Being Weighed: Medically Sound or Fattist Bullying?

Here is a follow-up on discussions we’re having right now on the forums regarding some truly atrocious interactions where individuals have actually been denied medical care on the basis of their refusing to be weighed.

As a refresher, there is only one common practice reason that a medical doctor will need to know your weight and that’s for prescribing drugs requiring weight-based dosing. A doctor may also want to know if there have been any unintentional changes to your weight as this can sometimes be a marker for the onset of several disease states. However, in recovery from an eating disorder weight changes are intentional and therefore those weight changes do not suggest anything is amiss.

I've now added Ragen Chastain’s helpful blog and printable cards on how to navigate medical care to the Resources section on this site and they are here for when you have to endure fattism during your medical interactions. It’s a horrible experience to be bullied by fattist healthcare providers. If you feel shaky from past nightmarish interactions, it might be helpful to take a supportive friend along with you who can apply Ragen’s helpful suggestions for neutralizing the bullies. And of course it can be tremendously helpful to address how to engage with medical bullies in advance, by role-playing with a supportive therapist.

Paraphrasing (restating what has just been said to you as a way to confirm your understanding) can be a really helpful tool both in cases where you hope to clear up misunderstandings and in cases where you simply want to confirm that you need to fire your healthcare provider. If you are being denied care because you will not step on a scale, then the problem is rarely with you.

“Just so I'm clear, you will fire me as a patient because you are unable to do your job as a medical doctor if you do not regularly weigh me when I come in to see you? Could you help me understand, as obviously I don’t know how this works, what exactly it is about not knowing my weight that impacts your ability to offer me the best medical care?”

Now it could be that you are currently taking weight-based doses of prescriptions and the change in weight that has occurred from your recovery efforts will mean the doctor has to get a sense of your new weight to adjust your prescription. In that case, you indicate you are happy to be weighed but that it’s really important your doctor understand you cannot see the result or be informed of it after the fact by him or any of his office staff. If their electronic system, to which you have access, includes your current weight, then you’ll need to ask for them to create a coded entry that is decipherable to them but not to you.

A combination of effusive thanks along with reiteration and confirmation that they understand your requirements tends to help them adhere to the request you are making. If a nurse is handling your weigh-in then say before you step on the scale: “Just want to make sure, and I know you already know, but my weight is not to be relayed to me or entered into the system and you’ll be using a code in the electronic file, right? I am sorry to pester you with this, but my ability to avoid relapse of an eating disorder really depends on me staying well clear of the number right now. Thanks!"

In cases where the weight is not needed for prescription dosing, the doctor may respond to your question by stating he must know if your weight increases as you could be at risk for chronic illnesses, disease, suffering, death, death, dying, dying, pain, agony, suffering without end...you get the idea. Let it run its fire and brimstone course and then follow up with:

“Yes, but aren’t all those chronic illnesses and health risks you just listed specifically not screened using someone’s weight because thin people get those conditions as well? And given that the change in my weight is intentional, and clearly visible to us all right now because I am recovering from an eating disorder, the number is going to be a red herring for trying to use it as a marker for looming ill health, isn’t it?”

Then you’ll likely get puffer-fish responses that you can actually interrupt and politely shut down: “No, that’s okay you don’t need to explain any further. You have made it very clear that you are a doctor who is comfortable with patient profiling and so you needn’t worry that I will be returning to see you again. Thank you for your time and best of luck in your practice moving forward.”

When it comes to urgent care, that’s very tough. You are usually maximally stressed, in pain and needing (obviously) urgent care. Once they actually utter the words that they will refuse you treatment if you refuse to be weighed, my response would be as follows:

“I am absolutely sure I am misinterpreting what you have just said. I know you don’t intend to deny me care based on my size, sex, race or any other discriminatory facet you’d care to name but that’s what it’s sounding like. So let’s just take a step back for a moment and help me understand how I’ve gotten the wrong impression here. I am comfortable having you weigh me for dosing-related reasons, however until we have determined that I am going to be taking a weight-based drug, you can hold off weighing me until that time. And should I need to be weighed, you will not be relaying the result to me either on purpose or by accident because that would be very damaging to me. These are reasonable requests from someone in recovery from a deadly eating disorder so I know you and your management will find them reasonable as well.”

