healthcare, mental health, psychology

“Please, Doc, don’t weigh me unless it’s really necessary!”

Yesterday marked the first day of National Eating Disorders Week 2022. Fittingly, a few days ago, I read an interesting article in the Washington Post about a new trend in U.S. healthcare. It involves special cards that one can hand to a physician. See below:

I like this idea.
From the More-Love.org Web site.

I haven’t seen a doctor since 2010. One of the main reasons I don’t visit doctors is because I once had a very traumatic and unnecessarily physically painful and humiliating experience with one. I did see doctors a few times after the traumatic experience, but as I’ve gotten older, it’s gotten even harder to make the phone call for an appointment. I know very well that this isn’t the greatest policy for promoting my personal longevity. I could definitely use a check up. However, for many reasons, visiting medical people causes me a great deal of stress. One of the main reasons it’s stressful is because of that goddamned scale, and my long history with eating disorders. No, I don’t mean the obvious ones that might put a person in the hospital. There are actually a lot of eating disorders out there, and most don’t get diagnosed. But they do exist, and I’ve struggled with them for years. I have less of a problem with them now, mainly because I have a very loving and understanding husband who doesn’t body shame me. I would be lying, though, if I said those problems have gone away entirely. There isn’t a day that goes by that I don’t think about it.

I know I usually have less of a problem going to see a doctor if I know I won’t have to be weighed. For instance, in 1999, I had facial cellulitis that almost put me in the hospital. I had to see an ear, nose, and throat doctor for treatment. He was a great doctor, but one thing that I especially liked about him was that he didn’t force me to get on a scale. He simply looked at the mess on my face and prescribed antibiotics. The family practice doctor who sent me to the ENT guy was kind of an all knower, but he actually reassured me that my weight wasn’t that bad. At that time, it wasn’t that bad, since I was waiting tables and lost a lot of pounds because of that. However, I was never so sick, so often, as I was in those days.

Although I know weight is an important measure for some health issues, I think it’s pretty cool that someone has realized how absolutely mortifying getting on the scale is for some people. The above cards were offered at Element Primary Care in Omaha, Nebraska. A 30 year old woman named Dani Donovan, who is an attention deficit/hyperactivity advocate and suffers from binge eating disorder, happened to see the cards at the office. Donovan reportedly avoids going to see physicians because of the stress of being weighed. She happened to find a practice where, apparently, the staff recognizes this issue, and how it prevents people from seeking care. According to the WaPo article:

“I didn’t even know that saying ‘no’ to being weighed was a thing you could do,” said Donovan, 30, an attention-deficit/hyperactivity disorder advocate who has a binge-eating disorder and often avoided doctor’s appointments because being weighed was so stressful. The card led to a good conversation with her doctor, Donovan said, that helped build trust and make her feel empowered.

Donovan took a photo of one of the cards and posted it on Twitter. It’s caused quite a stir.

These cards were developed in 2019 by a Los Angeles area eating disorder coach named Ginny Jones. Jones is a survivor of several eating disorders, including anorexia and bulimia. Jones came up with the cards after many experiences she had when visiting physicians. A lot of them would praise her for losing weight, even when it was noted in her records that she has had eating disorders. She now offers the cards for sale on her Web site. When Jones was contacted for a statement about her cards, she said:

“I wish I could say I was surprised by the ‘controversy’ around the cards. I created them to address weight stigma, and it’s basically fatphobia to jump to conclusions and say blanketly that asking not to be weighed is unhealthy.”

Personally, I think these cards are great, although I can’t imagine presenting one to any of the military doctors I’ve seen in my lifetime. But then, again, I haven’t been to see a doctor in about 12 years. My blood pressure shoots up whenever I’m in a military healthcare facility, and they usually take one look at me and assume I have any number of health issues just by my appearance. I have found that a lot of doctors aren’t good listeners, either. That is especially true with military providers, in my experience.

In 2007, before we moved to Germany the first time, I actually wore an ambulatory blood pressure monitor for 24 hours to prove that I didn’t have hypertension, because my blood pressure readings were so high in the office. As soon as I stepped out of the military hospital, my blood pressure was completely normal and stayed that way. I came back to the office the next day with a bruised arm and documentation in my file that I have white coat hypertension. That may no longer be true today, given my family history, but the way the providers acted during that last visit put me off of going back, even though the person I saw was actually very kind to me when I told her what had happened to me at the hands of an Air Force gynecologist back in the 1990s.

