Friday, March 26, 2010

You Have The Right To Decline To Be Weighed

A while ago there was a discussion over at the blog "Fat Positive Femin[IS]m" about getting weighed at routine doctor appointments. This is one of my hot buttons, so I started commenting, then realized I should probably save it for a post here.

Here's the bottom line: You really can decline to be weighed. You do NOT have to submit to being weighed at every appointment.

I decline being weighed all the time. Sometimes I get hassled for it, but most of the time I don't anymore. I make it clear that this is NOT negotiable. I do keep track of my own weight, informally, at home, but I don't agree to weigh-ins at the doctor's office unless there is a clear, pressing need for it. 

Some people don't have a problem being weighed routinely at the doctor; some do.  Some people weigh themselves regularly at home if they don't at the doctor; some don't. I'm not telling you what you should or should not do; I'm just reminding people that they have a right to decline being weighed at the doctor's if they prefer to avoid it.  This is something that some people of size don't realize.

Your Right To Informed Refusal

As a patient, you have the RIGHT TO DECLINE ANY MEDICAL TEST OR PROCEDURE at any time. It's your body, and you have the final say.

We don't think of weighing as a medical test, but it is a form of one. And you always have the right to informed refusal of a test or medical procedure. So no, you do NOT need to be weighed every time you go to the doctor. It is a test or procedure that you can refuse.

If you do plan to refuse weigh-ins, use strong, clear language when declining; don't be unpleasant, just polite and firm. I usually say something along the way of, "I don't do weigh-ins, thanks" if I'm not anticipating trouble.

If you meet resistance, use stronger language than "I'd rather not" or "I'd prefer not to." That leaves arguing room and sooner or later you'll get arguments. Just state clearly and categorically "I decline to be weighed" or something similar.

If they press it or claim it's necessary, remind them that you have the right to decline any test or procedure at any time and you are declining this one. If they really push (I've had it happen), use legal language, like "I DO NOT CONSENT." Any medical person worth their salt knows that this carries legal heft and that carrying out a procedure on someone after a phrase like this could potentially be construed as assault.

If it gets unpleasant, ask to speak to the office manager, the care provider, or just leave. A letter of complaint afterwards, reminding them of your legal right to informed refusal of any test or procedure, can also help change their tune.

The Power of Complaint

Complaining can be powerful. As I've mentioned before, I once visited an urgent care facility whose large blood pressure cuff was "out for repair." I declined to have my BP taken with a too-small cuff (which can strongly elevate BP readings). Long story short, they manipulated/badgered me into agreeing, the numbers were very high, and I was furious that those inaccurate numbers were now in my medical record.

So I wrote a letter of complaint to the clinic, to my insurance company, and to the head of medicine. I reminded them that I had the right to refuse any medical test or procedure, I included research that showed how much BP can be altered with a too-small cuff, and I quoted the American Heart Association's policy on cuff size. I demanded that they get a working large cuff, that they train their staff on the importance of its use, and that they remind staff of the right of patients to decline testing. Boy, did THAT get results.

So I'm just saying, if this is an important issue to you, feel free to resist being badgered into it. Start by politely refusing to be weighed.  Try to keep things low-key whenever possible.....but if pushed it can be very effective to complain verbally, to ask to see a superior, or even to write a letter afterwards and remind them of your LEGAL RIGHT to informed refusal.

I've had a couple of tussles with med techs who insisted I had to get weighed routinely.  One tried the excuse that the insurance companies were really cracking down and everyone had to be weighed now at every visit.  I noted that they might be trying to encourage that, but it was still my right to decline it. She kept arguing, so I asked whether I was going to need to talk to the office manager.  At that point she backed down, and my nurse-practitioner noted wryly afterwards that no one could ever accuse me of not being able to stand up for myself.  No one in that office bugs me about it now. We do a little dance out of formality; they take me to the scale every time, I politely remind them that I decline to be weighed, and we go on our merry way without any more hassle.

