Your Next Follow-up Doctor’s Appointment: How to Focus on Health, Not Weight or BMI

Have you ever avoided scheduling a follow-up doctor’s appointment because you’re concerned you’ll get lectured about your weight?

If so, you’re not alone!

Let’s face it, our medical system is very focused on weight and BMI as a measure of health.   And this weight bias causes negative effects.

Research shows that getting regular physicals leads to better health, but when a large percentage of the population is avoiding follow-up doctor’s appointments because they are concerned they will get shamed about their weight, we have a big problem!

There are so many other, and better, ways to assess our health and screen for chronic conditions.  Getting regular medical care that includes labs (including HbA1c and blood lipids) and blood pressure is a more effective way to measure health risks as compared to weight.  

Avoiding the doctor won’t make you healthier, but sometimes the stress of scheduling your follow-up doctor’s appointment makes you keep putting it off.

In my work as a non-diet dietitian, my clients ask me for advice and support to help them get the most out of their follow-up doctor’s appointment without getting unsolicited weight and nutrition advice.

Weight and Health: What You Should Know

Here’s what we know about health and weight*:

  1. Getting regular physicals is linked to better health.
  2. People tend to avoid the doctor when they get shamed about their weight.
  3. You do not have to be weighed at the doctor’s office in most cases.
  4. Weight cycling (aka yo-yo dieting) is linked to a greater risk of inflammation, heart disease, and diabetes.
  5. Research shows a correlation between higher BMI and disease risk but that same research doesn’t show a causation.
  6. Research shows that those in the overweight category tend to live the longest, followed by those in the obese and normal categories.  Those with a BMI <18.5 tend to live the shortest.
  7. Cutting calories to lose weight in middle-aged women, can negatively impact bone density quickly.
  8. There are currently no research studies that show a majority of people can lose and maintain lost weight long-term.

Given these factors, the research shows that a weight-centric medical system has many drawbacks and few if any, benefits.

It’s understandable why people who experience weight stigma avoid the doctor.  However, I encourage you to get your annual physical and

I hope that the strategies discussed in this article can make your doctor’s appointment more pleasant and more effective.

 

How to prepare before your doctor’s appointment.

Use my PDF toolkit to help prepare for your appointment.

1.  Gather relevant information and reflect on your health and behaviors.

If you’re seeing a doctor for the first time, this is particularly important.  

Make a list of:

  • Any concerns, aches, or pains that have arisen in the past year.
  • Your current medications. Don’t forget your over-the-counter medications and any dietary supplements.
  • The healthy habits you’re already doing: Some examples might be getting 7-9 hours of sleep, eating 3 meals a day, eating more fruits and vegetables, meditating, or doing physical exercise that you enjoy.
  • Any healthy habits you might want to work on as future goals.
  • Note any questions you have about your health or any goals you might have.

2. Consider any boundaries you want to set.

It’s okay to let your doctor know that you are not comfortable discussing weight loss, weight loss medications, or restrictive eating practices. Instead, redirect the conversation towards evidence-based approaches to health that align with your personal goals.

3.  Send a note ahead (or if you are working with a dietitian, ask them to do it). 

If you have access to a portal to communicate with your doctor, sending a note ahead can begin the conversation.  If you’re working with an Intuitive Eating dietitian, they can call or fax ahead similar information.  I’ve included a template of a note you might send as a PDF download.

4.  Decide before your appointment if you would like to be weighed or would prefer to skip.

Or, if being weighed is OK as long as you don’t see the number, you can ask for a “blind weight.”  (A blind weight means you turn around so you don’t see the number on the scale.  It’s helpful to tell the person weighing you that you don’t want to see the number too.)

There is no right or wrong answer here!  And if you get nervous and let them weigh you, please don’t beat yourself up about it!  We are dealing with a very weight-centric medical system and it is very hard to decline getting weighed. Some offices make it very easy, while at others you might encounter some negative comments.

 

I’m a huge fan of keeping your symptoms, questions, and medications in one place.  You might use a note on your phone, or carry a small notebook for medical appointments.  My memory isn’t as good as it used to be and it stinks to forget something important you’ve been waiting to discuss! 

But, if you’re looking for a comprehensive way to gather all this information, download my PDF toolkit to prepare for your doctor’s appointment.  It has a template letter you can use to communicate with your doctor and space to reflect and write down your notes.  [Insert link and graphic when final] 

A note about the scale:

You do not need to be weighed. 

