Weigh-ins
Medically Sound or Fat Discrimination
Originally written in 2015, this post has been completely rewritten and reposted now in 2024. It was a post on the various ways in which you could handle fattism in the doctor’s office in the moment, but I realize now that it was not my best work and Ragen Chastain does a much better job and is utterly on target with these really handy Printable Cards. Instead I went looking for the evidence around the tradition of weighing patients in doctors’ offices as that is more in my wheelhouse.
Upfront it took me a while to find any details on why a doctor would weigh a patient. It appears to have started in the late 19th/early 20th centuries but it’s equally difficult to find good sources for this general knowledge. I could find one reference on the start of weighing babies in the 1900s. Adolphe Quetelet, the infamous mathematician who gave us BMI, measured the length and weights of 100 newborns and determined boys were heavier at birth and at year one when compared to girls. Measuring babies was done in his quest to uncover “the average human.” The entire history on weighing babies can be found here: In the Balance: Weighing Babies and the Birth of the Infant Welfare Clinic. Essentially, weight was a surrogate for growth and therefore represented the viability of a baby. There is this vague undertow in these sparse early references to measuring humans, as a matter of state policy, to categorize them for expediency and not individual welfare. For example, there were Better Baby Contests in the US from 1908 to 1916.
“Nurses and physicians judged infants participating in the contest on mental health, physical health, and physical appearance. In 1913, the Woman’s Home Companion (WHC) magazine cosponsored de Garmo’s better babies contests and introduced the competition to state fairs throughout the US. Better babies contests helped promote routine health assessments of children by medical professionals.
During the late nineteenth century, people in the US began promoting eugenics. Proponents of the movement focused on creating a better populace composed of individuals with traits that they desired, like high intelligence, and without deformities.”
It reminds me of the bioengineers of today. Their agendas are filled with good intentions and tonnes of hubris, but very little in the way of ethics or any humility surrounding the fallibility of humans. It’s all starry-eyed “for the betterment of humankind” and a quick wave of the hand to shoo away any concerns for what could possibly go wrong or be actively leveraged for harm.
Insurance companies were the main driver of the development and existence of weight and height tables. The data suggested both above and below average weights had higher incidence of morbidity and mortality. That information was useful for trying to maximize profit: don’t extend a life insurance policy to someone who is more likely to use it (their beneficiaries would use it technically). When these average measurements were adopted into medicine, they were translated into “ideal” cutoffs. The medicalization of anthropometrics (measuring humans) coincided with the rise of eugenics across western countries in the inter-world-war period. It was also the insurance companies that spearheaded the wellness and health initiatives purely for profit in the hopes that it would further lower the incidence of life insurance policy payouts. Medicine was willingly co-opted into this endeavour. [2]
But ultimately Medicine made it its own, by framing measurement and control of the body as treatment and disease prevention.
You Become What You Measure
It is not that these huge social movements were without any redeeming qualities. The massive improvement in child mortality throughout the 20th century was the result of state interventions and state control no doubt. While it turns out that nutrition and even immunization and antibiotic development in the first half of the 20th century could not really explain infant and child mortality reductions and general life expectancy increases, they did contribute. However of all the insertion of state policy and control over many areas of day-to-day life in this period that had not been present before, it was the massive engineering infrastructure that resulted in clean sanitation and water that had the most influence on mortality and life expectancy.
“We find that clean water was responsible for nearly half of the total mortality reduction in major cities, three-quarters of the infant mortality reduction, and nearly two-thirds of the child mortality reduction. Rough calculations suggest that the social rate of return to these technologies was greater than 23 to 1 with a cost per life-year saved by clean water of about $500 in 2003 dollars. ”
In the end, weight interventions did not and do not realize even small returns on improvements in mortality or life expectancy. For emphasis: they have had no influence on either mortality or life expectancy. How do we know this? Global statistics for life expectancy steadily increased from 1950 to 2004. In 2004, life expectancy continued to climb on a completely unchanged trajectory despite the fact that weight had stopped increasing and stayed flat to 2020. In 2020, life expectancy dropped about a year wiping out a decade’s worth of year over year increases (the pandemic). [4] Global annual mortality has been modestly increasing since 1980 (minus the huge pandemic spike in 2021) and this reflects the general aging of our populations at large. [5] Despite $3.7 billion dollars assigned to “obesity” and nutrition research in the US in 2024 [6] and a further projected market size for the weight lost industry in the US in 2024 of $90 billion, [7] here we all are unchanged, and not just in the US but globally.
