Yoni Freedhoff, MD
May 08, 2019
"Back when he was a graduate student, my friend, Dr Travis Saunders, was a ridiculously active runner and cyclist who primarily ate home-cooked meals made from whole ingredients. Despite living a healthier lifestyle than what I'd venture 99.9% of us are, he was told at his yearly physical to "watch his weight," as he was approaching a BMI of 25 (the start of the medical descriptor "overweight").
In a similar interaction, a patient of mine told me about how she had lost more than 100 lb by maintaining a lifestyle of high physical activity and eating an unabashedly healthful diet. But after being weighed by her new family physician, she was quickly lectured about the risks of obesity and told that she ought to try exercising more and eating healthier.
Meanwhile, how many thin patients do you think have never had their physician explore the fact that their diets are made up primarily of ultra-processed and fast foods, and that their exercise is limited to changing the channel on the remote control or scrolling on their phones?
What Does a Scale Measure?
The problem in all of the cases above tracks back to faulty scale use, and perhaps it isn't all that surprising. When I was a medical student in the 1990s, I wasn't taught how to use a scale, and I'm betting that the same is true for most medical students today. Don't get me wrong; it's not that I think scales are complicated pieces of equipment, but after exclusively practicing obesity medicine for the past 15 years, I do think that their proper use is worth discussing.
Scales do measure the gravitational pull of Earth at a given moment in time. Scales don't measure the presence or absence of health, nor do they measure lifestyle or effort. And for patients, it's useful to note that scales don't measure happiness, success, or self-worth, either.
The only [noncommunicable disease] for which patients are judged if they don't...tackle it on their own is obesity.
Although weight is undeniably a risk factor for a host of medical comorbidities, especially at its extremes, it's not a guarantee that any of them will occur. And so the use of a scale to infer the presence or absence of health ignores the actual person standing on the scale.
Similarly, scales don't measure lifestyle. There are scads of patients with obesity doing all of those good things—exercising regularly, getting enough sleep, not smoking, cooking with whole ingredients, etc. Similarly, plenty of thin patients' lives are spent living on junk food, smoking, drinking to excess, and spending all of their off-hours binge-watching television and being inactive.
Relying on scales to measure things that they can't leads physicians to make assumptions that undermine the care and understanding of all of their patients, and is no doubt reflective of weight bias. This, in turn, has been shown to affect the quality of care for patients with obesity.[1]"
https://www.medscape.com/viewarticle/912503?src=wnl_edit_tpal&uac=279348AG&impID=1958729&faf=1
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I found the above article on Medscape and it really hit home for me because this reminds me of my husband and myself. I'm the one that tries to eat well and exercise, but I struggle with my weight due to hypothyroidism, pre-diabetes and metabolic syndrome. My doctors constantly chide me about my weight and assume that I'm not doing anything to change it, in spite of my efforts.
My husband stays very thin on pizza, fast food and other junk and spends hours in front of the TV every day, with basically no exercise. No, he's not "healthy" because he has high cholesterol, high blood pressure; he's had a TIA and some other issues, but he's not overweight so his doctor says nothing to him about his diet or exercise.