The Air Force gyno I saw back then gave me my very first (of two in my entire lifetime) gynecological exams. It was so painful and distressing that I left her office traumatized and horrified, and actually felt violated on the level of sexual assault. Besides really hurting me with her instruments and not apologizing for the pain she caused me, this doctor also fat shamed me and predicted that when I went to Armenia, I would gain tons of weight. In the 90s, I was dealing with eating disorders more acutely than I do today. Today, I seem to have replaced eating issues with drinking issues. Again… not healthy, and I probably should see a doctor, but I just can’t bring myself to do it. Even having these cards probably wouldn’t get me into the office, although I do think they would help, if I found a kind and understanding physician who was sensitive to these issues.

According to the Washington Post article, as well as my own anecdotal experience, there are a lot of physicians who have a bias against obesity. They seem to take obese patients less seriously, especially if they’re women. The article reports, “one piece published in the British Medical Journal found that weight stigma actually led to increased mortality and other chronic diseases and ‘most ironically, (weight stigma) actually begets heightened risk of obesity.'” There have been a number of articles about how the medical community tends to focus on weight, even when a medical issue is clearly not related to the patient’s weight. Like, for instance, someone comes in with a broken arm and gets told that weight loss would benefit them. There’s no doubt, weight loss would be beneficial, but that’s not why the person came in to see the doctor. In that sense, I can see how these cards could be useful. If you’re going to see the doctor for a specific issue that has nothing to do with obesity, perhaps it wouldn’t be a bad thing to skip the scale, at least for that visit.

Of course, some physicians will never be onboard with avoiding weigh-ins. In the WaPo article, a physician named “Umbereen S. Nehal, a former chief medical officer for Community Healthcare Network in New York and a board-certified pediatrician,” reported that she strongly believes patients must “be weighed every time, regardless of when they were last weighed or why they are in the doctor’s office.” The doctor claims to be have sympathy for patients like Donovan, but she’s not convinced that avoiding the scale will improve healthcare outcomes. She says, “Is the hypothesis that somebody who is obese, let’s say, if we don’t weigh them, fatphobia will go away? Those visual cues will not go away. So my beef with this is that it disrupts processes in the system for efficient data collection and that data are used for a variety of things.”

My answer to Dr. Nehal is that a lot of people avoid the doctor entirely because of this issue. She may be getting more data when she weighs patients at every visit, but a lot of people won’t even come see her because of the mortifying prospect of being weighed, the psychological stresses that come from that experience, as well as the potential humiliation that comes from a fat shaming doctor. Seriously… if you’re feeling fine, and you don’t want to deal with the discomfort of being weighed, how likely are you to schedule screenings? Is that the outcome Dr. Nehal wants? For people not to come in to see her at all? Then she won’t get ANY data, and the person will show up in the emergency room instead. And that will not only lead to poorer healthcare outcomes, but it will also lead to much higher medical bills.

Another doctor who was quoted in the article, Fatima Cody Stanford, an internist who specializes in obesity medicine, also insists that weight is an important measure. She notes that U.S. medical schools do a terrible job teaching students about weight, and that many people don’t visit their doctors very often. Stanford says she would tweak the card to something that says:

“I’m happy to get weighed but please do not provide any negative or derogatory comments associated with my weight.”

That way, the doctor gets their data, and the patient doesn’t have to deal with fat shaming. I would add, though, that in my case, it would not be true that I am “happy to get weighed”. I hate being weighed every time. It causes me a lot of distress, and that’s why I avoid doctors unless I’m about to croak. So I think Dr. Stanford might want to rethink that wording, although I appreciate that she recognizes how upsetting being weighed is for some patients.

I looked at Element Primary Care’s Web site, and it appears that their approach to care is different on many levels. For instance, I notice they offer telemedicine appointments, focus on keeping their practice small, and it appears that instead of using a traditional insurance model, they provide care for a monthly fee. This eliminates co-pays and insurance deductibles, and allows patients to access care when they need it. The direct primary care membership plan can be combined with a high deductible/less expensive insurance plan which would cover hospital care or other unforeseen care needs that still use the traditional insurance model. I have heard of a growing number physicians’ practices eschewing traditional insurance coverage, which allows them to be able to make medical decisions that don’t have to go through third parties at insurance companies. I think it’s a great idea, although it will probably take some time for it to catch on nationwide. Change can be slow, but I do think overhauling our health insurance model could be a game changer for a lot of people.

At Element Primary Care, about half of the patients decline to be weighed, but some will weigh themselves at home and report their weight that way. Or, if they have a condition that requires their weight to be monitored, the patient can turn backwards on the scale, which is how many eating disorder patients get treated. That way, they don’t have to know that number, and it won’t affect their psyche. The cards allow the patients to advocate for themselves and be more of team member in their healthcare. It may also make them feel “safer” from judgment and humiliation. Personally, I don’t weigh myself at all anymore, and when I have gone to see the doctor, I don’t let them tell me how much I weigh. I know from personal experience that knowing the number can lead to distress.