Medicine has been measuring weight for a century and it has nothing to show for it. Are there any valid reasons for a doctor to measure a person’s weight?
What They Say vs. What the Research Proves
Here are the common reasons given by doctors for weighing a patient in the doctor’s office [8]:
During pregnancy
To determine a child’s healthy growth
As one parameter in a treatment protocol for individuals with eating disorders
To work out the appropriate medication dosage
To monitor recent diagnoses of certain diseases, such as hypothyroidism, insulin resistance, diabetes, or cancer
To help determine whether an underlying medical issue is present.
It would be reasonable to assume that such a list is merely a reflection of best-practice with plenty of good evidence to support these categories. Of course, if you’ve spent any time on this site at all, you already know that none of these categories has sufficient evidence to support how they are used in practice and several have evidence they should not be used at all. Let me explain.
Weight Gain During Pregnancy
Everything revolves around the Institute of Medicine (IOM) guidelines for gestational weight increase. A recent systematic review and meta-analysis on the implications of either gaining above or below the gestational weight guidelines of the IOM make conclusions not supported in the actual data they assessed. Here is their concluding statement:
“In this systematic review and meta-analysis of more than 1 million pregnant women, 47% had gestational weight gain greater than IOM recommendations and 23% had gestational weight gain less than IOM recommendations. Gestational weight gain greater than or less than guideline recommendations, compared with weight gain within recommended levels, was associated with higher risk of adverse maternal and infant outcomes.”
Nope. Nothing in the review quoted above that looked at 1,309,136 pregnancies had any confirmation of increased adverse maternal impacts. They did try to look at gestational diabetes correlating to weight and weight increase, but they found nothing. As for adverse infant outcomes, yes there are some, however the less than or more than categories, compared to the recommended IOM weight increase, cannot be equivalently bundled as they have done in their concluding statement.
First of all “adverse infant outcomes” is bit dramatic— these are risks of hazards (not actual hazards) that are not far beyond 1.00 (1.00 is the expected risk-of-hazard level). There was a 1.70 odds ratio of having a pre-term birth and 1.53 of a small for gestational age baby if you gained under the IOM as a mother, and a 1.85 odds ratio of having a large for gestational age baby if you gained above the IOM as a mother. There was a 1.30 odds ratio of having a caesarean if you gained above the IOM (problematically that could be due to weight bias in the medical community and therefore not a reflection of a complex birth necessitating a c-section [10]). Furthermore, maternal risk is equivalent whether there is a vaginal birth or c-section. [11]
There are some more significant longitudinal impacts associated with small gestational age and pre-term birth when compared to normal or large gestational age as per another review quoted below. The impacts in this study are now listed as hazard ratios, meaning they looked at the mortality that occurred for the full gestational term (39-41 weeks) and assigned that mortality as a hazard ratio of 1.00. They subsequently adjusted the results for the various pre-term categories. What they are referring to when they say “adjusted” is the cox regression they used to incorporate all-cause and specific cause mortality and also to compare the deaths with matched co-siblings so that they might rule out any genetic or shared environmental factors that might be more responsible for the death than pre-term weight.
“Relative to full-term birth (39–41 weeks), the adjusted hazard ratios for mortality associated with gestational age at birth were: 66·14 (95% CI 63·09–69·34) for extremely preterm (22–27 weeks), 8·67 (8·32–9·03) for very preterm (28–33 weeks), 2·61 (2·52–2·71) for late preterm (34–36 weeks), and 1·34 (1·30–1·37) for early term (37–38 weeks), from birth to age 45 years; and 2·04 (0·92–4·55) for extremely preterm, 1·48 (1·17–1·87) for very preterm, 1·22 (1·07–1·39) for late preterm, and 1·16 (1·08–1·25) for early term, at ages 30–45 years.”
Translated, the mortality rate is very high at a gestation 22 to 27 weeks and declines sharply from 28 weeks to what is defined as full term.
There is very little in the way of good reviews on large for gestational age long term implications for the child. We enter into the land of “obesity marketing” where, while a large baby does tend to become a large adult, the excessive effort applied to try to prove they are at increased risk for cardiometabolic negative outcomes fail as there’s no data to support that fattist expectation. [13] I think this next quote sums up the unevenness of risk from small for gestational age when compared to large for gestational age (LGA):
“LGA infants show positive long-term health, development and educational outcomes. Concerns for LGA infants still remain in the perinatal period as a result of birth trauma; however, these complications usually do not persist in postnatal and early childhood.”
