When every doctor’s appointment becomes a conversation about your weight

You go in about your shoulder. Or the tiredness that has lasted since spring, or a cough, or a period that has changed. You have rehearsed it in the waiting room so you don’t forget anything. Somewhere in the first few minutes the conversation turns, and you realise you are no longer talking about your shoulder. You are talking about your weight. You leave with advice to lose some, and without an answer to the question you came in with.

If that has happened to you once, it can be written off as a bad appointment. If it happens every time, it becomes something else: a reason not to go. And that is where the real harm starts.

This is documented, not imagined

People in larger bodies are often told they are being oversensitive about this. The research says otherwise.

A review of the evidence on weight bias in healthcare found that many healthcare providers hold strong negative attitudes and stereotypes about people with obesity, and that there is considerable evidence those attitudes influence their judgement, their behaviour with patients and their decisions. When researchers recorded ordinary primary-care visits and analysed how doctors spoke, they found that physicians built less rapport with patients who had obesity — less of the emotional connection that helps a patient feel heard.

Patients notice. In a survey of nearly 500 women in the United States, women with higher body weights said they delayed routine gynaecological cancer screening, and the reasons they gave were specific: disrespectful treatment, embarrassment at being weighed, negative attitudes from staff, unsolicited advice to lose weight, and equipment too small to use. The heavier the women were, the more of them reported these barriers. Among those with the highest BMIs, the rate of cervical screening was lower than among everyone else.

That is the cost of the redirected appointment. Not that people become thinner, but that they stop coming back until something is too serious to ignore.

When weight genuinely matters

It would be dishonest to pretend weight is never clinically relevant, and I am not going to. Some medicines, including anaesthetics, are dosed by body weight. Weight is tracked in pregnancy, in children’s growth and in a number of conditions where a change in it is itself a symptom. Excess body fat is a real risk factor for several diseases, and a good doctor may reasonably want to talk about it.

The real question is whether weight is being discussed alongside your symptom or instead of it — and whether it is being discussed with you, or at you. Canada’s national guidelines for treating obesity are worth quoting here, because they are written for doctors: weight is a sensitive issue; do not assume every patient with a larger body has obesity; ask for permission to discuss body weight. The same guidelines say success should be measured by improvements in health, function and quality of life — not only by the amount of weight lost.

If doctors are expected by their own guidelines to ask first, you are entitled to expect it too.

Before you go

• Write your symptom down as a short timeline. When it started, what makes it better or worse, what you have tried, how it affects your days. A written account is harder to redirect than a nervous summary.
• Lead with it. Put your main concern in the first sentence of the appointment, before anything else can take the floor.
• Consider bringing someone. A friend or partner can take notes, remember what was said and ask the question you forget.

In the room

These are not magic words. They are ways of keeping an appointment pointed at the reason you came.

• “I’d like us to focus on my shoulder today.” Polite, clear and entirely reasonable. You can agree to talk about other things another time.
• “What would you recommend for someone in a smaller body with the same symptoms?” This is not a trap. It invites the clinician to think about the investigation that would normally follow — the scan, the blood test, the referral — and to explain why it should be different for you.
• “If you think weight is a factor, what else could be causing this, and how would we rule those things out?” A symptom can be related to weight and still need investigating. The two are not alternatives.
• “Could you note what we’ve decided and why?” Asking for the plan to be written into your record is ordinary and useful, and it tends to sharpen everyone’s reasoning.

About the scales. You can ask whether your weight is needed for today’s visit, and if it isn’t, ask to skip it. If it is needed — for a prescription, a procedure, a monitoring plan — you can ask to be weighed without being told the number, and ask that it isn’t read aloud. These are reasonable requests, and for some people they make the difference between going and not going.

If it goes wrong anyway

You are allowed to ask for a second opinion. You are allowed to see a different doctor in the same practice, or a different practice. You are allowed to make a complaint; complaints procedures exist precisely so that services learn when they have treated someone badly.

What I would ask you not to do is let one clinician’s attitude close the whole door. The shoulder, the cough, the tiredness do not go away because the appointment went badly. The women who delayed their screening were not being foolish; they were protecting themselves from being humiliated. But the delay is where the danger is, and you deserve care that finds things early.

A body’s size tells a doctor less than it seems to, and you can want better health without hating your body while you pursue it. Which brings it back to the shoulder. It deserves the same examination, the same questions and, if needed, the same scan as anyone else’s, with your weight as one fact in the file rather than the answer to every question. That is the most ordinary request in medicine.

Sources

• Phelan SM, Burgess DJ, Yeazel MW, et al. Impact of weight bias and stigma on quality of care and outcomes for patients with obesity. Obesity Reviews, 2015.
• Gudzune KA, Beach MC, Roter DL, Cooper LA. Physicians build less rapport with obese patients. Obesity, 2013.
• Amy NK, Aalborg A, Lyons P, Keranen L. Barriers to routine gynecological cancer screening for White and African-American obese women. International Journal of Obesity, 2006.
• Wharton S, Lau DCW, Vallis M, et al. Obesity in adults: a clinical practice guideline. CMAJ, 2020.