Sometimes, you might find a provider will not keep you as a patient if you decline being weighed.  I haven't found that yet, but I'm sure it could happen.  In that instance, you have to decide if avoiding weigh-ins is worth it or not to stay with that particular provider. Generally speaking, my view is that if they don't recognize that routine weighings are a fairly meaningless measurement and that you always have the right to decline such things, they're not worth having as a care provider anyhow.  I would worry what other medical procedures or interventions they might try to bully me into, and I would not want to stay with a provider who tried such strong-arm tactics.

When Weighing is Appropriate

Most med techs have been matter-of-fact about it when I decline to be weighed, but occasionally one will fight me. I have no doubt that regular weighing is encouraged but the fact is that they cannot "require" it because legally you can always refuse tests or procedures.

That said, sometimes I'll pacify them by telling them that I'd be happy to weigh later in the appointment IF there is something in the appointment that requires an accurate weight. Examples of that might be:
  • Certain types of prescription drugs (although most drugs do not use weight-based dosing, some do and an accurate weight would be important for these)
  • Before a surgical procedure (anesthesiologists need an accurate weight for anesthesia dosing)
  • Prenatal blood tests for birth defects (an accurate weight is very important for these tests)
  • If the doctor has reason to be concerned about something like Congestive Heart Failure (weight gain from fluid retention can be a marker for worsening CHF)
These are all legitimate reasons for weighing at certain appointments, and a history of CHF would be a legit reason for weighing on a regular basis.  No doubt there are other reasons that could justify weighing too, but these are the ones that spring to mind most readily.

Sometimes they will tell you they need to track your weight so that if there is a big increase or decrease, they know to look for possible problems like diabetes (which often causes a sudden, unexplained weight loss), etc.  This is an accurate point. As Living ~400 lbs. notes, it certainly is true that a big change in weight can indicate problems, and there are certainly advantages to tracking your weight trends. I'm not opposed to that, and in fact I track my own weight for just that reason. 

However, it's your choice whether you prefer to do that for yourself or have your doctor do that for you.  Personally, I prefer to track my own weight trends and stop being a slave to the medical weigh-ins. I simply reassure my healthcare providers that I am perfectly capable of watching for any alarming patterns myself and that I will report in if there are any concerns.  They know me well enough to know that I care very much about my health and that I really will follow up on it if there is a problem.

Because there may be other situations in which weighing really is important medically, be open to listening to reasons. If it seems reasonable and in your best interests, do it. If you don't mind routine weighings and it's no big deal to you, it's probably easier to just go along with it; there's no law that says that if you are into fat-acceptance you have to decline being weighed.

But think through your feelings so you are making a conscious decision about routine weighing; if it doesn't seem reasonable, if it's just routine and you prefer to keep track on your own, or if you find being weighed triggering or judgmental, feel free to decline it.

Remember, you have the power to refuse or acquiesce.

Conclusion

Weighing every time you go to most doctors is not a requirement. If it bothers you to be weighed, if it's triggering to you, or if you just refuse to be constantly subjected to scale scrutiny, just say no.

Personally, I always agree to be weighed the first time I visit a new care provider, so they have a ballpark figure on record for med dosing or whatever. I think that's a reasonable request.  But after that, I decline to be weighed routinely. Some days it's a battle to have that decision honored, but I don't ever back down.

I do consider circumstances individually; if there is a justifiable reason to get an accurate weight, then I agree to it gracefully and without making it into a big deal.  But only if there's a real reason for it.

I do have a scale at home and I do weigh regularly in order to watch for any alarming trends. I find that just relying on the fit of your clothes is not enough to really monitor your weight trends and that a closer watch than that can be useful, so I do weigh.

However, I don't need to rely on a doctor's office for that; I'm perfectly capable of monitoring my own weight trends. It doesn't take a medical degree to weigh yourself and keep track of those numbers.

