So the Doctor Said You Need to Lose Weight

For the last several years, I have been standing on the scale backwards when I go to the doctor and they want to measure my weight. I know that weight does not equal health, and I know that in the past, whatever the number was, used to send me into a tailspin of euphoria or anxiety that wasn’t based on anything other than a number. I didn’t want to subject myself to that stress anymore.

Last year, when I went to the gynecologist, I stood on the scale backwards as usual. Then, the doctor brought me into her office. After she affirmed that everything looked great and that I had no problems, she told me to lose weight. I told her that I don’t diet anymore and I gave it up because it’s bad for my health. She said, “oh of course, diets don’t work, but you need a lifestyle change”. At the time, I didn’t quite have the nerve to challenge her anymore than I already had, so I swallowed the lump in my throat and doubted myself. I mean she’s a Dr. right?

One can only assume that by “lifestyle” she thought I needed to eat more grilled chicken and move my body more, but how did she know if I was doing that or not already? She actually didn’t know anything about my lifestyle, so how did she know that it was unhealthy? What if I was already doing everything she was suggesting and I was still fat? How did she know I was not suffering from anorexia or any other eating disorder? You don’t have to be thin to have anorexia.

She was assuming an awful lot wasn’t she? Not to mention, there was not a single physical issue that I had, that she knew of, that was even correlated with fat. (And we all know there are no diseases that are directly caused by fat.) Did she know the results of my blood work? Did she know anything about the history of body size in my family? (And I love my Doctor, this is not about her specifically, this is about what so many Doctors typically say and do.)

That exchange between us bothered me all year long. Then this week, it was time to go back. This time I was a bit more prepared. First, I refused the weigh in all together. I have learned that if doctors need to take a certain number of vital signs, and weight is considered one of them, you can refuse and they will do something else. You are the patient, so you can actually refuse anything you don’t want. (Obviously, if you have noticed a big change in your weight in one direction or another when little else has changed in your life — it wouldn’t be a bad idea to know your weight or keep an eye on how it’s changing. Weight is also important when figuring out medication of course.)

When I refused the weigh in, the nurse commented that lots of people are doing that since it’s after the holidays. I said — no — actually I am refusing because weight does not equal health and that number often leads people to disordered eating and I am healing from that and helping other women do the same. She said — yes, you wouldn’t believe the number of girls that come in to the office and struggle with disordered eating. Yeah, actually, I’m not surprised, I said. In my mind, I was also thinking that the reason all these young girls have disordered eating is because of the over emphasis we put on weight in so many ways, the doctor’s office was case in point.

After the appointment, my doctor brought me in and again, concluded that everything looked fine. Then she told me to lose some weight again. So I pulled one of my favorite articles out of my purse, Weight Science by Linda Bacon, and politely told her that losing weight was not a great recommendation and that trying to lose weight from age 12 to 40 is likely what made me weigh what I weigh in the first place. I told her that dieting makes you gain weight and that weight does not equal health. I told her that fat people can be healthy and thin people can be unhealthy and that there were so many other things that were more important to our state of health than weight.

And you know what she said?

She said, you are right and I agree with you completely.

She said BMI is meaningless (I could have told her that) and that it’s only the people who set the protocol that require Doctors to tell people to lose weight.

She asked me what I do for my health rather than lose weight. I told her I focus on getting good sleep, and moving my body, and eating enough of a wide variety of foods, and doing what I can to keep my stress down. And I added that dieting is a huge stressor on the body. She again agreed and said that stress was the worst.

There is no evidence that says losing weight makes a person healthier (and I didn’t even have a health issue that we were talking about in the first place.) Why make weight a medical issue? It’s like making male pattern baldness a medical issue. It is what it is and it happens to some people and not others largely based on genetics and you can no more tell a man to go grow some hair as you can control losing weight.

And there IS evidence that people about my size and larger actually live the longest. So telling me to lose weight is actually going to increase my chances of dying earlier. Why isn’t this basic knowledge and how can we make it be known? Have you ever stopped to think how much training doctors have in weight science? (Not much if any.) Or how much information they have been given that is not funded by pharmaceutical companies or other doctors who have stock in weight loss companies? I don’t mean to get all “Big Brother” on you — but there are some inconvenient truths we do need to look at here.

I can’t wait until next year when I am going to suggest the Doctor goes rogue and checks the box on the form that she asked me about my weight and then keeps the weight loss speech to herself. Does she know how many women won’t even go to the Doctor because they are afraid to get a lecture? And then they end up really sick because something wasn’t caught early that could have been helped?

If weigh in’s at the Doctor are stressful for you, just remember that you don’t have to be weighed if you don’t want to be. And know that your doctors may tell you you need to lose weight because they are told to say that by insurance companies. And please know that dieting only makes you gain weight and there are so many other pieces of health that you can concentrate on if that is your choice.

It’s true, health is a choice, and you don’t get extra credit if you do it the best and you aren’t even guaranteed that it will work if you do everything “right”. And please know that there is no one right answer and that our bodies are amazingly resilient and smart and really don’t need your micromanagement.

The doctors mean well, but they don’t know everything because no one knows everything. There is so much we are learning. But one thing they can agree on is that there is not a single evidence based (oops, sorry Trump) method for intentionally losing weight and keeping it off that is sustainable and works for the majority of people and doesn’t cause disordered eating. So the next time the Doctor tells you to lose weight — tell them you will, as soon as someone figures out how to do it. (Or you can give them the middle finger and a lecture on fat phobia, stigma and discrimination — your choice!)

I help women feel good in their bodies using a non-diet, weight neutral approach to food and movement based on permission, allowance, self compassion and trust.