While doctors will trot out gestational diabetes when defending the need to weigh a pregnant patient,1.3 million births were systematically reviewed and analyzed and the researchers could not link gestational weight gain to maternal gestational diabetes.
Taken as an entire body of research, when looking at gestational diabetes and pre-pregnancy weight, or young adult weight gain, or trimester rates of weight gain, we have absolutely no confirmation of causation. Gestational diabetes is presumed to be the placenta’s production of hormones inhibiting the mother’s ability to use insulin effectively, or conversely to somehow cause insufficient production of insulin. So what if, and follow me here, we start by figuring out whether those presumptions are even close to what might be going on or not.
Furthermore, gestational diabetes is yet another biomarker that the medical industrial complex has bestowed with a new lower cut-off for diagnosis (as I have discussed in the other Fat articles has happened for blood pressure, diabetes type 2, cholesterol, etc.). For a great article that explains the cut-off change in 2010 and its impacts on women and their babies: 1 in 6 women are diagnosed with gestational diabetes. But this diagnosis may not benefit them or their babies.
I’d like to call attention to Dr. Andrea LaMarre and colleagues’ paper from 2019 “This isn’t a high-risk body”: Reframing Risk and Reducing Weight Stigma in Midwifery Practice. Their investigation looks at weight stigma in midwifery practice and it was not intended to disprove evidence associated with weight and pregnancy. It is really a call to humane care regardless of weight.
Sadly, I see poor response to the call to be humane from the medical industrial complex. While I have laid out some modest research evidence supporting weighing a patient during pregnancy, it is really to confirm they are gaining weight. Being below the IOM guidelines for weight increase does increase somewhat the risks of hazards for the baby. However, beyond confirming weight gain in pregnancy, the practice of weighing pregnant patients is about fat discrimination and baseless assumptions that fatness and gestational diabetes, among other birth complications, are likely due to that fatness.
Does a doctor need to monitor your weight increase during pregnancy? Only to confirm you are gaining weight. Could this be accomplished in some other way? Of course. How about a profile photo taken each visit (baby bump visible) and maybe a circumference measure where the number is not seen by the patient (around their back) and coded. Yes, truly eyeballing and paying attention to the patient in the room would likely suffice 95% of the time.
The scales cannot uncover the presence of gestational diabetes. If the doctor is concerned about gestational diabetes, then you would have a blood test obviously.
If you have an active eating disorder, no matter your pre-pregnancy weight, then you should a) advise your doctor of the presence of the eating disorder, and b) request blind weigh-ins (where you also don’t have the weight show up in an electronic file that you have access to, or someone “accidentally” relays it to you in the office).
With an active eating disorder, the risks skew to small for gestational age and pre-term birth and so working to lower food avoidant behaviours takes on a high priority for you and your treatment team.
Weigh ins are dangerous catalysts for relapse for anyone with an eating disorder. They also reinforce discrimination resulting in poor medical treatment and outcomes for fat pregnant patients.
A Child’s Healthy Growth
I am a firm believer we need to try to extend to our children the respect and rights we would wish for ourselves wherever possible.
Children have several points in their development where they are at high risk for being fat shamed, the most obvious one is of course puberty.
We have known for a couple of decades that white adipocytes (white fat cells) produce: leptin, several cytokines, adipsin and acylation-stimulating protein (ASP), angiotensinogen, plasminogen activator inhibitor-1 (PAI-1), adiponectin, resistin, and also produces steroids. [15]
“In recent years, brown adipose tissue (BAT) has been recognized not only as a main site of non-shivering thermogenesis in mammals, but also as an endocrine organ. BAT secretes a myriad of regulatory factors. These so-called batokines exert local autocrine and paracrine effects*, as well as endocrine actions targeting tissues and organs at a distance. The endocrine batokines include peptide factors, such as fibroblast growth factor-21 (FGF21), neuregulin-4 (NRG4), phospholipid transfer protein (PLTP), interleukin-6, adiponectin and myostatin, and also lipids (lipokines; e.g., 12,13-dihydroxy-9Z-octadecenoic acid [12,13-diHOME]) and miRNAs (e.g., miR-99b).”
* autocrine and paracrine effects – referring to acting within a cell or on other cells pertaining to stimulating repair of damage and diseased tissue.
