Dear Doctor, commenting on my weight is damaging…

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…please don’t make comments about my weight without me expressing concern about it or not knowing anything about my lifestyle or behaviour. It is not helpful and in fact is damaging.

This is meant to be more of a plea on behalf of my clients rather than a critique as I know many great doctors. I know most doctors also have great intentions. However, I have clients and people I know continually telling me stories of negative experiences in the doctor’s office (and with other health professionals) that have affected them deeply. Most of them caused by a few words: you need to lose weight, you should try this diet, etc. without any other conversation on what is going on in the patient’s life.

Let me give you a few examples directly from my clients on how this is damaging:

  1. “I have had doctors congratulate me on weight loss (in a way reinforcing my eating disorder, because often my weight loss is a result of unhealthy behaviours)”
  2. “I went in for a full physical exam and without any conversation on what I was doing for exercise or any other lifestyle behaviours, the doctor weighed me and said “ooh you used to be ___Kg…we need to keep an eye on your weight”. Little did the doctor know that I was feeling really good about my health because for the first time in a while I was in a regular exercise routine and had gained muscle mass and strength with guidance of a trainer.  (To make matters worse ~10 years ago, the same situation had occurred where I gained weight with building muscle and I ended up quitting solely because of the weight gain despite the health benefits)”
  3. “I’ve had doctors make diet suggestions (i.e. keto) for weight loss when in reality I was suffering from anorexia and was already severely restricting my intake. This was obviously triggering.”
  4. “I had a doctor directly tell me that I was overweight with recommendations to “eat less, exercise more” without first asking me what I was doing.”
  5. “When I’ve shared that I have an eating disorder, I’ve had several doctors assume that I binge eat or overeat based on my weight and they’ve provided weight loss suggestions without first assessing what my eating disorder behaviours are.”
  6. “I went to see my doctor for cold/flu symptoms and she started lecturing me about how I should work on losing weight. I felt embarrassed and it has made me reluctant to see any doctor for any issue in the future.”
  7. “I’ve had doctors minimize my eating disorder because I am not underweight.”
  8. “I have had comments about my BMI (body mass index), like “are you aware that you’re in the overweight range?” Thanks for pointing that out when I already hate my body. Not helpful.”

What to do?

Ideally ending weight bias/stigma and a shift in focus to promoting health behaviours vs the number on the scale are important for doctors and any health professional. However, just as essential is the need for a patient-centered approach in terms of really listening and understanding what is going on in the patient’s life (and yes that includes addressing weight concerns if that is the patient’s concern) and then individualizing care plans.

No matter what our job title, area we specialize in or our personal beliefs (General Practitioner, Dietitian, eating disorder expert, weight-inclusive, weight neutral, Health at Every Size® practitioner, obesity specialist, certified bariatric educator, weight management practitioner, etc.), we need to address and listen to our patient or client’s experiences and concerns, not our own agenda. Otherwise we are missing the point of patient-centered care. Also, in order for patient-centered care to be evidence-based practice we must integrate the best available research evidence, clinical judgement and expertise, and client preferences and values.  We cannot let our pronounced views, title, network, paradigm or guidelines prevent us from openly listening to the people we are supposed to be supporting.

In the end, imposing conversations on weight can be just as damaging as avoiding conversations on weight. Both can make people feel unheard and unsupported. Lets do a better job at listening to the concerns of our patients.

If you or someone you know has been impacted by a health professional commenting on your weight please comment below.