Why Are Doctors Trying to Guess Fat Patients’ Weight?

WTF are you doingI refuse to be weighed in at the doctor’s office.  There is no medical reason to weigh me in – I haven’t had unexplained weight changes, I don’t need medicine that is prescribed per body weight, so I don’t need to be weighed.

While I don’t think that weighing people is a medical intervention, the doctor does and therefore, like any medical intervention, I’m well within my right to refuse. If they had a good reason (ie: we have to dose this medication by weight) I would consider it. But since they just want to weigh me so that the can suggest that I try to change my weight – which is asking me to do something that nobody can prove is possible, for a reason that nobody can prove is valid, I’m out. For years this has been no problem, they say “step on the scale” and I, politely and firmly, say “no thank you” while I keep walking, slowing slightly to let them catch up after I pass them so that they can lead me to the exam room.

But recently something weird has started happening. When I refuse to be weighed the person asks me something like “do my mind if I make my best guess.” The first time it happened I was so surprised that I said the first thing that came into my head which was “This is not the State Fair…no you may not guess my weight.” She was taken aback and she immediately dropped it.

It was so weird that I did some digging. It turns out that insurance companies and Medicare have started to pay for something called “Intensive Behavioral Therapy for Obesity” In order to charge you, you must have a BMI over 30. BMI (Body Mass Index) is nothing more than a ratio of weight and height. Though it’s become misused as one, it’s not – and never has been –  a health measurement of any kind. It’s just your weight in pounds, times 703, divided by your height in inches squared.

Here’s where the guessing comes in. In order for doctors to get paid for “obesity counseling” they have to have your BMI on file. So if you refuse to be weighed, they simply guess the weight that they need to get paid.

Obviously this is crap, and not just because guessing people’s weight like you’re guessing  the number of jelly beans in a jar is exactly as medically relevant as it sounds. But more to the point, these doctors don’t have any idea how to create long-term weight loss. There isn’t a single study of any intervention that they could prescribe, that has been shown to lead to long-term weight loss for more than a tiny fraction of participants, and that weight loss is often less than 10 pounds. Once again, they would be better off just giving all fat people ponies (with the possible exception of those who are allergic.)

So what do we do? Every fat person gets to decide how to deal with this each time it happens. We shouldn’t have to deal with it at all, and we get to do whatever we have to do to get the medical care we need. That may include educating our doctors, lying to them, or placating them by letting them make up a weight to make a bullshit math calculation that they will use to get paid for giving us information that is useless at best, and most likely harmful.

Here’s some scripting that you might use. By way of a disclaimer, we have the right to refuse treatment, but doctors in most cases have the right to refuse us as patients. Unfortunately, there can definitely be consequences to fighting for our rights to be treated without weight stigma, so we have to take that into account when we decide how to respond.

Here are some options:

Per my rights to refuse a medical intervention, I refuse to be weighed, I refuse to allow you to guess my weight, I refuse to have a BMI calculation made, and I refuse any type of obesity counseling. Let’s focus on what I came in here for.

No, you may not guess my weight. Please just write “patient refused to be weighed and refused to allow me to guess their weight.” I’m happy to sign something if you need me to.

You can try asking them “why do you want to weight me?” or “Is this so you can bill my insurance for obesity counseling?” if they say yes, consider saying something like “I’ll submit to this if you can show me a study where this counseling has led to significant long-term weight loss for a majority of participants.” (Remember, no such study exists, so this might take awhile.)

Just continue to say “No thank you,” while walking past the scale.

If you decline, or don’t receive, “obesity counseling” it might be interesting to check and see if your doctor charged your insurance for it, and if they do then promptly report them.

Again, this shouldn’t be happening. People of all sizes should be able to receive competent, unbiased medical care. Nobody should have to prep for a doctor’s appointment like they are memorizing lines for a (literally life or death) audition. Unfortunately, that’s not something that fat people can always access, so we have to do way more to get even close to the same level of care. Fatphobia kills, fat activism is the cure for fatphobia.

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17 thoughts on “Why Are Doctors Trying to Guess Fat Patients’ Weight?

  1. Whoa. What explains SO much. After nearly 15 years with the same primary doc, with no significant changes in weight or health conditions, suddenly last year I started getting WL crap from him. Even after several instances over the years when I’d mention WL crap I’d gotten from specialists and he would strongly say “You’ve never gotten any of that from me, have you?? Of course not.” When the PCP started this last year, I put it down to the WLS department that the multipractice specialty opened. But honestly, they’ve had that department for a while. This…THIS…explains so much more.

    What does is matter if the “intervention” is bogus? What does it matter if the entire premise is bogus? What does it matter if the discussion causes huge mental distress? What does it matter if you kicked in my dormant ED, you lousy shit. You got your “money for nothing” and that is what’s important, no?


  2. “Hello, this is Microsoft tech support. We regret to inform you your body has contracted obesity and may have been compromised. We require an up-front fee of 25,000 USD plus unrestricted access to your body and bank account in order to fix the problem.”

    Sounds just as legit, really…

  3. Great information and I highly recommend everyone speaking to their PCP about the practice of harping on WL with patients and how it is a turn off, keeping people from getting the health care they need and also threatening. I never allow them to weigh me. I know what I weigh and the doctor knows, other than that it is no one’s business. I think there might be a connection to this being a HIPAA violation also.