I am in a place emotionally where I don't fear seeing the number on the scale....it's more a matter of principle.  I was a slave to the scale for many many years and I lived and died emotionally about what the damn thing said and on the reactions of the people weighing me.  I refuse to go to that place anymore.  I know what I weigh and I don't have a problem with that number, but I don't need to submit that number to public review unless I choose to or there's a compelling medical reason to do so.

Most of the time, it's just routine to weigh people, not truly necessary. And it's ALWAYS your right to accept or decline.

What do you choose to do in your life?  Do you agree to routine weighings at the doctor's office, or do you refuse?  Do you keep track of your weight at home, or do you find simply monitoring the fit of your clothes is enough?  Why do you make these choices?

*Coming Soon:  The Debate Over Routine Weighing During Pregnancy

22 comments:

Kate said...

Thank you for this. I will definitely remember this the next time I go to my GP, they apply a lot of pressure for me to weigh.

What annoys me the most is when I have to see the same doctor really close together, like days within each visit and they insist on weighing me. I see a rheumatologist 4 times a year, I think I'll let him handle the weighing in combination with me weighing at home.

Rebecca said...

I liked this post a lot! I've always remembered and respected a woman I saw one time when I was shadowing a reproductive health clinic counselor doing an intake. The patient had a history of eating disorders and she said, "I don't weigh myself and I don't like anyone else to know my weight." She firmly declined a weight and the counselor was very respectful about it. That's always stuck in my mind. I don't weigh myself either and while I haven't declined weights (I just stand with my back to the scale) this post made me think about how I could go about politely declining them if I wanted to.

k. emvee said...

Thank you so much for posting this! I'm still a midwifery student and haven't made up my mind exactly what I think about routine weighing in pregnancy, but I do want to encourage people to get creative about working with their care providers around this issue. The practice I am currently working with usually has women weigh themselves, on their own, and then come back and report their weight. Some clients weigh themselves at home and then self-report - sometimes verbally and sometimes by writing it in their chart themselves). A few clients have us weigh them, but they stand on the scale backwards and ask not to be told their weight. If you and your care provider decide that regular weight checks during pregnancy are important, I strongly encourage you and your care provider to find a way to do so that gives the agency and power in this exchange back to you.

Also, I didn't know until I began writing my own informed choice documents in midwifery school that not only can you refuse any procedure for any reason, but if you're signing a big informed choice legal document about it, you have the right to cross out or change any part of it that you want to. The choice is not always consent to the procedure as is or refuse, you often have some wiggle room in there too.

jaed said...

I don't let myself be weighed at routine appointments, primarily because of the bad effect on the quality of medical care I'm offered.

I'm not sure whether it's that my refusal signals that I don't want to be harassed about body shape, or whether not knowing the number actually does reduce the usual reaction of revulsion. Possibly some of both (the fact that I'm fat can't be hidden, obviously, but I look like I weigh somewhat less than I do). But there's a noticeable difference. If a doctor has my weight in front of him or her, most of the appointment is invariably taken up with weight shaming, and if I have a health concern I have to fight to get it addressed.

I worry that it will become standard to instantly dismiss a patient for refusing to have weight and BMI measured, though.

erylin said...

as a recovering bulimic i have BIG issues with seeing a number on the scale.....most of the time a simple i refuse to get weight will work....but they ALWAYS stop at Im a recovering bulimc and dont want to derail my recovery works even better.

A question though...anyone know about birth control? i was told by someone at planned parntethood that i HAD to get weighed every year i see them to watch for weight gain as a pre-requsite to getting the pill...any thoughts on that? anyone know if, legally, you HAVE to get weighed to get precribed oral contraceptives?

CecilyK said...

I do refuse weigh-ins at my GP. The only time I accepted regular weigh-ins was while I was pregnant, particularly in my second pregnancy since I'd suffered the loss of twins at six months pregnant in my first pregnancy due to preeclampsia. Large weight gains, also caused by fluid, are a symptom of preeclampsia, and it was important to keep track.

