What if physicians stopped weighing heavier patients? Some people suggest that if doctors would quit pointing out when patients are obese — something the patients already know — it would improve overall health care by reducing tension during exams.
Bernie Salazar understands that theory. It upset him when, during a recent annual physical, he stepped off the scale with what he considered a scant four-pound increase on his 260-pound frame only to have his doctor suggest it was time to talk about weight-loss surgery.
“I felt a very familiar sense of defeat and shame,” said Salazar, 37. “He didn’t ask if I was concerned about my weight or if I was open to discussing weight loss at all.”
This tension between Salazar and his doctor is common: In a review of research on weight, Rebecca Puhl and Chelsea Heuer noted that 69 percent of higher-weight women reported feeling stigmatized by their physicians. And a 2018 Drexel University study on health care avoidance found that some higher-weight patients give up doctor visits altogether as an attempt to escape the stress and anxiety.
Epidemiologist and biostatistician Janell Mensinger, the study’s lead study author, said that makes it difficult for higher-weight people to stay healthy.
“Avoiding health care can result in the delay of important routine screenings, diagnosis and treatment for health issues,” she said. This both decreases quality of life and increases health care costs in the long run.
By weighing their patients, doctors are following established guidelines. The U.S. Preventive Task Force recommends physicians screen all adults for obesity by weighing patients and calculating their body mass index (commonly called BMI). However, the recommendation does not acknowledge weight stigma as a possible harm of the screening.
Patients have the right to decline being weighed, as with any other medical screening, but that’s not obvious because most medical practices weigh patients before they even get to see the doctor.
Dr. Ana Paunovic, a Washington-based internist, is changing the way she handles the issue of weight. “I delay weighing new patients so I can make sure doing so would not cause harm, like in the case of clients with eating disorders or a history of body shame,” she said.
Which is not to say that she discounts the helpfulness of weighing patients as a matter of routine screening. “If there are sudden weight changes, physicians can look for signs of health problems, including malnutrition, which can happen at any size,” she said.
The Preventive Task Force suggests further research into what effect screening for obesity has on long-term health outcomes. Perhaps such studies will encourage the medical profession to examine its treatment of patients at higher weights. But for now, “the burden of reducing weight stigma at the doctor’s office currently falls primarily on the patient,” Paunovic said.
This is how Salazar said he will handle that challenge: He will return for a wellness visit next year, but he will be setting firmer boundaries around weight conversations with his doctor or finding a new provider who will respect his body no matter his size.