by Louise D. Metz, MD
Many people avoid going to the doctor for years for fear of being shamed about their weight. We are told to step onto a scale first thing after being checked in at most medical offices, and this weigh-in is often followed by judgement and bias about that number on the scale. Do we really need this number to care for our patients?
At Mosaic Comprehensive Care, our approach to weight and nutrition is very different than the standard in medical care. If you have been to our practice as a patient, you have probably noticed that we do not weigh our patients as a routine part of an office visit. The number on a scale is not a piece of information that is typically useful or necessary for our providers and staff to care for our patients. We do not need to know your weight to do your pap smear or to check you for Strep throat. We do not need to know your weight to treat your blood pressure or your arthritis. We do not need to know your weight to treat most other medical conditions, or to provide preventive medical care.
Just like there is diversity in skin color or hair color, there is also great diversity in body size. We all have a genetic predisposition to be a certain size, which is called a set point weight, and there is great variation in these set point weights that do not all fall within ranges that have been arbitrarily determined as normal by our medical system. No matter what we try to do to alter our body size, our bodies are going to do their best to stay at or revert back to their set point weights.
Another important point is that body size does not equate to health or disease. We cannot look at a person and know whether they are healthy based on their weight. This is a very common misconception in our society and our medical system. There are many parameters other than weight that we as providers can assess in partnering with our patients to evaluate their health. If healthcare providers can accept this normal genetic body diversity and lack of connection between weight and health, we can eliminate the obligation to tell patients to change their body size, and instead spend more time providing compassionate care for our patients’ health concerns.
Our healthcare system is highly weight and diet-focused despite research showing that patients can be harmed by this approach. In fact, the research is very clear that diets don’t work. Medical studies about diets show that though some people do lose weight on diets, most patients regain the weight within a year and almost all regain the weight within 5 years. This is known as yo-yo dieting or weight cycling. This weight cycling is actually harmful for people and has been associated with an increased risk of heart problems and an increase in mortality risk.
In addition to being ineffective, diets often lead to eating disorders. We have seen many patients who have eating disorders that began after they went on a restrictive diet of some kind or were told by a doctor that they needed to lose weight. Another helpful way to think about this is that the restrictive diets that are standardly recommended by doctors for people with larger bodies would actually be considered disordered eating behaviors in people with very thin bodies.
At Mosaic we offer a non-judgemental approach to body size and a safe place where patients can come to address health concerns and receive preventive care without having to worry about being shamed in discussions about their weight. We treat all of our patients the same irrespective of their body size, and weight loss is not a goal that we set for our patients. When our patients are interested in talking about nutrition or weight concerns, we focus on eating behaviors rather than weight. We talk with our patients about intuitive eating, which involves learning to focus on our bodies’ natural cues for hunger and fullness, and often partner with dietitians and therapists to help patients address disordered eating and stop the cycle of dieting. When we do discuss exercise, we talk about enjoyable movement that is not focused on calorie burning or weight loss. These recommendations are the same for all of our patients across the size diversity spectrum.
We hope to help change the paradigm surrounding the way we address body size in medical care. These concepts are new to many people, both patients and providers, since we have been taught to look at weight in a certain way for so long. However, we can shift the standard way of thinking about weight and health, and steer the focus away from the scale.
References and Resources:
Mann et al. Medicare’s search for effective obesity treatments. Dieting is not the answer. American Psychologist, April 2007. Vol 62, No 3. Pages 220-233.
Clifford et al. Impact of Non-diet approaches on attitudes, behaviors, and health outcomes: A systematic review. Journal of Nutrition Education and Behavior. Volume 47, No 2, 2015. Pages 143-155.
Scchaefer et al. A review of interventions that promote eating by internal cues. Journal of the Academy of Nutrition and Dietetics. 2014; 114: 734-760.
Health at Every Size ® Blog: https://healthateverysizeblog.org/
Intuitive Eating by Evelyn Tribole and Elyse Resch