But I was also lucky to have an awesome, non fat shaming OB (Dr. S. Mama at Cooper Hospital in NJ, just outside of Philadelphia; he's really an amazing man and I highly suggest him if you want to use an OB).

Thanks for this.

Ashley said...

I just started refusing to be weighed, and it's wonderful, if hypertension inducing. When I went in for strep throat the nurse only looked at me askance. For my pap the nurse fought me on it, and the NP who did my pap remarked, surprised.

When I went in for my c-section (after a homebirth attempt) I was NOT weighed, but I was asked how much weight I had gained in pregnancy. At no point did they ask my pre-prego or current weight, which really confuses. me.

Well-Rounded Mama said...

CecilyK, please enter your OB's name into the fat-friendly practitioner's list that Stef keeps. There's a link on my blog and on my website. It's important to have a good collection of these size-friendly docs.

As far as weighing in pregnancy goes, I decided to make that debate a whole separate post. The pre-eclampsia argument is probably the most compelling for keeping track of weight in pregnancy....but even so, many midwives in other parts of the world do not weigh pregnant women at all. They rely on other signs to watch for PE before weight gain.

Erylin, I honestly don't know if being weighed regularly is *required* for getting the pill. Why can't a gain (or lack thereof) be self-reported? But they'd probably only trust that if they knew you really well; not in a high-traffic clinic situation. Anyhow, I'm not a fan of hormonal birth control so it's never come up for me. Anyone else want to share their experiences?

Ashley, they now have intake beds in many hospitals which weigh you automatically so they get an accurate weight when you come in without having to put you on the scale. Don't know why they needed to ask you how much you gained in pregnancy though; probably just to chart it, since you'd been seen by a homebirth midwife and they don't always take the homebirth midwife's chart info seriously. Or maybe for database purposes, collecting info on all the pts that come in for a study or something.

Keep the comments coming, folks! So far, those who refuse to weigh (or would like to) outnumber the folks who do weigh. Can we hear from both sides?

Christine said...

I refuse to be weighed and have for several years now. But last year I made an important discovery - my refusal carried an unintended consequence of its own.

Instead of leaving the weight field blank, or noting my refusal, staff was checking a box that indicated I was over 350 lbs and thus "too heavy to be weighed on their scales."

I have no idea when this inaccuracy was first recorded - probably some time after the office switched over from paper charting (where a nurse could just make a note about my refusal) to a computerized system that offered that checkbox as the only alternative to leaving the weight field blank. But each subsequent nurse saw that it was already in my record and continued to click that box.

In a discussion with the clinic manager over this and other FA issues (stemming from my complaint over a specific doctor), I was told that the "vital statistics" requirement is coming down from insurance companies. In order to pay a claim, many require that vitals be recorded at every visit in which a doctor is seen. I can verify myself that they were never taken if I was just seeing the nurse - for my Depo shot, for example. Yet staff tried to weigh me, and take my temp and BP when I was just there to discuss some test results with an MD.

This clinic director was so receptive to my concerns and FA suggestions that I tend to believe her when she says her hands are being tied on the weighing issue. If their only options are recording an actual weight or indicating that an individual is too fat to be weighed, I don't know if that refusal is ultimately beneficial to us.

nv said...

I have also refused to be weighed for as long as I have had my GP, who is very accommodating. But every time I go I am asked by the nurse to step on the scale, and every time I remind them it is in my chart that I prefer not to be weighed. I do not weigh myself either.

When I received my reminder to schedule my annual physical this year, I noticed that the practice now includes with the notice a graph of the patient's blood pressure and BMI over the last several visits. I am doubly glad now that I have refused to be weighed. I mean, really, what meaning could a BMI progression hold for someone like me who would conventionally be told to lose 150 pounds? Of course, BMI is a questionable measurement in general, as has been discussed in the fatosphere many times - but, honestly, wouldn't it be better for the practice to write on my chart, "You're very fat, but you know that!", which at least has the virtue of being direct.

