments beside “try to look different” are available for all of the conditions for which weight loss is often recommended (spoiler alert - they are the treatments that are prescribed to thin patients with the same symptoms/diagnoses.)

If you are a healthcare provider, I would recommend doing some real thinking about whether getting someone’s weight is worth them dreading the appointment or disengaging from care (and if you can really justify the idea of weight loss prescriptions as ethical, evidence-based medicine.) Consider ending the practice of routine weigh-ins completely, reserving weigh-ins for medically necessary situations. Consider not telling clients what their weight is unless they ask (and even then being clear that weight diversity is natural and weight-neutral care is possible.) At a minimum, consider signage that lets people know they can refuse routine weigh-ins, no questions asked (or, as I’ve heard of some practices doing, keep these cards in your waiting room.)

The idea of weight/BMI as a “vital sign” has driven massive profit to the weight loss industry (including within healthcare,) tremendous harm to higher weight people (with the most harm going to those of the highest weights and/or with multiple marginalized identities,) and a lot of confusion among healthcare practitioners. It’s a mistake that is entrenched in the current system, but that doesn’t mean that we can’t tackle it head on - doing what we can to reduce harm under the current system, while working to change the system itself to respect the natural diversity of body sizes, the high failure rates and risks of intentional weight loss interventions, and the greater benefits (with fewer risks) offered by a weight-neutral model.

In part two we’ll discuss strategies to deal with weigh-ins.

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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.