And I would suggest leveling up if you get an unresponsive worker: “Clearly we are not making progress. I will sit quietly over here and wait until you bring your supervisor and I am sure we can sort this out. Thank you.”

I have had, on occasion, front line workers who will accuse me of being hostile and abusive not because I am being hostile or abusive, but because they have discovered the accusation is a very quick way to shut down disagreement in their favor. It’s what happens when you put these individuals through conflict management training and don’t follow-up on the quality control in the field. In any case, it’s not too hard to persist even in those cases.

They will raise their voice and say something along the lines of: “Ma’am, I’m afraid if you keep talking to me in this way I will have to ask you to leave. We’re done here and you need to stop arguing.” In conflict management training courses they are encouraged to project their voice, but not yell, primarily to attract the attention of nearby security and coworkers to maintain their safety. And we do need to keep in mind that patients often verbally and physically abuse these employees, so I won’t make light of their need to remain safe. However, their response when no hostility is present can leave you feeling the judgment of the entire room and that does little for you trying to maintain your sense that you have a right to respectful treatment as well.

Create space between your teeth while keeping your mouth closed and breathe through your nose. Bring your hands down to your sides, palms open and facing three-quarters towards the individual (this has the benefit of dropping your blood pressure and sending a message that you are relaxed, calm and open). At this point security will now be in earshot or have joined the common space. When you speak drop your voice down both in pitch (if you’re female, but don’t if you’re male as that can add threat markers) and volume (for everyone) and look to both the healthcare worker and security guards (or nearby employees), addressing them all:

“I am here as a patient needing urgent care. I don’t want to interfere with your ability to get your job done at all. I think we’ve just hit an unfortunate misunderstanding. Perhaps it would be best if you bring your supervisor over as I’m sure we can sort this out to everyone’s satisfaction. I’ll just go sit down and wait over there and I really do appreciate your making such an effort to resolve this confusion.”

If the employee actually walks away from you before you have a chance to make that response, do not step towards her retreating. Do not follow her. Remain absolutely rooted in place. Breathe. Turn away from the direction in which the healthcare worker retreated and return to main seating area and sit down.  In most cases, someone will approach you if you stay put. It may be the security guard or another healthcare worker.

Whichever employee approaches you, remain seated and ask if he or she could possibly have someone in charge just come out and speak with you and that you’ll wait until that person is available to come and chat with you. Not to worry if you are crying or shaking, just work hard to maintain a calm pitch and low volume to your voice. The most common resolution to this kind of employee fried-fuse response is that another employee will swoop in to resolve the problem and it will be to your satisfaction.

I call these approaches to healthcare provision: “we’re on each other’s team”. There is rarely a time when I am interacting with an average healthcare worker where I will not do the following:

  1. Make a direct reference to their expertise and my relative ignorance.
  2. Phrase everything I possibly can as either a question or that I believe X but am seeking their input for further guidance.
  3. Matter-of-factly state that I know they are looking to help me and that it’s me who is struggling to understand/cooperate/get on board etc.

I am being genuine in this approach as my goal is to extricate as many healthcare workers as I can from the system they often mindlessly defend against the very patients they are there to help. While I have never personally experienced discrimination in healthcare due to being fat, I have experienced discrimination as a woman with male doctors on several occasions. But let’s face it, I have a lot of inherent privilege given my understanding of medicine and that I am a white, educated woman. And that means that all the above techniques are not going to be universally applicable.

Being an accredited healthcare professional does not confer anyone with automatic sainthood. There are plenty of irredeemable folk who should quit working in healthcare to spare their patients the cruelty they spew all over everything and everyone. There are racist, fattist, sexist, homophobic, bigoted and all round unpleasant people in all walks of life and in all professions, and no amount of “we’re all on each other’s team” is going to get you anywhere with those types.

I cannot emphasize enough the value of bringing in your own trusted friend or family member to advocate on your behalf. If you cannot, to quote RuPaul, “sashay away” and you need urgent care that’s when your advocate can take up the charge to have the crazed fattist healthcare worker removed from your space to be replaced by someone who is willing and able to do their job: i.e. help you.

Edited to add: This blog post is framed within the context of those who are not in either inpatient or outpatient eating disorder treatment settings where patients are blind weighed as a way to monitor re-feeding progress during early and medically unstable phases of recovery as well as to capture and reverse common relapses in step-down outpatient settings as well. In those settings, there is a valid medical need to monitor weight restoration.

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