That said, I have a dilemma, which I'm glad to raise here: I've been pursuing a diagnosis of hypothyroidism for a while now, in the face of completely normal tests. It's not entirely about my weight, but I have been gaining weight, and quicker than my usual ups and downs. I don't want my care to be all about a number, but do I need to have the numbers in order to have someone pay attention? The weight is a symptom, after all, not a cause, and it's the cause I want to treat. Like many of us, I have a long history of emotional entanglement with the scale, so am finding this a difficult conflict to resolve. Advice is welcome.

QoB said...

Re: Contraception/the pill:- my GP doesn't weigh me, she asks me something like "Has your weight been stable?" The answer is yes, and she doesn't weigh me.
(in fairness, I'm within 'normal' BMI range so I'm not fighting fat stereotyping, and I'm not from the US so she's not under pressure from insurance companies).

I think for some types of contraceptives - low-dose pills, the patch, and diaphragm come to mind - weight and weight gain is important as it can affect the effectiveness of the method.

rebecca2 said...

Oops, I just noticed that there's another Rebecca here - the comment about hypothyroid is by Rebecca2.

dolcina said...

QoB - That's true about weight and some types of pill, but I don't think it's a reason for doctors/clinics to insist on weighing you every time.

I'm on the progesterone pill (I can take it, but I can't spell it), which is supposed to be less effective if you weigh more than about 11 stone. I had been on it for many years before anyone told me this, at well over 11 stone, so I figure, if it ain't broke, don't fix it. If I was going to get pregnant on it, I suspect I would have done by now.

The nurses at my FPC try to weigh me every time I go, and when I object, they trot out the 'your weight can affect the pill's effectiveness' line. Which, yeah, OK, but we all know I'm well over that weight and have been for many years, so why do we have to weigh me every 6 months just so that we can have the SAME DAMN CONVERSATION over and over again?

They did once nearly refuse to let me have any pills unless I agreed to be weighed, but they backed down at the last minute. We seem now to have reached a compromise where I don't get on the scales but I do let them take my BP - which is fine when I haven't been arguing with them for half an hour before they take it!

Adirondack Autumn said...

Any time fluid retention/severe dehydration is at issue a weight is a useful thing to have. That could be in connection with pre-eclampsia or hyperemisis in pregnancy or issues affecting the kidneys. That said, the same information is obtained about a gain or loss of 10 pounds whether the individual weighs 150=/- or 300 +/-

I think staff gets uncomfortable because if there isn't a weight recorded some statistical bean counter might get on their back. However if they can chart "pt refused" they should be all right. If you say it politely "Please just chart that I refused." you've said the magic words "I refuse" and they should be able to leave it.

Emily B said...

I loved this post. Thank you.

Willow said...

Kmom, have I told you lately how much I adore you? ;)

Lately I've found myself weighing much more than I have in years. I don't know what's provoked the urge; I certainly gain no particular benefit from the exercise-- though, after years of working on accepting myself as is, I don't draw a lot of angst from it, either. Still, I've been slightly frustrated to note that the numbers seem to be creeping up...

I dropped a goodly chunk of weight last year, and I suppose I was proud of myself. I went to my annual physical a few weeks ago, and for the first time ever, they weighed me. When the doctor came in he didn't comment, but I blurted it out anyway: "Just for the record, I've lost XX pounds since last year!" And I've been mildly stressed about it ever since.

I guess this is a very roundabout way of saying thank you... I needed the reminder. ((((HUGS))))

~jer

Meghan said...

I weigh myself weekly, a carry-over from my teenage years. I shot up to 6'0" from 5'2" in less than a year and gained very little weight (I weighed about 100 lbs). I still have to eat more than I sometimes find comfortable, and if I am stressed I tend not to eat, so losing very much needed pounds is an issue for me. Especially now that I am pregnant.

While in school, my parents had to inform the school that I would no longer be weighed there, for sports, PE, etc. due to the certain staff members harassing me about my low weight (ie accusing me of having an eating disorder). My doctor was monitoring my growth, which was typical for my family history.