Really.  There are a few reasons why your doctor needs to get your current weight:

  • when dosing certain medications, 
  • if you’re having general anesthesia for surgery, or
  • if you have kidney disease or COPD where you might retain water weight.

 For your average follow-up doctor’s appointment, it isn’t necessary (and it might even be harmful).

 

Why would weight be harmful, you might ask?  

For many people, including many of my clients, seeing an increase in weight may cause a relapse of an eating disorder, skipping meals, or preoccupation with food. It also might cause them to engage in extreme exercise or cut their food intake, often to very low and dangerous levels.  Sometimes a decrease in weight can cause a relapse too.

While seeing a weight might be perfectly fine for some individuals, for many, it is not the right decision.

Doctors do not need your weight to bill insurance.  They do need some objective measures but height and blood pressure will suffice.  

My advice is this: if the fear of getting weighed is preventing you from getting a physical or will harm your mental health, you should decline being weighed.

 

Is this easy to decline being weighed?  Absolutely not.  

I often rehearse this with my clients. One tool I love that you can order is called “Don’t Weigh Me” cards. 

If you are working with a weight-neutral dietitian, like me, you can ask them to send a note or leave a message for the doctor, asking that you not be weighed.  This is something I do for my clients all the time. 


Are You Curious What It’s Like to Work With a Non-Diet Dietitian?


Now, let’s focus on the day of your doctor’s appointment.

What to say during your appointment

While there are some exceptions, I believe that most people who work in healthcare have their patient’s best interests in mind.

But, your doctor’s training was probably weight-centric, i.e., weight loss is the ultimate goal for being “healthy.” I know mine was!

It took years and additional training for me to learn how harmful that belief is. The good news is that shifting away from weight isn’t quackery. There is real science behind Intuitive Eating and Health at Every Size.

Here’s how I recommend my clients begin the conversation.  While each of these suggestions may not apply to every situation, this is the approach I recommend.

  1. If at all possible, and if you or your dietitian has sent a note beforehand, you might ask if the doctor has had a chance to read the note.  We certainly don’t want to assume they have – doctors are so busy these days!  But if not, perhaps they can skim it while you wait.  If you haven’t sent a note ahead, here are some things you may want to say:

“I have a long history of [Insert your particular history here. Some examples might be: disordered eating, yo-yo dieting, an eating disorder].  I am interested in improving my health in a way that doesn’t focus on dieting or my weight.”

  1. Remember those lists you created before your appointment?  Now is a great time to pull that out and go through your questions and goals.
  2. If your doctor responds to all health conditions with a directive to “lose weight,” it can be helpful to say, “What do you recommend to your patients of a normal weight who have this condition?  I’d like to try that.”
  3. Remember your boundaries!  If your doctor continues to focus on weight or gives you unsolicited weight loss/nutritional advice or a prescription for weight loss medication you didn’t request, reiterate that you are not interested in weight-centric advice. You can ask them if they can treat you without focusing on weight. If the answer is no, you can ask for a referral to another provider.

 

A pep talk

I know this is hard, and the burden shouldn’t be on us as patients, but unfortunately, sometimes it is. If your doctor was respectful of your boundaries and listened to your point of view, consider thanking your doctor for listening to you.

I’ll be the first to admit that a weight-neutral model seemed unhealthy and unwise when I first heard about it 20+ years ago. But, research shows us that non-diet behaviors can help us improve our health, whether or not we lose weight.

Key Takeaways

Navigating health conversations with your doctor can be challenging in our weight-centric medical system. You can take steps to improve your experience at your doctor’s appointment and to make the most of your time.  

Consider using my toolkit to help draft a note to your doctor before your annual physical.  

And if you want personalized support and advocacy, consider working with a non-diet dietitian, like me. You can schedule a complimentary Take Action Call with me. It will give us a chance to chat about your unique needs and goals to see if we’d work well together.  

 

*Resources:

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Bacon L, Aphramor L. Weight science: evaluating the evidence for a paradigm shift. Nutr J. 2011 Jan 24;10:9. doi: 10.1186/1475-2891-10-9. Erratum in: Nutr J. 2011;10:69. PMID: 21261939; PMCID: PMC3041737.

Bacon, L., Keim, N., Van Loan, M. et al. Evaluating a ‘non-diet’ wellness intervention for improvement of metabolic fitness, psychological well-being and eating and activity behaviors. Int J Obes 26, 854–865 (2002). https://doi.org/10.1038/sj.ijo.0802012.

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Intuitive Eating Studies: https://www.intuitiveeating.org/resources/studies/