Refuse the Scale: “Fat” is Not a Diagnosis
By: Rachael Hope
Tags: Anxiety, Body, Health, Medicine, Mental Health

Refuse the Scale: “Fat” is Not a Diagnosis

How fat patients can reduce anxiety and stop avoiding the doctor

Photo via Representation Matters

Going to the doctor while fat is a minefield of frustration, nerves, and self-doubt. Tending to your physical well-being is a good thing, but the majority of people don’t really enjoy going to the doctor. But taking time off work, never knowing how long your wait will be, and facing unknown answers to new symptoms can be anxiety-inducing. If you’re fat, you also have to worry about whether your doctor will listen to you at all.

Why is it so hard? For starters, close to 70% of fat women have experienced weight bias in the doctor’s office, according to research from Yale’s Rudd Center for Food Policy and Obesity .

It was much easier going to the doctor when I was actively trying to lose weight. When they would inevitably remind me how fat I was, I could talk about how I was restricting my calories, attending Weight Watchers meetings, and walking for hours a day. I don’t do that anymore. I’ve left yo-yo dieting and a 0.8% chance of reaching a “normal” weight behind for self-acceptance and a focus on living my life.

Fat people can’t win. As Your Fat Friend says in What Happens When One Fat Patient Sees a Doctor:

If my practices are healthy, they are invalidated by my body. If my practices aren’t healthy, they’re proof of the deservedness of my size.

When we go to the doctor, we know we can expect gowns that don’t cover our bodies, blood pressure cuffs that don’t fit, and a lot of focus on our weight regardless of whether it has anything to do with our reason for the appointment.

Most doctors place unnecessary emphasis on weight.

Before you reach the exam room, before you say why you are there, before you meet the doctor, they put you on a scale. It doesn’t matter if you were just there yesterday, or if you are there for an ear issue or a neck problem- they always weigh you.

I broke up with my scale years ago, around the same time I decided that my self-worth was not directly related to my ability to restrict calories and yo-yo diet. A number on a scale doesn’t define me, and it shouldn’t dictate my medical care- at least not if evidence based practices are being used.

Since I don’t own a scale, it can be nice to see that even when I’ve been having a particularly fat-feeling day, my weight is not changing. But for a many fat people? Being weighed triggers feelings from stress to despair to self-loathing to panic. If you’re recovering from disordered eating, it can be extremely damaging to your progress and cause thoughts of restriction, weight loss, over-exercising and other disordered behaviors.

You do not have to get weighed.

Reminder: YOU are in charge of your medical care. Your doctor works for you.

There are a few reasons you might legitimately need to get weighed at your appointment. Maybe your provider is prescribing a medication whose dosage depends on weight or tracking a serious medical condition like like organ or congestive heart failure. But for most visits, it’s not medically necessary at all. It is part of procedure, a checklist they fill out the same way for every patient- weight, height, temperature, blood pressure.

On Be Nourished, Dana Sturtevant, MS, RD & Rachel Sterry, ND write:

There is no need to justify or explain the emotions behind the scale. The fact is that you are in the doctor’s office to be cared for. It is the responsibility of those within the practice to ensure your experience does not trigger or cause any unnecessary harm.

How to refuse the scale.

Refusing a medical procedure, even one as simple as a weight check, can feel hugely daunting. When a medical professional is asking or telling you to do something, you have been conditioned to accept what they are saying. Here are some suggestions for declining the scale, ranging from curt but polite to a bit more explanatory.

No thanks.

Please write “declined” on my form under weight.

I prefer not to be weighed today.

Could I not be weighed today, please?

I can estimate how much I weigh for your records.

I haven’t gained or lost a significant amount of weight recently.

Can you explain how my weight will change/inform my treatment today?

I’m happy to be weighed if my treatment depends on it. How will the treatment change based on my weight?

I’m going to pass on being weighed today.