Rather obviously, you need those fat-generated hormones for puberty. Furthermore your fat organ is a specialized and localized organ wherein the hormones it will secrete are distinct depending on the location in the body where the fat is situated. These hormones act on vascular tone control, immunity, reproduction, angiogenesis (development of new blood vessels), fibrinolysis (prevention of blood clots), homeostasis (or homedynamics as I prefer), coagulation (blood clotting), glucose metabolism, bone growth and formation…[17]
The last thing the fat organ needs is to be called upon to destroy its own cells to make up for an energy deficit because a pre-pubescent or pubescent kid has been put on a diet for “being chubby.” Fat has so many jobs on the go for successful maturation that I define dieting for kids as outright abuse: directly interfering with and harming a child’s natural maturation process.
From birth in almost all countries, your child’s development is monitored against growth charts that measure your child’s weight, height and size against the average. This systematic review found two trials that could meet inclusion when trying to ascertain if growth monitoring of babies and children is effective.
“At present, it is our opinion that there is insufficient reliable information to be confident about whether routine growth monitoring is of benefit to child health in either developing or developed countries. Thus it is not clear to us whether health professionals should actively pursue children to obtain measures of growth at arbitrarily defined intervals. This includes home visits for children who have not attended clinics at predefined ages.
However strong might be the academic argument against the clinical ritual of growth monitoring, I will have to concede (with some reluctance) that babies will continue to have their weight gain monitored. (It would take more than an Act of Parliament to stop it!) What, therefore, should we do to advance an existing unsatisfactory situation? Babies should be weighed on accurate weighing scales under constant environmental conditions with a minimum of clothes (preferably none), using appropriate centile charts with an understanding by those responsible how to interpret possible weight gain deviation. But there is also a need for further controlled clinical trials with clear definition of intervention and agreed outcomes (including medical referral and satisfaction indices) to establish the real value of this procedure...I will, however, continue to question the ethics of persisting with a clinical procedure, which is of unproved benefit, and with a capacity to do harm.”
That systematic review quoted above was published in 2000. The study quoted below from 2008 was looking at the evidence of impact and I believe it has landed on the crux of the matter:
“Growth monitoring can provide an entry point to preventive and curative health care and was an integral part of programmes that were associated with significant reductions in malnutrition and mortality. Good nutrition counselling is paramount for growth promotion and is often done badly. Effort must be made to improve this and provide age-appropriate advice to achieve exclusive breastfeeding and appropriate complementary feeding, irrespective of decisions about growth monitoring. This review highlights the paucity of rigorous trials to determine the impact of growth monitoring separately from the impact of growth promotion.”
Of the systematic reviews looking at the evidence of impact of using growth charts in clinical settings, they all appear to agree that there is no evidence of value.
It is important that your child grows; but growth promotion is necessarily feeding your child enough and with a broad array of foods.
Having your baby and child measured against growth charts is unscientific and prone to error that will result in unnecessary interventions. It does not need to be the entry point for discussions around sufficient food intake for the child.
Weighing and measuring your child is a clinical ritual with no value or beneficial impact.
However, as the researcher above correctly concluded, babies and children will continue to be weighed and measured. Furthermore, as a guardian you would be risking a non-compliant interface (as the practitioner would define it) with professionals who may choose to escalate if you decided you did not want your child measured in the clinic or at the doctor’s office.
Nonetheless, Ragen’s Printable Cards are equally useful for you in trying to set up these appointments ahead of time in a way that would hopefully limit the comments and adult fattist banter that tend to swirl around a kid being measured that could readily be internalized by them, subsequently causing harm to the child.
As Part of An Eating Disorder Treatment Protocol
No.
Obviously yes it is used everywhere as a parameter for determining progress in almost all eating disorder treatment protocols out there. I’ve covered this topic in numerous articles on EDI. Obviously in detail in the Phases of Recovery Series as well as Weighing Yourself.
An eating disorder is not a weight disorder. It’s about eating, not about
confirming that gravity is still working against your body’s mass.
The number on the scales does not actually determine progress in treatment. As with growth charts for children, weight restoration for eating disorders is prone to massive error. You may gain 8kg (17 lbs) in a few days on recovery amounts of food. That’s primarily edema (water retention) in place to help with repair. We know that patients in eating disorder inpatient and day program settings often use various techniques to appear heavier on the scales specifically to hasten hitting the target weight so that they might be discharged. [20]
Eating disorder treatment protocols need to turn their attention to growth promotion as is recommended for dropping pediatric growth charts in favour of promotion of adequate feeding for children.
