Healthy Living

Can You Refuse to be Weighed at the Doctor?

Mar. 12, 2024
Why We Stopped Doing Routine Weigh-Ins

If the first step in your visit to the doctor is onto the scale, it must mean your weight is a priority for your health—right? It’s part of the whole routine.

But here’s the risk of something routine: We don’t question the “why” behind it.

As a physician, I can’t ignore the lack of scientific evidence supporting routine weigh-ins. There’s no clear evidence that they improve a patient’s health, and guidance on a thoughtful approach to them is scarce.

What the research does tell us is that weight-focused care is dangerous for patients.

Scale doctor's office weight

Some people delay and even avoid health care because of experiences with weight stigma. Many have been treated disrespectfully or fear being lectured about losing weight. Research also shows that people with higher BMIs—a number that categorizes people based on a weight-to-height ratio—experience weight bias in health care settings, including being denied health care. (Read more about the problem with BMI here.)

Some clinicians even admit they feel less respect for patients with obesity and that they are less likely to engage them in health education.

Routine weigh-ins also spread the idea that there is an “ideal weight” and that higher weights are always linked with health risks, which isn’t true. That thinking naturally leads to weight loss as a recommendation to improve health, even though we know that the vast majority of people who lose weight regain it within five years. Nothing else we recommend so frequently in medicine has so little chance at long-term success.

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We owe it to our patients to be more thoughtful about how we use the time we have with them. We should question routines and actions that might go against our commitment to first do no harm.

That’s why, in our Family Medicine practice, we stopped routine weigh-ins for adult, non-pregnant patients at follow-up appointments. We’ll still do it on request or if it’s related to why the patient came to see us that day, but it’s no longer a required first stop on the route to the exam room.

This change spurred much discussion among our patients, staff, and providers. We have heard repeatedly how weight-related shame and stigma affect care. In fact, in one discussion, two of my physician colleagues confessed that they’d postponed their own preventive health visits until they could lose weight.

So now I spend the precious time I have with patients focusing on more reliable health measures and behaviors that have much stronger evidence for health and well-being than weight loss.

We know that people with strong social connections live longer and healthier lives, so we encourage our patients to spend time forming meaningful relationships. We know that being active can lead to a longer life, so we talk about how to move our bodies in ways that are enjoyable and therapeutic and don’t necessarily look like traditional exercise. And, most importantly, for people who smoke we can spend time counseling and linking them to medications that can help with quitting or cutting down, which can add a decade to their lives.

The movement away from routine weigh-ins and toward greater awareness of the harm in anti-fat bias in our culture and in our health care system is gaining momentum. But changing long-held beliefs and routines takes time. In the meantime, if your doctor’s office still does routine weigh-ins, you should know that you have a say in what happens during your visit.

I realize it can be intimidating and uncomfortable to speak up. But if you find yourself at the doctor’s office scale on a follow-up visit where your weight isn’t relevant to your care, here are a few things you can try:

  • Ask why: At the very least, it’ll get people thinking; and at best, you might be told it isn’t needed.
  • Just say no: A simple, “No thank you” when asked to step on the scale may do the trick.
  • Hit the pause button: Say something like, “I’d prefer to speak with my doctor first, to find out if my weight is needed for this visit.”

And if you’re up for it, consider asking your doctor why routine weigh-ins are a part of their practice. It may open a discussion about what really does have an impact on improving health.

When it comes to setting priorities for my patient’s health, I would much rather have them skip stepping on the scale than skip getting the health care they need.

Holly Ann Russell, MD, is an associate professor and board-certified Family Medicine physician at URMC. She also serves as medical director of clinical and community-based programs at the Center for Community Health & Prevention.