Did you know that you can declined to be weighed at the doctor’s office?!
YES, I KNOW. The internet has been telling me for years at this point. I hear it all the time: in shareable graphics, in posts from others either fretting about declining to be weighed or triumphantly describing declining to be weighed at an appointment, in articles and blogs written by people of all sizes, on Twitter, on Instagram. There are approximately 90 bajillion little graphics you can share on social media to inform others that they can decline to be weighed at the doctor’s office.
DID YOU KNOW? Yes. But I get weighed anyway.
1. They will know I’m fat whether or not I get weighed
I have heard people claim that if a practice doesn’t have your weight, they can’t calculate your BMI, and if they don’t have your BMI, they can’t bill your insurance for “obesity counseling” or put an “obesity” diagnosis in your medical record, thereby saving you from issues related to pre-existing conditions.
This may work for some people, but it’s never worked for me. A medical professional does not have to weigh me to know that I am fat. They don’t need to calculate my BMI to know it’s high. This is because they have eyeballs and can see me. I can’t hide! I’m fat. And even at appointments where I have not been weighed, I have been diagnosed with “obesity” and my insurance has been billed for the doctor informing me that I am fat.
It has never been my experience that standing in the way of a healthcare provider having a concrete number has saved me from a diagnosis or a lecture. I have been diagnosed with hypertension without having my blood pressure actually taken. I have been diagnosed with sleep apnea without a sleep study or any evidence because I mentioned casually that sometimes I snore. And I’ve been diagnosed as “obese” without being weighed.
If I’m honest, it seems like a little bit of magical thinking. If they don’t know my weight, they can’t talk to me about it! Well, yes. They can. The thing about weight stigma is that it’s really not about the number on the scale or your BMI. It’s about your body size and the conclusions medical professionals draw from observing your body size. It’s about bad science, bad medicine, money, and a lot of things that have absolutely nothing to do with the number on the scale. Perhaps this helps people who are thin, or aren’t quite so visibly fat. But it does absolutely nothing for me. And I think this is because we sometimes think the situation with weight stigma at the doctor’s office is a lot better than it actually is. Wouldn’t it be grand if all we had to do to escape the steely grip of bias was to politely decline being weighed?! Unfortunately, for people like myself who are undeniably fat, it’s not that simple. We need seismic, systemic change in the healthcare system in order to access better care.
2. I am already judged as noncompliant the moment a medical professional lays eyes on me
According to NAAFA, doctors associate fat people with “noncompliance, hostility, dishonesty,” and just to make it thoroughly insulting, “poor hygiene.” I have personally experienced all of those things. Doctors have often accused me of lying. When I had gallstones for nine miserable months, my doctor failed to catch it and accused me of lying about my symptoms and nearly fired me as a patient. If I ask questions or want to know more or seek a second opinion, I am not seen as a patient looking for understanding and an accurate diagnosis, but questioning the doctor’s competence. When I have told a doctor that I did something they asked me to do but it did not produce their desired result, it is assumed I am lying and was not actually compliant. Before I open my mouth at an appointment, I am perceived as difficult. Anything I do to advocate for myself is further evidence of my noncompliance.
So, for me, medical appointments are an uphill battle. I walk through the door at a disadvantage. I just want access to competent medical care. That’s all. I have to save my energy to fight for things that are important to my care. Declining to be weighed is not a meaningful stand for me to take. I see no tangible personal benefit from declining to be weighed. And, in fact, it could prove harmful to me by setting the tone for my appointment with me defiantly refusing to be weighed, or being weird and handing the nurse doing my intake a little card I printed from the internet informing them that I would like to decline being weighed. (Yes, these actually exist.)
3. There are, in fact, good reasons to be weighed at the doctor’s office
One argument I’ve heard is that declining to be weighed is pushing back against a “weight-centered ritual.” BUT… there are good reasons to be weighed! Even if it is not directly applicable to your appointment! Having a weight history can be a helpful thing. That way, if there is a rapid gain or loss, which can indicate a health issue, your doctor can catch it and investigate. So, perhaps it is not worthwhile for you to be weighed at the dermatologist or at urgent care for a standard issue cold. But at your annual physical? That makes sense. At a visit for an undetermined health issue? That also makes sense. At urgent care for the flu? Yeah, that could be useful, especially if you’ve been losing fluids. Before surgery? Obviously, if you’d like anesthesia.
Does it mean you should be forced to step on the scale? Of course not! If you would like to decline stepping on the scale, you can and should. But there are actually good reasons to be weighed. Having a weight history can be helpful, because rapid loss or gain can be an early warning signal that something is wrong. It’s appropriate to ask your doctor why getting a weight is necessary, if you want more information, and they should be perfectly happy to explain it to you.
