Ok I'm fat and I think this is the dumbest thing I've ever heard. Changes in weight (without corresponding changes in diet or activity) can signal and number of conditions such as hypothyroidism or congestive heart failure. It is important to be weighed regularly to spot these trends. What might make sense is a "weigh me but skip the sermon on how fat I am" card.
I am both overweight an self conscious about it, but I too felt like I was teleported to some bizarre alternate reality filled with dumb people while reading the article.
Then I scrolled to the end and saw: "You can order your own 'Please don’t weigh me' cards"... So it's just a bunch of grifters grifting away and preying on people's insecurities. Nothing to see here.
I can't imagine being this fragile. You're at a doctor's office. It's literally their job to assess your medical situation. That includes weight and everything else they check.
Reminds me of the outcry over micro aggressions in recent memory. Not to say that these things aren’t emotionality harmful, we shouldn’t dismiss people’s feelings or normalize hurtful behavior, but perhaps we should start asking why people are so sensitive.
Medical science relies on so many crucial data points based on mass, which is most easily determined via measuring weight.
Without your weight:
A Doctor cannot safely prescribe anything.
A Doctor cannot verify whether changes in your weight may containdicate a pre-existing course of treatment.
Second-opinions to sanity check a physician making a high impact diagnosis is right out.
What is wrong with people? Valuing avoidance of being confronted with an objective fact that makes you feel bad over not dying or not being treatable?
I just don't understand.
You can be squeamish with just about everyone else. Never your Physician.
I am not overweight, but I can understand this. I don't entirely agree with it.
If you want to stick with something objective: if your biggest association with going to see a doctor is being made to feel like crap about your weight, then you will see your doctor less.
I already avoid going to the doctor more than I should, and that's mostly based on inconvenience. If it were a miserable experience, then I know I would procrastinate even more aggressively.
But setting that aside, I think there are a number of reasons why this could make some amount of sense. Doctors do over-focus on weight, not bothering to look for any specific causes because they've supposedly already figured out the problem. Which means the patient leaves with an instruction to lose weight, they don't, and nothing changes. And being fat isn't as highly correlated with health outcomes as people—including doctors—assume. There are plenty of healthy fat people and unhealthy thin people.
There are many other legitimate reasons to control how your doctor approaches an issue. You may have tried the common fixes and know that trying slight variations is unlikely to be fruitful. You are an expert on your own body, with massive gaps when it comes to medical knowledge and details. Your doctor is an expert on human bodies in general, with massive gaps when it comes to specific patients' bodies.
I'm not going to argue that the right answer is to not weigh at all. There are a lot of other options, like not telling the patient the weight. And/or skipping the sermon on weight. Bringing up weight only in the context where it matters. Being specific about what aspect of weight is relevant. (Is it really the mass causing mechanical failure, or are we talking about fatty tissue? Endocrine problems?)
In a perfect world, measuring weight wouldn't be an issue because your doctor would be sensitive yet persuasive, and patients wouldn't be hung up on it and would be making rational choices (eg "I'm fat because it's a side effect of doing things that make me happy and this is what works for me right now.") We don't live in a perfect world. We need to do the best in the actual situation, and handing over all power to the doctor does not have that result.
It's interesting that they then go on to scare-stories where the physician had assumed that weight was a largely contributing factor.
Does anyone believe that not weighing them will change this? If you're large enough that the doctor assumes it's a primary medical concern, they can probably reach the same conclusion without the scales.
Not trying to be anti-anyone, just .. not sure it's solving the right problem.
> Please don't weigh me unless it's (really) medically necessary. If you really need my weight, please tell me why so that I can give you my informed consent.
But it's always medically necessary, because weight changes are a leading indicator of many issues, and the long-term trend is needed to see these. If people feel that they don't understand why it's necessary, maybe better communication and education is needed, but I don't think these cards help that.
This is interesting because improved weight management would probably the HIGHEST medical impact intervention for tons and tons of people, both in quality of life and disease / illness.
Reading this you realize that folks who are fat may not know (or don't want to know) just how many correlations there are between issues with weight and illness / disease, including mental health issues
I actually wish they'd do things like tie weight screening into things like a mental health referral for depression / self esteem etc support.