I think the pandemic has caused a lot of issues with weight and mental health. I recently read that a number of young people have developed eating disorders during the pandemic. Even President Biden is addressing it, which is very fitting, since National Eating Disorders Awareness Week begins today. Kudos to Mr. Biden for bringing this up, since I know Trump doesn’t care about helping people with eating disorders. I recently read that doctors are seeing a lot of adolescents in emergency rooms, dealing with eating disorders. There’s also a lot of depression and anxiety being reported, due to the pandemic. I think any measure that makes seeking help easier is commendable.

While it may not always be medically appropriate to skip stepping on the scale, I like the fact that some healthcare professionals are noticing and addressing this issue. And I think it’s amazing that some people are empowering themselves by presenting these cards, although I would not be surprised if some people get lectured by their doctors for not being weighed. I would like to see less lectures from doctors as a general rule. People need to take ownership for their own health, and physicians need to stop seeing patients as people who need to be given orders or lectures about taking care of themselves. Especially if they are competent adults.

Anyway… I probably won’t be going to see a doctor anytime soon, and in fact, I hope I don’t live to be super old. I think it’s overrated. But I definitely think the cards are kind of cool, even if I’m sure they don’t always go over too well with more traditional physicians. I know that if I had given one to my ex psychiatrist, for instance, he probably would have laughed me out of his office. And he never weighed me once– but he did fat shame me quite a few times before I told him to stop. He also gave me a prescription for Topamax off label, hoping it would slim me down. Is it any wonder why I hate seeing doctors?

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7 thoughts on ““Please, Doc, don’t weigh me unless it’s really necessary!”

  1. MARY BETH S DOOLEY says:

    Thank you for writing about this issue. Last summer I injured my knee. It is a small meniscus tear. I knee it was because I did the same thing to my other knee 12 years ago. I went to see an ortho doctor. Supposedly one of the best in Hampton Roads. It was a depressing humiliating experience. He took one look at me and made a diagnosis.

    He took x-rays told me you may have a tear, but it’s the osteoarthritis really causing the pain. He informed me I was too young for knee replacement and I was obese. I would have to loose weight before he could help me. I was using a cane to help me walk. How in the hell was I was going to exercise?

    He gave me a cortisone shot because my husband and I were leaving for Charleston in 2 weeks for our anniversary. The shot lasted a month and the pain returned. I went looking for another doctor. I knew I needed an MRI to even see if in fact I had torn the meniscus.

    I saw a PA and told her I know I’m fat. I know the weight is not helping me, but I am not sleeping and I am barely walking because of constant pain. She sent me for an MRI.

    I also then had to see my primary care. I got on the scale and was horrified by the number. I was seeing a new doctor. When my new Doctor came in the room I totally lost it mentally and emotionally. I was sobbing. She generally put her hand on my shoulder and comforted me.

    She spent 45 minutes listening to me and talking with me in the kindest and most helpful way of any doctor. Come to find out early in her career she was a weight loss doctor. She has me on medicine, e-mails me regularly and calls. I have dropped some weight. It is helping with my knee and I am beginning to feel better.

    I do have a tear. My new ortho gave me the choice continue down my current path loosing some weight and see where I am in a few months or he will do surgery. I choose to wait a few months to see if I can continue down the path I am on.

    I didn’t realize just how depressed I have been until I started to feel better. Without a sympathetic, caring doctor who took the time to listen to me I am not sure I would have made it through this experience. If I continued down the other path with not moving due to pain. Emotionally eating I would have slowly killed myself. Having a doctor who truly listened changed and saved my life.

    • Depression is a real thing. I was depressed for years. When I finally got on the right meds (by the same doc who gave me Topamax), I was amazed by how much better I felt.

      Congratulations on your weight loss. I have been fortunate in that I am able to take walks with my dogs, and they do demand that we go out! But I can’t deny that the older I get, the more pain in my back and feet I have.

      I am glad you found a good doctor who is willing to help you. Everyone deserves that!

  2. Re your comment about Trump not caring about folks with eating disorders (or any mental health issues): I agree. The only person Trump cares about in any meaningful way is…Donald J. Trump. He might be fond of Ivanka as well, but still, all of the man’s history shows that Trump’s ego and narcissistic tendencies are legendary.

    As for the main topic: I agree that the scale, weigh-ins, and the stress they cause to many folks are problematic, especially when it comes to patients that have eating disorders and the related problems with self-esteem. I know several people who have struggled with those same issues, so I can see where you’re coming from.

    My half-sister Vicky, too, has – on top of her other mental health issues – an obsession with being skinny and dieting. When she lived with us (both in Colombia and in South Florida), she was constantly reading about (and trying) every new fad diet that emerged in the Seventies. The grapefruit diet? She tried it. The cottage cheese and fruits only diet? She tried that, too. On at least two occasions that I recall, she convinced Mom to try those diets, too, but our mother would eventually stop dieting with a few days of starting, while my half-sister would persist.