There is no need for blind weigh-ins or any kind of weigh-in. Even for stabilizing a patient in an acute inpatient setting, the scales tell the practitioners nothing. What matters is how often and completely the patient is able to approach and eat the food and whether any biomarkers and symptoms suggest the body is having temporary challenges getting back up to speed (for example, a need for supportive digestive enzymes while the body rebuilds its own ability to produce them).
Again, as with the previous section, patients are viewed with deep suspicion in the medical system if they call into question the rationale for clinical practice of any kind, especially when it is a ritual and not actually grounded in evidence and proof. When a patient tries to establish humane boundaries for their own corporeal dignity, healthcare professionals commonly dismiss the boundary and direct further antagonistic treatment towards the patient. [21]
If you are within an inpatient program, then you may be able to negotiate a blind weigh-in assuring them you will work on your “fear of the scales” when you reach an outpatient status working with a counsellor. Yes, that’s a lie for the sole purpose of maintaining a compliant veneer while in care. In reality, you don’t have a fear of the scales; you have a threat system that has misidentified food as existentially dangerous. If I steer clear of wasps because a sting results in anaphylactic shock then steering clear of wasps is a well adapted response to what is a true existential threat: anaphylaxis. An eating disorder is the true existential threat so steering clear of weigh-ins is also a well-adapted response for protecting recovery and ultimately remission. However, it is not your job or responsibility to train healthcare professionals on that point.
Working Out Medication Dosages
Yes and it’s so poorly implemented everywhere as to actually precipitate further iatrogenic (doctor-generated) harm.
There are heaps of drugs that have weight-dependant dosing: thyroid medications, insulin, cancer drugs and antibiotics to name a few of the most common ones.
“One study highlighted the lack of computational training as a requirement for entry into medical school and evaluated drug calculation errors via a calculations test given to anesthesiology residents and attending faculty at 7 academic institutions.3 The study found a median of 2 errors for every 15 questions in both groups, although residents had twice as many hundredfold errors as faculty. Computerized prescriber order entry (CPOE) and clinical decision support systems (CDSSs) are examples of technologies with the potential to reduce prescribing errors, including those related to dosing, but errors still occur for a variety of reasons, including disjointed CPOE displays, order formatting, and inconsistencies within prescriptions.”
The researchers went on point out that even within computerized order entry, designed to lower calculation error, the descriptors for weight included a confusing and broad array: total body weight, ideal body weight, adjusted body weight, height, body mass index, and body surface area. [23]
“It was noted that dosing did not increase in proportion to weight classification...patients with higher BMIs had a higher frequency of dose discontinuation due to ineffectiveness. The reason for more frequent dosing titration due to ineffectiveness in patients with higher BMIs despite the dosing being within the package insert recommendations may be due to clinicians using weight strategies such as IBW, LBM, or adjusted body weight that may not be reliable or using lower doses than TBW based on intuition to minimize the risk of toxicity.*”
*IBW=ideal body weight, BMI=body mass index, LBM=lean body mass, TBW=total body weight
In the above study, they noted that patients who were above average weight were not provided increased dosing despite the fact the drugs being administered were weight-based and high-risk infusions. Just as a side bar, the researchers have no clue as to what might be the cause of clinicians underdosing patients who were at higher weights, their suppositions are just that: guesses.
“Unfortunately, early stages of clinical drug development tend to include adults within a narrow range of body size. This study population does not reflect the current U.S. population distribution and does not permit evaluation of the correct relationship between body size and drug clearance. As a consequence, a weight-based or body surface area–based dosing regimen defined during drug development may not be applicable to U.S. patient populations. These dosing strategies are more likely to result in drug overexposure (weight-based approach) or underexposure (body surface area–based approach) among obese patients. Alternate weight descriptors such as ideal body weight, adjusted body weight, fat-free weight, and lean body weight are used to prevent drug overexposure with weight-based dosing, but their benefits and limitations must be understood. ”
To reframe the evidence on weight-based dosing for drugs:
Many drugs are designed to be dosed based on the person’s weight.
Most drugs are trialled for approval with only a narrow range of weight for the test subjects.
Guidelines on the drug box for dosing above the narrow range used in trials have not been tested during that approval process.
