The post-BMI era is here: So how do you talk about weight with your patients now—especially women?
Key Takeaways
Industry Buzz
“Focusing on health behaviors and access to healthcare can benefit patients much more than a focus on weight.” –Charlotte H. Markey, PhD, Professor of Psychology in the Health Sciences Department at Rutgers University
“There should be no random or contextless discussions around weight [so that a] patient’s health or value would be single-handedly attached to a number displayed on a weighing scale, which is entirely wrong.” – Michael Chichak, MD, Medical Director of MEDvidi
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Patients—especially women—have long been saying that clinicians are too focused on their weight. On the one hand, evidence has shown that obesity is a public health issue, playing a role in the development of diabetes, cardiovascular disease, stroke, hypertension, cancer, and psychological problems, according to StatPearls.[] On the other hand, research has found that stigma around obesity has led to delays and avoidance in care.[]
@thesam_show did I cry in my car?! YES! #doctor #medical #RUDE ♬ original sound - Sam Hart
Sometimes, the focus on weight alone can be downright dangerous. One TikTok user, Sam Hart (thesam_show), said that her doctor recommended she weigh herself weekly, to which she responded that she had a history of disordered eating. Weighing herself regularly leads her to obsess about food intake. She said that the MD had her “almost in tears.”
@drsiyabmd It is an undeniable medical fact that excess weight causes a lot of health issues. Everyone deserves to be treated with respect and have their symptoms taken seriously and get the proper evaluation. How do I discuss weight with my patients? #weight #weightloss #obesity #health #shortnessofbreath #CapCut ♬ original sound - Dr. Siyab, MD | Heart doc
Doctors on TikTok have also joined the conversation, noting the nuance and complexity of the issue. “Obviously, someone’s weight shouldn’t be the first and only thing that is blamed for their symptoms,” says Muhammad Siyab Panhwar, MD, in a TikTok video discussing how MDs approach weight loss conversations with patients. But he still believes weight is worth exploring.
Related: Finally, a new alternative in the BMI debateSome of the comments on Dr. Panhwar’s video are from women who say that, in various doctors’ appointments, weight was the sole focus—with no discussion of medical history or an exam. Another commented that a physician focused on her need to lose weight, missing a cancer diagnosis that she secured through a second opinion. Many comments note that healthcare practitioners don’t seem to believe women about their symptoms, chalking everything up to weight.
To complicate matters, experts say that women are often forced to advocate for themselves in healthcare environments—and that their complaints aren’t listened to or their pain is diminished.[]
When should a patient’s weight be the focus of conversation?
To address this issue, some clinicians are taking a stance on the intersection between weight and health, offering what they call weight-inclusive or weight-neutral care.[]
The American Medical Association also recommends that clinicians stop relying solely on body mass index. Instead, clinicians should also consider other aspects of a patient’s health, such as their blood sugar.[]
How to address weight with cultural context
But why does this issue seem to predominantly impact women? “Women have been expected to conform to beauty ideals that require thinness and restriction for decades,” Dr. Markey says. “Being big is often viewed as masculine and unattractive. And healthcare providers are not immune to these cultural ideals.”
Michael Chichak, MD, Medical Director of MEDvidi, says that when it comes to weight loss discussions with patients, there are do’s and don’ts. “There should be no random or contextless discussions around weight [so that a] patient’s health or value would be single-handedly attached to a number displayed on a weighing scale, which is entirely wrong,” he says. Rather, “the discussion would be much more productive when addressing the patient’s diet, physical activities, sleep cycles, and even mental state as a whole, rather than just isolating weight issues,” Dr. Chichak adds.
“Encouraging or trying to help [a patient] by improving health overall, rather than fixating on weight loss, is more trusted,” Dr. Chichak says. He adds that these conversations about weight often add stress and burdens to women who may already be dealing with health concerns.