    The weird thing is that my half-sister has never been “fat.” Mom used to tell me that the only time Vicky was overweight was when she was in a Catholic all-girls’ school in Parkersburg, WV between 1965 and 1969. I have never seen photos of my half-sister from high school, so I do not know how overweight she was. Probably NOT too much so, because when I “met” her in ’69 I don’t remember her looking chunky.

    What I did notice was that Vicky had a love-hate relationship with food in all the time that I was around her. She would skip meals – especially in Bogota, where (at least in our social circle, which was one of privilege and high status in the hierarchical class structure) we had five meals a day (yes, five), with three-course lunches and dinners – and her favorite topic of discussion was how to lose weight.

    This trend got worse over time, even when we moved back to the States in 1972 and lived far more frugally. Vicky was obsessed about calories and caloric intake, and she claimed that she was “fat” even though she was rail thin.

    I think your attitude about food and body image is more realistic and more conducive to better mental health. And I agree that those “Don’t Weigh Me” cards are cool as hell.

      • Unfortunately.

        I think she inherited those mental health issues from both sides of her family. Her father, who was a brilliant surgeon (top of his graduating class in med school, per my mom) was also a heavy drinker and physically abusive man. Spoiled rotten, too, since he was his parents’ only male child. Mom said that when he was in his late teens and early 20s, my half sister’s dad, Manuel, would go to bars – seedy or elegant, it did not matter – with a pistol in his possession. He’d get drunk and rowdy, and if the proprietors tried to kick him out, he would shoot at the bottles and mirrors behind the bar, destroying property and scaring the living shit out of the barkeep and patrons alike. Of course, because he was – like my mom – a member of a prominent family, he never faced legal consequences; his dad, Don Manuel, would go to the bar where the altercation had occurred and whip out his checkbook (or wads of cash) and ask, “How much was the damage?”

        My mom said he was a wonderful guy when he was sober, but his personality darkened whenever he even had one drink. It was a Dr. Jekyll-Mr. Hyde situation, really. My mom stuck it out for, I believe, five or six years, but she eventually got my grandfather – who had connections with the higher-ups in Bogota’s Catholic Church – to pull some strings to get the marriage annulled. (Divorce was not yet legal in Colombia in 1952-3.)

        My maternal grandmother also had mental health issues. Hypochondria was one of them, but she also had a propensity to think that no one loved or even liked her. She was an intelligent woman, well-traveled, and when she was in a good mood she was witty, warm, and good to be around. She taught me my ABCs even when my dad was alive (and remember, he died before my second birthday), and she loved to putter around in the garden or – when she visited us in Miami – sweep the front porch/entrance with a broom.

        On the other hand, my grandma (universally called “Tata” by her numerous grandkids) was thin-skinned, overly critical, and had an obsessively overprotective relationship with my Aunt Martha, the oldest of her three kids (Mom, who was born in 1928, was the youngest). and favored her and her five kids (my cousins) over my Uncle Octavio or Mom and their kids. She didn’t neglect Uncle Tayo or Mom, but she practically smothered my Aunt Martha. (So much so, in fact, that before my aunt died in 2012, her last obsession was that she had to be ready to pick Tata up for lunch.)

        I loved my grandmother – far more than I thought I did when she was alive – but she was also overly strict and Victorian in her philosophy. Going to, say, Cozzoli’s Pizza at Miami’s Dadeland Mall was harrowing when Tata was around. She liked the food, but we had to eat pizza with a knife and fork. And, speaking of Dadeland Mall, she was the catalyst for my dislke of going to the mall for long shopping trips. When she went to Miami (first with my grandfather – a guy you would have loved – before 1977, then solo after his death), we had to go to Dadeland on shopping expeditions that started at 10 AM and frequently ended at 5 or 6 PM.

        And Tata was paranoid as hell. She always thought that people were talking behind her back, and (of course) it was never positive stuff. My poor grandfather even suggested that my grandmother visit a psychiatrist, but Tata would not go. “I’m NOT crazy! You all think I am, but I am not….” This is from the Gospel According to Mom.

        I don’t know if I have any mental health issues beyond fear of rejection and risk-adversity. But I do know that several of my cousins – at least the first cousins I am acquainted with – do have personality disorders. And, of course, there’s Vicky…..

      • My grandfather was one of those “nice guys until he took a drink” types. I sympathize, although I never really knew Pappy, because he died when I was two years old. He had a stroke and a car accident, and they weren’t clear which happened first. And although I never knew my grandfather, I kind of knew him through my dad, who was also an alcoholic and took out on me some of the abuses perpetrated on him by his father.

        Mental illness is not an easy thing to deal with, whether you have the illness, or someone close to you does.

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