The broad range of definitions of a person’s weight (ideal, lean, adjusted, surface area) are confusing; originate with the drug companies who have not tested the drug beyond the narrow range in initial safety trials; and leads to practitioner interpretation and dosing errors.
Patients who are above average weight receive inadequate dosing for a variety of reasons and hence have a greater incidence of discontinuation due to ineffectiveness.
There are numerous studies correlating the estimates of weight applied in emergency department settings and subsequent drug errors. One systematic review and meta-analysis did find that the patient’s own estimate of weight in these emergency settings was by far the most accurate. [26]
Do physicians and nurses need to measure your weight for prescribing a drug for which the dosing is weight-based? Well, yes. But will it be done in a way that is accurate and not prone to error? Not so much.
If you are beyond approximately BMI 24 then chances are the dosing listed for the drug for your weight is a guess, because the drug company never included your weight range in the trials to gain approval for selling the drug. Remember that 70% of us are between BMI 22-27 [2018 data] and fully half of us in that range are not included in trials for weight-based drugs. Furthermore, for reasons that are unclear in the literature, patients beyond BMI 24 are liable to be prescribed a lower than company listed dosing for their weight by the prescribing physician.
Somehow you will need to navigate this mess if you need a weight-based drug. Relapse is an outsized risk for those with eating disorders when they are apprised of their weight. Even if you are taking high-risk infusions (say chemotherapy for cancer or other chronic conditions), the last thing you need to add to that medical challenge is the reactivation of an eating disorder. Additionally, if you are above BMI 24 (or suspect you are because you are not measuring to protect your recovery effort), double-checking you are receiving the right dose for your weight is an important way to avoid ineffectiveness due to under dosing.
What follows is a downloadable flow chart to try to help you meet these challenges:
Downloadable PDF version for printing.
Monitoring for Disease
From a proven medical research standpoint, this should be about capturing unintended weight loss. Specifically, a patient who is either unaware they have unintentionally lost weight, or is unaware that unexplained weight loss is a possible harbinger of disease. [27],[28] However, in practice, much of the weight monitoring occurring in doctor’s offices is about a mistaken belief that fatness is a disease.
What is somewhat heartening to see is that recent systematic reviews suggest that doctors and nurses have more nuanced and conflicted attitudes regarding “obesity” as a disease requiring treatment. [29],[30] These recent reviews would suggest that cultural influences are more relevant for those in general practice than for those who depend upon obesity research dollars for their wages. It could be that body positivity and fat justice efforts have had some influence on practitioners, when compared to those same attitudes captured even just a decade ago.
“I just have not seen it be very successful with very many people. … I mean the reality is [that] you know from everywhere you look weight loss does not work very well for most people. GP, USA”
For those unfamiliar with the fact that fatness is not a disease to be treated, it’s best to go visit all the papers on the topic here on EDI: Fat.
Additionally, if you look at the list above as to what is usually given as the medical reasons for monitoring weight, it does not reference monitoring unintentional weight loss for revealing an as yet undiagnosed and new disease; it suggests ongoing weight monitoring is required for newly diagnosed conditions. There is no reason to monitor weight once a patient has been diagnosed with a condition, unless this is being conflated with the previous category where the patient is now on new weight-based dosing prescriptions that may require adjustment with weight changes. In fact many drugs directly act on a patient’s weight and so it is relevant to periodically capture if they might inadvertently be over or under dosed now that their weight has changed. Although, as I point out in the previous section, they could be wrongly dosed regardless of weigh stability or change, as weight-based dosing is a maze of chaotic, non-standard calculations and rife with error.
Now you know that what you need to look for is unexplained, noticeable and sudden weight loss, you can let your healthcare practitioner know that your weight is stable and that you will flag if something has changed. And you can use how your clothes fit and how people in your life mention “gauntness” to you as a sign you should see your doctor to investigate whether any underlying possible disease at play.
Helping to Uncover An Underlying Medical Issue
As already mentioned in the previous section, the only time an underlying bonafide medical issue might be looming is when unintended weight loss has happened.
What about unintended weight gain?
