Three years ago, I made a decision that significantly improved my health and well-being: I stopped getting weighed at the doctor. It was just a few months after I’d begun intuitive eating coaching and a regular fitness routine, and I suspected my weight had actually dropped a bit. But the scale had been played such a huge, damaging role in my life up until that point, influencing my every decision and triggering any number of harmful behaviors. Tossing my bedroom scale had changed everything for the better, so when I came in for my annual check-up, I was legitimately terrified of what might happen if I stepped on my doctor’s. I asked him, tentatively, if I could just turn around when he weighed me so I wouldn’t see the number. He paused, then replied: “You know, I don’t have to weigh you at all, right?”
In a word: no. I did not know this, and judging by the stunned looks on people’s faces when I told them, nobody else did either. In the years since, I’ve talked a lot about this topic with my own doctor and others, learning a lot more about the subject on the way. Yes, weight bias is real, and a huge problem in the medical field. But there’s also a lot of worry and unanswered questions on the patient side. The only remedy for that is to ask.
To that end, I spoke with Dr. Deborah Ottenheimer, MD, an OB-GYN, and Dr. Michael Lief, MD, a primary care internist — just to clear a few things up. This year, I began getting weighed at the doctor again (though I still don’t look at the number myself). I’m glad! For me, personally, getting a little more relaxed with the scale is a sign of the progress I’ve made. But I never would have gotten to this point had I not first stepped off the scale, and started asking questions. If you give yours a chance, you might be surprised at the answers you get. Read on to learn more.
The Anti-Diet Project is an ongoing series about intuitive eating, sustainable fitness, and body positivity. You can follow Kelsey's journey on Twitter and Instagram at @mskelseymiller, or right here on Facebook. Curious about how it all got started? Check out the whole column, right here.
1. Yes, you’re allowed to skip the scale.
There are some circumstances where your doctor might want to know your weight, right then and there (more on that later). But you have every right to ask to skip the scale during an appointment, and your doctor’s answer may surprise you.
“Weight plays a role in certain things, but it doesn’t paint a whole picture of health by any stretch of the imagination,” says Dr. Lief. An annual exam, in particular, should give your doctor many other measures to go by, like blood pressure, lab-work, and — equally important — everything you tell them about your lifestyle. “If you’re getting regular exercise, I’m much more interested with that than the number on the scale,” he says.
It’s so important to be honest with your doctor, and many people struggle with that too, for fear of judgment. “Hopefully, if you get to know your doctor over time, you develop that trust,” says Dr. Lief. If removing the scale from the equation helps you feel more comfortable to share things with your doctor, consider that as well. It never hurts to ask.
2. Speak up — clearly.
Some doctors ask before weighing a patient. But don’t expect your doctor to be psychic. “I think, generally, women express a lot of anxiety about the scale,” Dr. Ottenheimer says. “Some of it’s real, and some of it’s conversational. ‘Oh my god, I can’t believe that [number].’” It’s a fair point; being worried about weight is (sadly) a well-established social norm, particularly for women. Your doctor probably hears that knee-jerk response to the scale a dozen times a day.
“Some people walk up to the scale saying, ‘Oh my god, this is going to be the worst part.’ And I’m like, ‘ Really? ‘Cause if it really is, then let’s not do that,’” Dr. Ottenheimer says. Don’t be afraid to clearly state, “I’m not comfortable being weighed today.” If you do weigh yourself at home, tell her the most recent number. Or if your clothing size has changed since your last appointment, let her know.
3. Be mindful of your history.
If you’ve ever struggled with disordered eating, odds are you have some feelings about the scale. In a perfect world, every doctor would ask about this, and every patient would willingly bring it up. But it may not have occurred to either of you, especially if this doctor hasn’t known you for very long.
“I always just ask,” says Dr. Ottenheimer. But she also knows that not everyone who’s had an eating disorder has the same reaction to being weighed. “Some people can never be near a scale again because it’s one of their anxiety triggers. [In those cases], we don’t weigh. We just don’t do it. But others,” she adds, “really rely on the scale as a reality check.”
Responses can vary so dramatically, and your worst nightmare may be someone else’s helpful tool. But these are questions only you can answer. No need to go into great detail; you might just say, “I’m in recovery from an eating disorder and would prefer not to be weighed,” or “The scale is one of my panic triggers. I’d prefer to skip weighing this time.”