There is often no grand reason for other standard intake procedures, like taking your temperature if you’re not there for a suspected infection. But we happily submit to this most of the time, because we are not culturally triggered to be alarmed and saddened by high temperatures on the thermometer like we are high numbers on the scale, and also because temperature (like blood pressure, like weight changes) can be an early warning sign that something is wrong.
The issue here is not that body weight is utterly irrelevant as a health marker; it’s that weight is usually translated into BMI, which is a useless determinant of health that was never intended to be a health marker, and healthcare professionals typically use that number as the most important (if not only) measure of your health. Weight stigma in healthcare is a complex, twisted, thorny system of roots and vines. Declining to step on the scale doesn’t even begin to hack away at it, nor does insisting that weight has no relevance to medical treatment.
4. Refusing to be weighed does not solve institutional bias and systemic discrimination and marginalization of fat people
As I get older and perhaps wiser, one universal truth jumps out at me more frequently: Individuals are not responsible for or capable of solving large-scale systemic issues with their personal choices. This applies to almost every major challenge we face as a society today. Recycling makes us feel like we’re doing our part for the environment, but individuals recycling will not prevent or reverse climate change until we get buy-in from the government, regulate the worst producers of greenhouse gasses, and make a large-scale, international effort to address the climate crisis. (And most of us are doing it wrong, anyway.) There are a million other ways we shift responsibility for big issues from the big systems that are responsible for them onto individuals. The list goes on and on.
We generally do these things because it feels good. It feels like we’re doing something. I’m not a Do-Nothing Bitch! I RECYCLE! These actions make us feel empowered in the face of issues that seem so big, so intimidating, so impossible. I work in philanthropy, and have for years, so this motivation is very familiar to me. Economist James Andreoni wrote about “impure altruism” and “warm glow giving” to explain why many people give to charitable causes — it is not because of pure altruism or the desire to do good, but because of the emotional response we tend to have to feeling like we’ve done our part. That feeling is the “warm glow.” (The warm glow can also be status, relationships, ego, and so on.) And that’s usually what we’re chasing when we give to charitable causes, and even when we do things like recycling. Does our $5 donation to a nonprofit organization make a huge difference to their bottom line? No, it’s a drop in the bucket. It’s negligible. But we do it to publicly show our support, and to get that sweet warm glow. Does it really help? In most cases, no, especially with large systemic problems that need large-scale solutions and buy-in from powers much greater than ourselves. But it feels helpful. It feels good. It feels like we’ve done our part.
To me, there is little that is more personally urgent than addressing weight bias in the healthcare field. It affects me personally. It could kill me one day. I care deeply about this issue. But I also feel strongly about this: it is not my personal responsibility to fix this issue. It’s something the healthcare profession must address. There needs to be pressure on them to tackle this problem, because it does real harm and even ends lives. Perhaps, in writing about my experiences as a person in a larger body who faces this bias, I can add to the pressure and help make the case that it is serious. And weight bias is tied into a whole slew of other issues, such as wealth inequality, and racism, and sexism (because women often bear the brunt of this problem), and our broken healthcare system. I have heard the issue of declining to be weighed is often framed as something we must do out of solidarity, to Make a Statement, to chip away at an institution that is hostile to us. And, honestly, it is just another thing that makes us feel like we’re working to solve a problem that feels too big to handle. We feel like we’re Doing Something About It. We’re helping. We’re Making a Difference. But are we?
Look. If it has personal significance to someone to decline stepping on the scale, more power to them! People should do what is meaningful for them. I am sure that for many people, it feels liberating, it feels rebellious, it feels like they’re putting their principles in motion. I just don’t like being told (and I have been told) that it’s something I must do FOR THE HORDE. We have no evidence that not having a weight in our medical records results in less weight bias or better care from practitioners, or makes an appreciable difference in the issue of weight stigma in healthcare as a whole. To me, the focus on Things Individuals Can Do To Address Issues Larger Than Them ends up distracting from the systemic issue and passing responsibility off to the individual. It gives the system that caused the problem in the first place a pass, and makes it the problem of some random person just trying to live their lives and get through a physical without crying. When I make it my personal business to refuse to step on a scale in an attempt to prevent my doctor from discriminating against me, it lets the doctor off the fucking hook for discriminating against me. It lets insurance companies off the hook for discriminating against us. It creates an environment when it is on the people who are facing discrimination to end that discrimination. And it’s simply not our goddamn problem to solve, even if refusing to be weighed could do such a thing. The dogma of Personal Responsibility is used in so many ways to redirect the focus of a systemic injustice back onto the people who are victims of it, and this is just one more example of that in action.