The two most common reasons for unintended weight gain are: the prescription drugs you are taking to treat, most commonly, risk factors for a future disease states (e.g. diabetes, or hypertension), or psychotropic drugs for mental health conditions [32]. Additionally there can be weight increases in response to stress. [33] Stress is rather a broad term, but would include difficult life events leading to insomnia, mental health challenges, strife and disagreement with people around you, etc. There are other less common examples, such as exposure to an environmental toxin or perhaps a pituitary gland tumour. While not rare (76 per 100,000), approximately 0.5% of all pituitary adenomas will come to medical attention. Less than 0.1% of these pituitary adenomas will become malignant, and probably around 0.5% of all detected adenomas will display an aggressive course. [34]
You don’t want to “treat the fat” in any of these situations, you want to address the underlying cause(s) if you can. If you can’t, just remember that a fat organ that enlarges in size in response to environmental assault generates better morbidity and mortality outcomes than if the fat organ does not enlarge in response to those assaults. For references and details on all of that, go to Fat.
Wrap Up
So are weigh-ins medically sound or fat discrimination? Weigh-ins are mostly, but not exclusively, medically unsound.
During pregnancy? Unsound and unsubstantiated.
To determine a child’s growth? Unsound, unsubstantiated and additionally damaging if restrictive intake is advised.
As one parameter in a treatment protocol for individuals with eating disorders? Unsound, unsubstantiated and very dangerous.
To work out the appropriate medication dosage? Sound, substantiated and inaccurately applied. Prone to massive errors.
To monitor recent diagnoses of certain diseases, such as hypothyroidism, insulin resistance, diabetes, or cancer? Unintended weight loss is the only medically sound early warning for a possible underlying and undiagnosed disease. Once diagnosed, it is unsound and unsubstantiated to weigh patients (except when this pertains to medication dosage: see item 4)
To help determine whether an underlying medical issue is present. Unsound and unsubstantiated.
Does this mean that most weigh-ins are just fat discrimination? At times most assuredly, and at other times it is the application of mindless ritual absent the implicit bias and discrimination.
Problematically, if a patient calls into question the decision of a practitioner to have them step on the scales, that may quickly elicit discrimination and substandard treatment whether the initial request was discriminatory or mindless ritual in origin.
In today’s disintegrating healthcare system (that’s global), the disjointed nature of being weighed by random clinicians and staff unknown to you because you have no family doctor and end up using urgent care and walk-in clinics for medical attention, who among them would even know or catch that your weight has dropped? And what of the chance of a dosing error in medication based on weight in these fractured care environments we have today today? We know that medication errors are much higher during in-hospital shift changes and inter-hospital transfers, as well as from inpatient to outpatient settings. [34] Essentially any discontinuity of care ups the rate of errors.
You may need to have your weight measured, more to keep the peace than perhaps to support evidence-based medical attention, but you do not need to know your weight. It is absolutely never necessary for your medical care to include you having to know your weight. Any practitioner or healthcare environment that compromises your protection of your health as someone with an eating disorder (whether it is in remission or not) in that way, is likely going to disrespect you further. Wherever possible seek out alternate care when practitioners push back on you for either asking for a blind weigh in, or for asking questions as to what purpose taking the measurement has for them today.
https://embryo.asu.edu/pages/better-babies-contests-united-states-1908-1916#
Czerniawski AM. From average to ideal: the evolution of the height and weight table in the United States, 1836-1943. Social Science History. 2007 Jul;31(2):273-96.
Cutler D, Miller G. The Role of Public Health Improvements in Health Advances: The 20th Century United States.
https://ourworldindata.org/life-expectancy
https://ourworldindata.org/grapher/number-of-deaths-per-year
https://report.nih.gov/funding/categorical-spending#/
https://blog.marketresearch.com/u.s.-weight-loss-industry-grows-to-90-billion-fueled-by-obesity-drugs-demand
https://drgiamarson.com/why-do-we-get-weighed-at-the-doctors-office-what-to-do-if-that-makes-you-uncomfortable/
Goldstein RF, Abell SK, Ranasinha S, Misso M, Boyle JA, Black MH, Li N, Hu G, Corrado F, Rode L, Kim YJ. Association of gestational weight gain with maternal and infant outcomes: a systematic review and meta-analysis. Jama. 2017 Jun 6;317(21):2207-25.
Abenhaim HA, Benjamin A. Higher caesarean section rates in women with higher body mass index: are we managing labour differently?. Journal of Obstetrics and Gynaecology Canada. 2011 May 1;33(5):443-8.
Gregory KD, Jackson S, Korst L, Fridman M. Cesarean versus Vaginal Delivery: Whose Risks? Whose Benefits?. American Journal of Perinatology. 2012;29(1):7-18.
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