Tuesday, 19 June 2018

Why Are Doctors Trying to Guess Fat Patients’ Weight?

WTF are you doingI refuse to be weighed in at the doctor’s office.  There is no medical reason to weigh me in – I haven’t had unexplained weight changes, I don’t need medicine that is prescribed per body weight, so I don’t need to be weighed.

While I don’t think that weighing people is a medical intervention, the doctor does and therefore, like any medical intervention, I’m well within my right to refuse. If they had a good reason (ie: we have to dose this medication by weight) I would consider it. But since they just want to weigh me so that the can suggest that I try to change my weight – which is asking me to do something that nobody can prove is possible, for a reason that nobody can prove is valid, I’m out. For years this has been no problem, they say “step on the scale” and I, politely and firmly, say “no thank you” while I keep walking, slowing slightly to let them catch up after I pass them so that they can lead me to the exam room.

But recently something weird has started happening. When I refuse to be weighed the person asks me something like “do my mind if I make my best guess.” The first time it happened I was so surprised that I said the first thing that came into my head which was “This is not the State Fair…no you may not guess my weight.” She was taken aback and she immediately dropped it.

It was so weird that I did some digging. It turns out that insurance companies and Medicare have started to pay for something called “Intensive Behavioral Therapy for Obesity” In order to charge you, you must have a BMI over 30. BMI (Body Mass Index) is nothing more than a ratio of weight and height. Though it’s become misused as one, it’s not – and never has been –  a health measurement of any kind. It’s just your weight in pounds, times 703, divided by your height in inches squared.

Here’s where the guessing comes in. In order for doctors to get paid for “obesity counseling” they have to have your BMI on file. So if you refuse to be weighed, they simply guess the weight that they need to get paid.

Obviously this is crap, and not just because guessing people’s weight like you’re guessing  the number of jelly beans in a jar is exactly as medically relevant as it sounds. But more to the point, these doctors don’t have any idea how to create long-term weight loss. There isn’t a single study of any intervention that they could prescribe, that has been shown to lead to long-term weight loss for more than a tiny fraction of participants, and that weight loss is often less than 10 pounds. Once again, they would be better off just giving all fat people ponies (with the possible exception of those who are allergic.)

So what do we do? Every fat person gets to decide how to deal with this each time it happens. We shouldn’t have to deal with it at all, and we get to do whatever we have to do to get the medical care we need. That may include educating our doctors, lying to them, or placating them by letting them make up a weight to make a bullshit math calculation that they will use to get paid for giving us information that is useless at best, and most likely harmful.

Here’s some scripting that you might use. By way of a disclaimer, we have the right to refuse treatment, but doctors in most cases have the right to refuse us as patients. Unfortunately, there can definitely be consequences to fighting for our rights to be treated without weight stigma, so we have to take that into account when we decide how to respond.

Here are some options:

Per my rights to refuse a medical intervention, I refuse to be weighed, I refuse to allow you to guess my weight, I refuse to have a BMI calculation made, and I refuse any type of obesity counseling. Let’s focus on what I came in here for.

No, you may not guess my weight. Please just write “patient refused to be weighed and refused to allow me to guess their weight.” I’m happy to sign something if you need me to.

You can try asking them “why do you want to weight me?” or “Is this so you can bill my insurance for obesity counseling?” if they say yes, consider saying something like “I’ll submit to this if you can show me a study where this counseling has led to significant long-term weight loss for a majority of participants.” (Remember, no such study exists, so this might take awhile.)

Just continue to say “No thank you,” while walking past the scale.

If you decline, or don’t receive, “obesity counseling” it might be interesting to check and see if your doctor charged your insurance for it, and if they do then promptly report them.

Again, this shouldn’t be happening. People of all sizes should be able to receive competent, unbiased medical care. Nobody should have to prep for a doctor’s appointment like they are memorizing lines for a (literally life or death) audition. Unfortunately, that’s not something that fat people can always access, so we have to do way more to get even close to the same level of care. Fatphobia kills, fat activism is the cure for fatphobia.

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