We need large-scale change to our healthcare system, to how doctors are trained (because their training is often where they pick up their weight bias), to the pharmaceutical industry that pays off doctors for prescribing their new weight loss medications (even if it’s done off-label), to private hospitals that profit handsomely from weight loss surgery. We need to burn the whole fucking village to the ground and rebuild it, because right now? Weight bias is built right into the fabric of healthcare. And if declining to get on the scale is a meaningful act of personal rebellion, if it gives you the warm glow, if it helps you assert your autonomy over your own body… then, by God, please continue to do it. But let’s just be honest about what it is. And continue to hold the medical profession to account for the system they’re part of, the discrimination they perpetuate, and the harm they do. Sometimes I wonder what would happen if we dedicated nearly as much energy into forcing this large-scale systemic change as we do fretting and talking about how to decline being weighed at the doctor’s office.
(I do, for the record, recycle, so don’t @ me. ❤️)
5. I am not triggered by the number on the scale
We’re all in different stops on our ongoing journey with body acceptance and weight and pulling away from diet culture. At this particular time, I am not bothered by the number on the scale. I feel neutral about it, like my height or my temperature. It’s just a number that tells me the force exerted by gravity on my body. So, I get weighed for the reasons listed above, and I am fine with knowing the number. I am not triggered by it. That number will not make me cry or ruin my day. I know that this is not necessarily the case for people who are in eating disorder recovery or still in the thick of working on their issues with weight, body acceptance, and weight neutrality.
But to me, there is a dissonance in saying “I DEMAND WEIGHT-NEUTRALITY from healthcare providers!” and also saying (sometimes on the same little printout or card!) that knowing one’s weight is extremely upsetting.
If you need to abstain from knowing your own weight because it’s upsetting for you, do it! But I think where we get into tricky territory is when we try to blend these two very disparate notions together. We are either neutral about weight or we are frightened of our weight. We cannot be both at the same time. We cannot be badass warriors for fat acceptance and terrified of becoming fatter at the same time. We can certainly be actively working on cultivating a weight neutral perspective and excising fatphobia from our daily lives, but it’s probably necessary to talk about the fact that the fear and dread we feel stepping on the scale is fatphobia. And you cannot fight fatphobia with fatphobia.
I’m not demanding perfection from anyone. But I am asking for honesty. Are you so adamant about not stepping on the scale because you believe it provides a better, more weight-neutral experience or are you afraid to learn that you’ve gained weight? Is there a number you have in your head that is “scary” to you, perhaps one that you’ve promised yourself you will never reach? (I’ve had several of those!) Are you still holding onto notions of a line you don’t want to cross with your weight? Again, all of those things are normal and okay. But these things are so often mixed in with the hardline stance about “weight does not matter” that it gets really uncomfortable for me.
6. Being weighed at all is something of a privilege
I have only encountered a scale that could not weigh me once in my life. I was at a very dumpy Planned Parenthood for a “well woman” visit so I could get my birth control prescription refilled. This facility was a depressing little office in an anonymous industrial park and clearly a lot of their equipment was old, dilapidated, and probably donated. I stepped on the old-fashioned scale and the metal bar hit the scale with a loud, comedic THUNK. I looked at the young gal doing my intake, and she looked at me, and she said, “Oh, it only goes up to 250.” Whoops! “Do you know your weight?” (At that time, I was very pleased to tell her that I did.)
Thankfully, most medical offices I visit have a digital scale that never has any trouble weighing me. For people who are on the larger end of the fat spectrum, sometimes the only places they encounter a scale that can weigh them is at a bariatric surgery center.
Now, please don’t conclude here that people who can be weighed by a scale should not only do it happily but treat it as a privilege. That’s not what I’m saying at all! But this constant focus on the fucking scale can be SUPER ALIENATING to people on the larger end of the spectrum, or even those who encounter scales that can’t weigh them from time to time. And that’s just another way in the healthcare field absolutely fails to serve them, and pushes them to the fringes institutionally (or uses this as yet another tool to push them into the bariatric surgeon’s office.)
We can still decline to be weighed. And we can still feel empowered by that, if that happens to be a thing we find empowering. But we cannot stop there and we cannot continually make it all about the goddamn scale. The scale is just one tiny part of how people who are clearly, visibly, and undeniably fat are mistreated by healthcare practitioners. I can smash my scale and never know my weight but that does not stop the world and my doctors from viewing me as fat. It does not stop me from receiving poorer care because of it. And it doesn’t force the healthcare field to step up to the fucking plate and do better. We need more accountability from them. And while we should all do whatever we must do to take care of ourselves, we must stop derailing the conversation by continually talking about what we can do, as fat people, to stop weight stigma from doctors and other healthcare professionals.
I’m fatigued by this particular talking point, and ready to move on from it so we can stop directing our ire at the scale and start directing where it belongs: the healthcare profession and the professionals who fail to provide competent, compassionate care.