I understand that my issues are/were different than yours, but weight discrimination pretty much sucks no matter what end your on.

I have had to switch OBs twice and am now looking into a midwife due to their poor attitudes. I am currently almost 6 months and have not gained a lot of weight, but I am keeping a food journal. The doctors' don't care that I can show them I am eating about 100 g of protein per day, lots of fruits and veggies, and that about 35%-40% of my daily calories are from fat (full fat dairy is best and most delicious!). I estimate that I am consuming about 2700 Calories/day, which is not easy when you only eat first order foods. I also have an undetermined allergy so any processed/pre-prepared foods are out of the question. My first OB accused me of having an eating disorder and trying to abort my child through starvation! BTW my father-in-law is a physician and has reviewed my journals, knows me well, and has says I am very well nourished woman with an appropriate activity level for pregnancy.

Sorry this is so long. I just wish people, especially the medical establishment, would learn that people have different metabolisms and how to work with that.

I am moving to Princeton, NJ within the next month, and would very much appreciate any advice about finding a non-weight discriminatory provider for the remainder of my pregnancy! I am also trying for a low-intervention, unmedicated birth if that isn't too tall an order.

Anonymous said...

I'm concerned about BMI tracking with insurance companies and possibly paying higher premiums. My BMI is on the cusp and I don't want my ins company to have that info. I have an appt next week. Will be curious how this goes.
-penny

Anonymous said...

I walked into an Urgent Care place this morning after seeing a chiropractor a few days ago. The chiro. said I might need an MRI prior to removing some floating bodies in a thigh joint which was restricting my movement. The chiro did not use weighing-in for his patients, but today I was told by the nurse assistant at Urgent Care that I had to submit to being weighed and when I refused the nurse-practitioner evicted me. I don't know how to get around this and if I need surgery I don't know how I will be able to get it. Can one refuse this humiliating and unnecessary ritual and still get treated? If my wounds are aggravated because I couldn't get a doctor to see me without forcing me to first get weighed is there any medical liability involved? In other words, what are my real rights here and how can I enforce them? In practical terms will I have to expect that just about any random medical practitioner will just not respect my rights, so if I want relief I will have to let to do with me as they will??? Also this chiropractor could not refer me to an MRI or surgery, but are there any kind of alternative practitioners who could? And/or what kind of entry level doctor (GP?)would care about this?

Amber said...

This post made me feel SO much better!! With my last baby, I was gaining weight perfectly, and ONE TIME I gained an extra two pounds, and the doctor gave me SO much crap, despite the notes in my chart saying I was in recovery from anorexia. It had such a horrible effect on me, I've been putting off going to the doctor now that I'm pregnant again. My appointment is tomorrow, and I had so much anxiety over the scale, I lost countless hours of sleep! Knowing I can just tell them "no" to the scale is a relief, and I feel empowered to lay down the law if they try and force the issue. Thank you so much!

Giulia said...

I had my ex-prescribing psychiatrist who asked me to weight myself once a week under Ritalin.
She was so concerned about anorexia and skinny chicks that she considered that I must absolutely weight myself once a week or I would die because of anorexia. No, really ?

Needless to say, I didn't weight myself once a week. For my own sake. I see how I feel in my clothes.

I let GP track my weight. She does not weight me all the time, only when she thinks I lost weight.
Ritalin suppresses appetite, so I understand that she is careful about weight loss (I am thin for my height).
But contrary to my ex-psychiatrist, she is not completely obsessed about weight. She does not berates me about the need not to lose weight.

I don't like owning a scale and track my weight at home because it can easily become obsessional. I let GP do it, she handles the problem much better than I do.
At least, I avoid being obsessed by that number.

SmKent said...

I know this is an old post but I found it when I googled "refuse to be weighed." Thank you for empowering me. I am seeking fertility treatments for a condition I had when I weight 100 pounds less. All the doctor's keep telling me to just lose weight and it will fix itself. I know it won't. I've decided to see a new doctor and refuse to be weighed.