Bottom line, obseity is associate with large decreases in life expectancy and higher incidence of early mortality. Given the billions spent on other areas of health (including end of life care) there is probably a fair bit of bang for the buck in actually being more aggressive here.
Just like they want to mandate employers force shots on all staff, you might have strong outcomes if they forced employers to mandate all staff exercise 2x per day for 30 minutes (fitness / stretching etc) - monitored eating during the day to healthy diet etc.
I'm not saying this should happen, but the crazy lockdowns due to COVID for kids (massive impact, modest benefit) - they might not be focusing on areas of greatest payoff.
> This is interesting because improved weight management would probably the HIGHEST medical impact intervention for tons and tons of people, both in quality of life and disease / illness.
Yeah, and if I know I'm going to get a lecture about my weight that I've already heard, I'm going to put off going to the doctor.
What is the difference in outcomes from going to the doctor timely vs waiting 3 months?
Also, consider that the medical industry does a pretty bad job of adapting to the bodies people have, and all of the downstream data that drives. For example, you need a proper size blood pressure cuff to get an accurate measurement, but the larger and smaller than 'regular' cuffs are usually not immediately available, so medical staff just tries to wing it when presented with a larger or smaller arm.
Shots were not forced on staff. There was informed consent, and staff were allowed to quit their jobs in lieu of getting the shot. The card is asking for informed consent. It is not a flat refusal to being weighed. Patients are exposed to a lot of misinformation, and that needs to be addressed by healthcare professionals. It is unfortunate, but that's the world we live in. For all the play that vaccine hesitancy gets on HN, it's really interesting how ferociously people have responded to a different treatment hesitancy.
> They have better things to do while running a 12-16 hour shift.
One way to view this is as a component of bedside manner. Some patients need to be educated (and perhaps won't need the card after certain things have been explained to them). Patients with hard-earned sensitivities need a little extra hand-holding. For example, people with phobias of needles need some extra hand-holding. The doctor/nurse doesn't "have better things to do" in that case -- most have training to mitigate the patient's anxiety in that situation. Why should this be different?
I feel like there is a lot of context to this that each of us can easily miss that can make discussing this hard.
From my experience, I don't get weighed by unrelated medical practitioners but when it is relevant for tracking my health. Unless there are cases outside of my life experience where people are being weighed, that context adds an implication to the card's existence and text that most of these existing weigh-ins are not medically necessary and that you need to justify each time you do do a weigh in.
With that said, as I read the article more, I can understand receiving accommodations specifically dealing with body image and eating disorders (as well as improvements with how doctor's deal with weight). How to make those accommodations while also tracking vitals important for your health is tricky. Needing to deal with unhealthy habits and unhealthy weight is a real thing. Its also a real thing when doctor's dismiss patients as lying when they are living healthy when it turns out there are other underlying conditions (like PCOS). None of this is in my life experience but I've been slowly hearing from more friends who have had to deal with this, like a very active folk dancer who eventually found out she had PCOS no thanks to her doctors that accused her of lying about her habits.
Wouldn't there be an implied consent to routine data collection during a physician visit? A clinician may also make notes on patient appearance or mannerisms that they feel may be relevant to the diagnostic process, not to mention non-invasive tests based on touch.
JFYI, please at least mention the stated purpose of the cards before dismissing them.
> A tendency to see size over everything else may lead providers to misdiagnose patients in larger bodies and misattribute symptoms to size instead of the true underlying condition.
> Later, I found another doctor for an annual checkup. At the appointment, he physically recoiled at the sight of me. He quickly told me I’d need to lose weight before I saw him next, then left the exam room. My body was never touched, never examined. I learned nothing new about my health, and was left only with the searing shame of believing that even a professional couldn’t bear to touch my body.
> At another appointment, a nurse took my blood pressure four times. When I asked her if I was okay, she told me my blood pressure must be wrong. "Obese patients don’t usually have low blood pressure," she said. Even my health was impossible to believe.
> Their primary purpose isn't to deal with shame, its to ask doctors to not jump to the conclusion that the problem is the weight.