It might help to practice saying these things out loud before your appointment. Saying ‘no’ is really hard for many of us, especially for women, and especially to people we perceive as being in authority. Even if your doctor has given valid medical reasons for the check, you can request to step on the scale backwards if you prefer not to see the numbers.

“Fat” is not a diagnosis.

At the majority of my doctor visits, the fact that I am fat is largely irrelevant. It’s not even a symptom. Yes, it can be a factor in the overall picture of your health, emphasis on can be. It’s just one piece of a much larger puzzle.

One of my friends suggested that a potential purpose for the every-appointment weight check is to include a code on the visit for the insurance company that reflects obesity. That is entirely not okay with me. Unless some medical issue I’m having can be proven with facts to be directly related to my weight, coding an appointment as having anything to do with my fat is fallacious.

Diets don’t work. Not only that, but gaining and losing large amounts of weight is actually detrimental to your health overall. It isn’t expecting too much to ask your medical provider to give you evidential information about why they’re making a certain recommendation.

Other ways to improve your patient experience.

Because of the way our health care system works, Americans are often in the position of largely managing our own medical care. As a fat woman, I’ve found this to be especially true, and I’ve often suggested options for treatment that my doctor didn’t suggest first. What can you do to make going to the doctor a better experience?

Ask for Chart Notes

If you prefer not to be weighed at your visits, ask them to add it to your chart. This will allow the person checking you in and taking your vitals to skip the process altogether, so you don’t have to be anxious about saying no. After two recent experiences with a digital blood pressure machine giving falsely high readings, I’ve requested that only manual cuffs be used in the future. Asking for notes to be added to your chart can reduce anxiety by preventing you from having to repeat the same things over and over.

Request Evidence Based Care

If your doctor makes a recommendation, it is not only within your right, but makes you a responsible patient, to ask why they are recommending it. Medical doctors should be well-educated and well-informed, and part of this means that they know why they are doing what they’re doing. They have access to new treatment methods and research, and should be using it in your care.

Find a Doctor who Cares

Much of your comfort at your doctor visits will depend on your trust, rapport, and personality match with your provider. It’s not always easy to find a doctor who takes your insurance and treats you in the way you want to be treated. On Huffington Post, Michael Hobbes shared these tips:

Be direct about how you want to talk about your size. You can include everything from how often you want to be weighed, what words you’d like to use when referring to your size, and how you want to talk about your weight when it’s a factor in your condition. For years now, the Association for Size Diversity and Health has offered a database of doctors who’ve committed to an approach called Health At Every Size. This means, as the name implies, that they won’t push you to lose weight, won’t make assumptions about your habits and won’t frame diet and exercise as moral imperatives. If you can’t find a doctor in the database, HAES also has a Facebook group where you can ask for recommendations, get tips and share warnings.

One of my friends used to visit a nurse practitioner who would not allow her to decline being weighed. Even when she’d been there earlier the same week, and asked to skip it, they made her get on the scale. A doctor or NP who refuses to treat you unless you get weighed does not deserve your business. A medical practitioner who refuses to acknowledge or care about doing something to you that causes you serious anxiety does not deserve to be the one managing your care.

Level Up: Don’t Let Weight Bias Stand

Finding the courage to go to the doctor and to ask for the care you want is absolutely enough. If you can achieve that, you are ahead of the game. If you’ve joined me in the realm of feeling strong and angry and like using your voice, that is awesome too!

We don’t have to continue brushing off size bias at the doctor. Almost all health-care centers or hospitals have patient advocates who are available to listen to suggestions and complaints. If you’re more comfortable writing, send a letter describing your experiences. Leave reviews on the web or in local Facebook groups about doctors who are particularly friendly or unfriendly for fat patients.

Someday, I hope we get high-level policy change spurned by our rejection of fatphobia and the false correlation between “being fat” and “being unhealthy.” Until then, saying no to being treated poorly is the number one thing we can do to promote change.

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