For years, weight has been used as a measure of health in doctors’ offices, a higher body mass index being correlated with heart disease, diabetes, certain types of cancer and other conditions, but experts now suggest that focusing on weight could result in patients delaying or avoiding healthcare.
Research, in recent years, has also shown that the weight focus might even delay recommended cancer screenings.
People with larger bodies often report that when they go to the doctor, their problems are ignored or written off as an inevitable result of their weight.
They say that without even asking questions, healthcare providers suggest diets they’ve already tried and lifestyle changes they’ve already made, reports NPR.
And sometimes, doctors miss major health problems – in both people with larger bodies and those with smaller ones – when they're too focused on a patient’s weight, said Dr Lisa Erlanger, who practises weight-neutral medicine and is a clinical professor at UW Medicine in Seattle.
“There are many stories … of diagnoses missed because the focus was on weight,” she said.
The evidence that focusing solely on weight can harm patients has led some in healthcare to examine their approach.
In June, the American Medical Association started recommending that clinicians look beyond BMI to understand a patient’s health.
The new policy suggests considering factors like genetics, blood sugar levels and where there is fat on a patient’s body.
But a growing number of doctors are going beyond that: practising what they call weight-inclusive, or weight-neutral, care. Some subscribe to a set of principles called “health at every size”.
“In most cases, the care you’re providing should be the same, no matter what the number on the scale is,” said Tess Moore, a family medicine physician in Seattle who has made her practice weight-neutral.
Moore started by trying to make her clinic feel comfortable for patients of all sizes. Every exam room has an array of blood pressure cuffs for different sized arms, as well as gowns and speculums of various sizes. The chairs and exam tables fit all patients.
But it’s her approach to talking about weight that’s most different from a more traditional practice.
“We don’t recommend weight loss as a way of treating medical conditions,” said Moore. Instead, she tells patients that exercise and nutritious food are good for them regardless of whether or not they lose weight.
“We recommend moving your body in a way that’s sustainable, and eating food in a way that nourishes.”
Emphasising the inherent benefits of exercise can help people start, as well as stick with, a routine, she added, pointing to research showing that even well-meaning comments about weight from family and doctors can increase exercise avoidance, and that people with more internalised anti-fat attitudes are more likely to avoid exercise when they experience weight stigma.
“If, after that discussion, a patient is still fairly certain they want to focus on weight loss, I do tell them that it is likely to fail in the long term.”
For example, a meta-analysis of 29 long-term weight loss studies found that, on average for people with obesity, more than half of the weight lost was regained within two years and that more than 80% was regained within five years.
“When someone loses weight, it kicks in a series of hormonal changes that tend to increase appetite and slow metabolism,” said Ellen Schur, an obesity medicine doctor and researcher at UW Medicine.
Schur and others who specialise in obesity medicine say they recognise the need for a new approach when talking to patients about their weight, but that it’s still possible to encourage weight loss when appropriate.
“For those with a condition like diabetes, weight loss in combination with some lifestyle changes could be an option that they would choose,” Schur said.
She agreed with weight-neutral providers like Moore that encouraging patients to exercise and eat nutritious food has obvious benefits, but added that for some patients, weight loss can still have additional benefits.
For example, studies have shown that even a relatively small amount of weight loss – in the range of 3% to 7% – cuts the chance of developing type 2 diabetes for those at risk, and improves blood sugar among those with diabetes.
And Schur said that when weight loss might help, doctors should say that.
Schur said it was possible to have conversations about weight loss that were sensitive and respectful.
“When a physician approaches it in a non-judgmental manner and not assuming that a person hasn’t made changes, it can be discussed as a treatment option in a way that’s supportive,” she said.
Increasingly, weight loss drugs like Wegovy are her primary tool for managing patients' weight, she added.
“To be totally honest, what we’ve been asking them to do, you know, with just lifestyle alone, has been unrealistic.”
Critics of the newest weight loss drugs point to their limitations – they’re expensive and in short supply, and their long-term effects are still unknown.
And weight-neutral providers say that even in a world with these new drugs, people with larger bodies still need to feel heard and respected in the doctor’s office and have their primary health concerns addressed.
See more from MedicalBrief archives:
Weight-loss drugs frenzy risks return of body size stigma
Scientists call for stigma education after study reveals strong ‘weight bias’
Anti-fat bias training for doctors in the US