That's dumb, because doctors that are weight-fixated (which is a real problem) aren't going to be less weight-fixated with a patient that is visibly defensive around weight. It centers attention on the thing you want least attention on. If you've got a doctor with this problem and it is interfering with your care, you don't need a ”don’t weigh me” card you need a different doctor.
(OTOH, I’ve seen the “don’t weigh unless specifically necessary, and don't put the weight in follow-up notes” thing, whether in card or oral-request form, recommended for people with eating disorders where seeing/knowing their current weight can be a trigger, and think it is wholly sensible there.)
At one point being morbidly obese I get these antidotes. I had one doctor look at me and tell me if I wanted to wager with him that I would die before 45 (I didn’t, so should have taken the bet). I think it was some piss poor attempt at shocking me to action, which it didn’t do. The only thing it did was cause me to no longer go to him.
However, poor bedside manner aside…if your obese it is a pretty good bet that it’s going to kill you, and kill you early…which is why docs focus on it.
Would a card for smoking tobacco have a similar acceptance? "I smoke, please don't bring up my breathing issues" I lean on they wouldn't, and the purpose is not comparing smoking to weight, just known health risks.
Cards are a dumb idea, but people suffering from the whitecollar effect should inform the doctor in a normal way. I always take the measure at home before and after the appointment and take my blood pressure meter to the doctor. I inform them it's probably going to be 150 even though normally it's 130. Sometimes they measure it anyway, and I also repeat it using my home meter. Usually I'm correct - and once I get back home it's again 130.
I was worried about it but several cardiologists explained it to me that if it's for a short time, these values are harmless and I shouldn't worry but continue observing it.
For some bizarre reason, at one particular health care provider my blood pressure always read high. At my current and previous primary care doctor, as well as with my personal BP monitoring deice, my BP was always in the "normal" range. But at the one doctor (a cardiologist) it was always, consistently, very high, regardless of who did the measurement or which machine they used. I felt no particular stress or discomfort there (no more so than at any other doctor), but it was like that for years.
"Ask to step on the scale backwards (so you can’t see the numbers) and for the staff not to tell you or put it in follow up notes from your visit."
It is expected that patients are medically illiterate but to be the best patient for a doctor is the best thing you could do for your physical health. The scale is just an accurate representation of reality just like your LDH level.
I feel like doctors have a responsibility to inform patients that they're in an unhealthy state. Even if a patient should/does know. In the USA it's probably a legal thing too if the patient has a heart attack they'll sue the doc for not being told they were overweight!
Given you need a person's weight to calculate their BMI and you need a BMI on every patient per government PQRS requirements this will not fly in a doctors office unless you are paying cash.
The comments here, Jesus Christ. This is about harm reduction. Yes, being overweight is unhealthy, but it's more unhealthy to be overweight and never see the doctor because you're ashamed of your body.
People avoid going to the doctor for all kinds of irrational reasons. This is a way to entice a population that'd be embarrassed by a public weigh in (and thus avoid care) with an easy way out of their shame (thus hopefully not avoiding care).
I agree that some of the comments are, depressingly, of the standard internet variety (low-quality, reductionist, pointlessly negative/provocative, false equivalencies, etc). Regardless, I do have a hard time relating to the alleged benefactors of this card - I would be so much more embarrassed handing my doctor this card than having him learn my exact weight (yes, having it expressed as a metric hits a little harder - but it's not like he can't ballpark it by looking).
The practice in question is driven by the grift, not organic.
I believe it's safe to assert that the set of people for whom the determining factor in whether or not they seek medical care, or not, is a function of the actual stepping on a scale, is so small as to be a distraction.
What general BMI someone is and what relevance that might have to whatever concerns bring them in, will of course be easily judged by health care professionals.
The value in tracking a number is as others have said, specific and obvious, that it affords an opportunity to detect changes and incorporate them in a model that has to be constructed very quickly about potential diagnoses if any and next steps.
IMO this is in large part grift which is wittingly or unwittingly in service of the broader politicization of expertise, which from my perspective amounts to nothing so much as an opting out of a science-based consensus reality in service of toy notions of liberty and what "harm" looks like.