  4. The nurses tell me the insurance company penalizes them if they don’t get a weight once a year. I didn’t believe them, but now I don’t know what to think. It makes more sense that doctors who were previously against weight crap are now for it if it’s not only a bonus, but a penalty.

    1. This is different for different insurance companies. Still, even if it is true, it’s not my problem. I offer to sign a form, or suggest that they let the insurance company call me if it’s a problem.

  5. I ignore it. They ask, I stand on the scale, fascinating. It think it wigs em out that I do not comment, take my coat off, set my purse down or act embarrassed. I have even stood on the scale holding my 8 oz bottle of water. Pahahahaaa. Do I care?

    1. I do this just to see what they say. Boots, coat, purse, whatever I happen to be holding. They dutifully write it down anyway. And attribute the weight fluctuation to different eating habits between summer and winter. Gotta amuse myself somehow.

  6. So funny, about four visits ago, the nurse told me I was “almost down to the regular sized BP cuff.” I wasn’t sure what she meant…Oh, she thought I MUST be dieting and would come in next time and fit the skinny person cuff. MM whatever.

    Any one want a group update? New session started. Therapist actually managed to add no comment about weight allowed, other therapist rolled his eyes, and annoying group member was visibly irked, made no comment, regrouped by insisting it being too hot out was no excuse to cancel group as she had no problem walking the two blocks from the bus stop to get there… The gal in the motorized wheel chair agreed. Hot temps, no big deal…
    You know, I have accepted being emotionally unsafe and psychologically not protected in group like months ago, but when it comes down to it, I am not willing to risk my physical well being to show up for a two hour program to listen to former tweekers, truants and bullies make themselves feel better about their lives by using me as an example of what not to be.
    Therapist said last year 95 was too hot, now it is 105. I think she was kidding…

  7. When I think of how many times I have avoided going to the doctor when I was really ill because I didn’t want to go through the weighing trauma, I become terribly sad and angry.

  8. I was speaking to a friend of mine who works in healthcare (albeit not a physician) and he told me that, for medicare (under some new regulations called MIPS), not only will this “counseling” be encouraged and paid for (Ding ding ding, profit at the expense of the patients’ wellbeing) but eventually it will become a standard that, if not met, could result in docs being penalized via lesser pay. I have not researched this and do not know how true my friend’s statements are, but I will not be at all surprised. This just ups the ante on the medical staff and, in my case, could easily result in being “dismissed” from my doc’s practice for noncompliance. Holy shitballs. I hate everything right now.

  9. I strongly suspect that I weigh less now than I did at my last doctor visit. My clothes are looser. I tell them that they can weigh me, but I’m not going to face the scale and I don’t want to hear the number unless it represents a sudden drastic change. I am trying not to have a sudden drastic change because I have gallstones and rapid weight loss could cause an attack. I am working on creating a diet that I have time to eat and that keeps me from getting so hungry I can’t think, because a lot of my old standbys are now verboten due to gallstones. All of this I’m going to want to discuss with my doctor at my next visit. But first I’ll have to sit through the rah-rah-sis-boom-bah of praise for having moved a number on a scale. Gee, thanks, that’s great, doc. Could your praise extend to paying for me to have my clothes taken in? Because that wasn’t in my budget. Also, I’m still very fat, so she’ll probably also talk about how now that I’m “on a journey toward health” I should go on XYZ blah blah diet….it makes me tired.

  10. I agreed to be weighed today for my pre-op because I’m being sedated for an endometrial biopsy. I told the medical assistant not to tell me my weight, and she respected that. The doctor didn’t say anything about my weight. Under normal conditions, I refuse to be weighed. I like what Ragen said about “this is not the state fair, you are not allowed to guess my weight.” That was great!

  11. I always refuse the weigh in at my doctor’s office and they don’t hassle me about it. And my doctor is great; he never says anything about my weight. Unfortunately, I just found out I’m being laid off from my job, so I don’t know if I’ll be able to keep my doctor.

    I hate everything about health care in this country and I really hate the rat bastards in congress who are willing to spend my tax dollars on everything but health care.

  12. I’m a fat medical assistant who works in family practice. We are required by several insurance companies and Medicare to take a weight once a year. I, and my co-workers, work very hard to be respectful of all our patients and never argue when someone wants to decline any care. I know that this is not true for all, or many, medical offices, but we have worked hard to make care accessible to all bodies. We still have work to do; not enough of our exam rooms have wide chairs, for example.
    It is important for people with high blood pressure and several other common conditions to be weighed frequently. This helps track water retention and helps determine if medication is working correctly.r

  13. Heh.

    I just had to buy food at the Place in the Supermarket Where Americanized Versions of Chinese and Japanese Food May Be Purchased Hot. Because gallstones, I had to stick to certain types of foods or else owie owie owie hospital. I did find something quite tasty. I happened to realize that back in the days when I was doing Wate Wotchas, I would have picked the same dish because low POINTS(TM) (or was it (R)?) plus lots of satisfying ingredients.

    But I would have been steered away from it because, trademarked measuring system or no trademarked measuring system, the salt in the rice bowl would’ve sent the all-important number on the scale up for just long enough to count against me at weigh-in time.

    Because weight is such a great measurement of health you guys.

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