As with the rest of your medical history and your lifestyle habits, it’s primarily on you to tell your doctor what she needs to know.
4. You can also ask to be blind weighed.
If you have been through eating-disorder treatment, you may already be familiar with the practice of blind weighing, wherein a patient turns around so as not to see the number on the scale. (When I became more secure in my new eating habits, I began letting my doctor weigh me in this style.)
Blind weighing can be helpful for anyone who finds the scale a stressor. If, for any reason, your doctor wants to see your current weight, it doesn’t necessarily mean you have to see it. “There are many ways to do this in a sensitive way, without putting the number in the person’s face,” says Dr. Lief. In addition to turning around, you can also ask your doctor to omit the number from any report he may send with your lab results, etc. “That’s a totally legitimate request,” he adds.
Again, sometimes the scale itself is just too great a trigger, and if that’s the case with you, make it clear to your doctor. But if you’re on the fence, blind-weighing is a great and simple way to ease back in.
5. Here’s the main reason your doctor wants to weigh you.
A lot of us assume that getting weighed will inevitably lead to some sort of scolding in the doctor’s office. There’s a sad logic in that fear, because — well, we’re constantly scolded, judged, and shamed about weight virtually everywhere else in the world. But both Dr. Lief and Ottenheimer say it’s just not the case.
“The major reason I'm weighing someone is so I can have a reference point,” explains Dr. Lief. He says patients often come in reporting major weight loss or weight gain, terrified that something’s really wrong (i.e. cancer. Everyone thinks they have cancer — not just you!). In nearly all cases, he says, “I get them on the scale and show them that they’re exactly where they were six months ago.” Dr. Ottenheimer echoes this sentiment, adding that, “We’re terrible at accurately estimating our own weight changes.”
Your doctor knows the difference between a sudden change and normal fluctuation. But in order to really see that, they need to know what your normal weight-range is. However, Dr. Ottenheimer adds, you can give them a sense in other ways. “I always tell people, if you don’t want to weigh yourself, pick an outfit — that is reasonable. Not your high school jeans that you wish you could fit into but you’ll never fit into.” Use that as a measuring stick to gauge your weight over time.
6. Weight change can be a helpful indicator.
And if there is a major change in weight, that’s helpful for your doctor to know. “The only time I think it really matters [to weigh someone] is if they look dramatically bigger or smaller,” says Dr. Ottenheimer. “Obviously, that’s not just about eating.” It could indicate a thyroid issue, for example. “If there’s a constellation of complaints or issues that a patient comes in with, which fit neatly in with a weight change too, that’s important.”
Because it’s such a touchy topic, it’s hard to think of weight as just another vital sign. But that’s what it is to your doctor. Normally, it’s just part of the puzzle, no more important than any other vital sign. But sometimes, it can really help to point your doctor in the right direction. If you have a decent doctor, and a decent relationship with them, that direction will probably not be toward scolding.
“I don’t scold people,” Dr. Ottenheimer adds. That’s not because she disregards any connection between weight and overall health. There are doctors actively challenging the mainstream emphasis on weight in medicine, but it’s worth noting that neither of these doctors are affiliated with that movement. Dr. Ottenheimer points out that your weight may indeed have an impact on your health, “and if you want help, I will help you. But scolding people just doesn’t work.”
7. Give your doc a chance to surprise you.
The subject of weight can often lead to a productive (and surprising) conversation with your doctor. For example, Dr. Ottenheimer says, weight talk “can be a segue into talking about exercise. A lot of women who suddenly start exercising — I mean, this happened to me too. I lost two sizes but I gained weight, which is when I threw away my personal scale. It’s just too stressful!”
Again, it’s all about establishing trust so you can be open with your doctor. “Hopefully, the doctor’s goal is to make the patient feel comfortable,” Dr. Lief adds. But in order to get comfortable talking about touchy subjects (including weight), you kind of have to talk about the touchy subjects.
No matter what your stance on the scale, it’s worth learning to talk to your doctor about weight. Worst case scenario: You discover that your physician has a really lousy, unhelpful attitude. That’s always a possibility. But it’s just as likely that you’ll find out your doctor is a rational human being with no interest in shaming you or anyone else. You may even find out they don’t like being weighed either! There’s only one way to find out: Start talking, asking questions — and really listening to the answers.
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