I cringe to think of it, but several years ago, before my medical group moved to a more spacious office, we kept our scales in the halls. They simply didn't fit in the exam rooms. One of our medical assistants tried to inject a bit of humor into what was clearly an unpleasant experience for our patients (getting weighed in a cramped hallway, that is) by tacking a cartoon on the wall by one of the scales. It showed two kids looking at this odd object with a numbered dial. One kid says to the other, "Don't step on it. It makes you cry."
Not everyone who steps on the scale in my office cries--though more than a few have--but getting weighed is traumatic enough for so many of my patients that I sometimes wonder if the benefits of the scale are worth the pain.
There's no question that Americans are heavier than ever and that excess pounds can cause many health problems including heart disease, diabetes, and certain cancers. Also, there are some situations in which knowing exactly what a patient weighs is necessary to provide good medical care, such as when calculating the dose of certain medications or monitoring unintentional weight loss in ill or elderly people. So there are good reasons to weigh patients, but, I fear, too often in doctors' offices patients are weighed reflexly and not much is done with the information. Either the patient has a problem--say, a sore throat--unrelated to weight or, even if they have medical issues caused by obesity, for a variety of reasons doctors don't engage the patient in a conversation about that.
And the procedure of getting weighed is, as I've mentioned, not entirely benign for the patient. This article summarizes nicely the various ways in which embarrassment, including about the prospect of facing the scale, may keep obese patients, who very much need health care, away from doctors' offices.
In my own practice we've taken steps to deal with weight more sensitively. Scales are now kept in private exam rooms, we don't routinely weigh people who come in for issues unrelated to weight, and we offer people the option of not being weighed. We, along with many other practices, provide large gowns, blood pressure cuffs, and other equipment, and have gotten better, I think, at nutrition and exercise counseling which--only a few years ago--were all but ignored by M.D.s.
Still, we doctors have some ways to go to before we convince our patients that we're as serious about helping them achieve a healthy weight as we are about weighing them.
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