‘Weight-inclusive’ doctors slammed for refusing to weigh patients for fear of upsetting them

A growing number of doctors across a wide range of specialties have done away with routine patient weigh-ins in an effort to avoid weight shaming, but others argue this obscures a critical health metric.

Patients are typically weighed as a first step at a routine doctor visit.

But the standard practice is increasingly falling out of favor as more and more people say this makes others feel shame about their weight, which sends them running from the doctor, even when they’re having health issues.

Weight has long been thought to be strongly linked to a laundry list of health issues. Thus, doctors rely in part on the number on the scale to guide their thinking and serve as a building block for a diagnosis.

And people have been told for decades that obesity can be solved with a strong will and strict dieting and exercise regimens, and a failure to lose weight is a sign of a fatal personal flaw.

Dr Pamela Tambini, Medical Director at Engage Wellness, an addiction recovery center where a patient’s weight is crucial for medication dosing, said weight checks at doctor appointments ‘are more than just stepping on a scale — they’re an essential health tool.’

She added: ‘Weight is a crucial indicator of overall health, especially when it comes to chronic conditions like diabetes, heart disease, and high blood pressure.

‘While conversations about weight can feel sensitive, routine weight monitoring remains a key part of preventive care, offering insights far beyond the number itself.’

Many professional medical organizations, such as the American Medical Association, have issued guidelines minimizing the importance of weight and body mass index as key health indicators. Instead, they urge doctors to focus on all aspects of a person’s health equally.

While reducing focus in examination rooms on what the scale says can make a patient feel more comfortable and willing to continue going for preventive care and check-ups, brushing it aside may introduce more risks than benefits.

Dr Paul Rosenberg, head plastic surgeon at New Jersey Gynecomastia Center, is a strong proponent of patient weigh-ins.

Weight checks are critical to evaluating whether a patient is healthy enough for surgery. 

They help differentiate between excess fat and glandular tissue for procedures to remove excess breast tissue in men.

He said: ‘These metrics can reveal underlying medical conditions, including diabetes, hypertension, and certain cancers. Sudden or unintentional changes in weight can be a red flag for things like thyroid dysfunction and heart disease.

‘These routine checks are about prevention and early detection. It’s easy to miss detectable health risks when we disregard weight checks entirely or avoid sharing this information with patients.’

Weight checks are simple, noninvasive tools in a doctor’s diagnostic arsenal. Although indicators, such as slight irregularities in weight patterns, may seem insignificant and fine to skip, they can sometimes mask underlying diseases.

Continuous weight monitoring is recommended for timely intervention to reduce the risk of long-term disabilities and improve patients’ quality of life.

‘On the other hand,’ said addiction and internal medicine expert Dr Courney Scott, ‘abrupt and involuntary changes in weight — wherein one experiences sudden changes in weight — might emphasize deeper and more serious problems that need attention at the right time.

‘Rapid weight change could be due to underlying factors such as thyroid dysfunction, heart or kidney failure, nutritional deficiencies, and even depression or anxiety which deviate one’s normal expectations.’

Nowadays, patients can deny consent to be weighed, even handing over business cards with bold lettering saying, ‘Please Don’t Weigh Me Unless It’s (Really) Medically Necessary. ‘ This is an effort from an eating disorder advocacy group to empower patients.

However, many experts say weigh-ins do empower patients.

Dr Scott said: ‘This is made possible by enabling patients to keep track of their weight trends, thus giving them the upper hand in deciding dietary changes or even asking for medical advice.’

Weight checks also allow for frank discussions with the doctor about the potential benefits of trying other interventions known to improve cardiometabolic health, such as GLP-1 drugs such as Ozempic and Wegovy.

Dr Rosenberg added: ‘In my practice where I’m prescribing GLP-1s and related treatments, I’ve seen first hand how empowering it can be to deliver information to patients in a respectful manner with the right context.

‘When patients are informed about their weight and how it relates to their health, they are more likely to adopt strategies to manage or improve it. Avoiding the conversation entirely in the name of preserving mental health can do more harm than good by potentially delaying critical care.’

Obesity is a persistent public health issue in the US, where about 40 percent of people are overweight or obese. 

Obesity rates were consistently highest among adults ages 40 to 59. Overall, 46 percent of Americans in that age group were considered obese. 

People with obesity are projected to be about 28 percent more likely to be diagnosed with heart disease, a 24 percent increased risk of stroke, and a nine times greater risk of developing heart failure.  

When doctors and nurses weigh patients, approaching the topic with tact and sensitivity is crucial.

Surprisingly, despite healthcare settings being designed to support and promote health, research spanning 40 years indicates that individuals with obesity often face weight stigma and discrimination from healthcare professionals.

Studies have found that 69 percent of doctors, 46 percent of nurses, and 37 percent of dietitians exhibit biased attitudes toward people living with obesity.

In 2023, experts found that half of about 380 women thought it was okay to refuse to be weighed at the doctor’s office, and almost a third reported doing so in the past because of concerns about weight discrimination based on prior negative experiences with providers and its negative impact on their mental health.

Dr Scott said: ‘A significant practice that should support this process involves clinicians being sensitive to what the patients want. For instance, aspects such as the feeling of shame and brutality of focusing too much on one’s weight can be avoided by them opting out of seeing their weight, even if the clinicians are using that data for health purposes.

‘Creating the possibility to discuss such issues encourages more focus on trust and takes people’s involvement in caring for their health in the long run.’