One step off the scales, another step toward inclusive health care

COLUMBIA, Mo.— A routine trip to the doctor’s office almost always includes being weighed, a request that can be stressful. However, stepping on the scale isn’t always necessary and as more people learn they can decline being weighed, researchers at the University of Missouri are uncovering the reasons why a growing number of people are refusing the request.  

What they found is more than half of the people studied felt being asked to step on the scale at the doctor’s office negatively impacted their emotions, self-esteem and mental health. Additionally, many were concerned their health care provider might discriminate against them if they knew their weight.  

The findings pave the way for policy changes that might provide more awareness to patients about their rights and ability to protect their mental health.

“Research shows that most of the time being weighed during a visit to the doctor isn’t necessary. The first step is getting the message out there that you can refuse being weighed. Most people don’t know,” said Virginia Ramseyer Winter, an associate professor in the School of Social Work within the College of Health Sciences and director of the Center for Body Image Research and Policy. “Learning the reasons why people refuse being weighed gives us more insight on the broader relationship between people and their health care providers. We can utilize these findings to inform health care from a policy-level.”

The researchers recruited 384 adult women to participate in a survey which included questions about their most recent health care visit. Ramseyer Winter said it was significant that researchers were able to recruit participants with diverse body sizes because the results of the study show that the negative impact of being asked to step on the scale wasn’t necessarily tied to any specific body type or size.

Kate Trout, an assistant professor in the College of Health Sciences and collaborator on the study, said patients aren’t the only people who could benefit from education about weighing during health care visits.

“The implications of these results show that we really need to start training the health care workforce to bring light to this issue because it is urgent,” Trout said. “From our study, we know that over 30% of women are refusing to be weighed, and we also know that women will even avoid health care all together in an effort to refuse being weighed. We have to be more inclusive to ensure everyone gets the care they need, which could lead to improved health outcomes in the long term.”

One way to mitigate the impact of being weighed when it’s medically necessary is to wait until the end of the doctor’s visit to step on the scale once medical necessity is determined, said Ramseyer Winter and Trout. That way, other issues that might arise from the stress, such as increased blood pressure, can be avoided.

Ramseyer Winter, an expert in body image and health, and Trout, an expert in health services and health equity research, collaborated on the project with Gillian Bartlett-Esquilant, an expert in primary care research and associate dean for Graduate Research Education in the MU School of Medicine. They also collaborated with experts in social work from Washburn University and the University of Denver, as well as an expert in human development and family sciences and weight stigma and discrimination from the University of Connecticut. Ramseyer Winter and Trout said this collaborative effort allowed them to view the research from several unique perspectives.

“We viewed this research from several different lenses and were able to use an interdisciplinary approach, which really help us understand what is really happening here.” Trout said. “Taking this approach provides the information we need to develop tools and interventions that will ultimately provide weight-inclusive health care for all.”

“Women’s refusal to be weighed during health care visits: Links to body image” was published in Body Image: An International Journal of Research.