Thank you for this-- total aha moment for me! I got that ridiculous paperwork about managing my weight once after an urgent care visit for an ear infection (which I mostly thought was funny/baffling) and saw it in my chart after giving birth (which wasn't funny at all and made me think twice about my otherwise positive interaction with the triage nurse).
This is more amazing than you may even realize. I had a reasonably good PCP appointment. I allowed them to weigh me but my provider didn't mention it. However, when I went to MyChart for the visit summary it said in red all caps: the patient is ob*s*. I'd gotten through the fears about weight during the appointment only to have it in my face on my chart. :-( I dread all doctor visits because of things like this.
We ran into a similar thing with our pediatrician. For babies, tracking weight/height seems to be important in a different way than for adults, but our 2 day old baby had a BMI listed on her chart! We talked to our pediatrician about it and she said her charting software added it automatically.
It's not a big deal now (still under 2) but kids are subject to a lot of weight checks and as she sees more of that, I want to help her understand that it's not something she needs to track or worry about.
Thank you for this! I stopped weighing my patients and took it off all my paperwork. Luckily, as a chiropractor it is easier to stop than in primary care. As a fat provider and patient I appreciate all of your work. Happy to hear more from you in the future.
Thank you for being mindful of what ends up in the patient’s paperwork! As a patient, it’s frustrating how much of medical care is defined by systems created to accommodate the terrible way we pay for health care in this country. I often feel like providers are (forced to be) checking boxes rather than caring for anything I actually need.
I recently had a routine visit to establish care with a new provider, and I asked not to be weighed. The nurse basically said there was no getting out of it but I could turn around if I didn’t want to see the number, so that’s what I did. When I got home and reviewed my paperwork, there was my weight, boldly printed on the first page. I’ve been declining to weigh myself for years since a bout with disordered eating and obsessive intentional weight loss, and that experience has triggered a lot of old anxieties that make me hesitant to return to care.
Yep. I’ve been through this many times at this point. One doc about 15 years ago literally went out of his way to write my weight in 3 inch high letters on my chart and to sit in a way where I could not avoid seeing it, after I’d declined to look at my weight earlier in the visit. That triggered massive anxiety and food restriction while my family was visiting for the holidays. I had just wanted to make sure that the ankle swelling was seeing wasn’t indicative of an imminent heart attack. Instead he nearly gave me one, and ruined my vacation. Eventually we decided that the swelling was because I had eaten a bunch of chips around my period. He had the gall to say “you didn’t tell me you were on your period.” I responded “you didn’t ask!”
Then there were the times that I was forced to deal with that number at the allergist’s office. I’ve had allergies to dust my whole life, but never had exercise induced asthma. Nevertheless, my (newish) allergist insisted that my asthma would be so much better if I’d just lose weight. I pointed out that my very mild allergies/asthma had literally never changed from the time I was a kid, through the times in my 20’s when I was Irish dancing for 4+ hours a week and weighed close to “normal,” up to now, at my present “OMGFAT!” weight. I had a hard time seeing how losing weight would affect those very mild symptoms when those exact same symptoms had been present at all those differing weights.
And yeah, I HATE that they INSIST on putting that information up front and bolded in our chart, even when we request to not make a note of it. Or read it out loud “just to make sure I’ve got it right.” Doc, your tech just took that weight a few minutes ago; why are you checking with ME? Do you not trust your staff? 🤦🏻♀️
It is infuriating, and literally damaging to my health. My blood pressure spikes, and I start to panic, and become hyper vigilant or obsessive about food and exercise … or I quit exercising altogether because now I am
hyper aware of that number, and I can’t bear to be seen to be “a fat person exercising in public.”
There is just nothing good that comes out of forcing me to track that number.
I have post-concussion syndrome. I have weight cycled from the time I was a tween, and the incident that caused my undiagnosed concussion happened at the low end of a cycle. Then exercise started causing massive headaches, nausea etc so I stopped and I gained weight rapidly. I went undiagnosed for 10 years because practically every doctor would tell me the problem was my lack of exercise. It still makes me so so angry that I suffered for years due to a basic cause and effect logical error.
Oh also, while every visit in America would require a weigh in, this has not been the case in Canada. It makes me so much more likely to seek preventative care.
It is fantastic that you don't include "obesity" on your patients' charts. It really is so refreshing, especially as I imagine that you are one of very few. Also, the billing & coding guide is so infuriating... Especially the part about "morbid obesity due to excess calories". How would a doctor even know? They would probably just assume, which is such a dangerous assumption, of course (and even if they were correct, if a patient truly is eating excess calories, then maybe binge eating disorder would be a more appropriate diagnosis).
Do you think there’s a connection between what you describe here with pressure to code for higher reimbursement and the seeming obsession with weighing us at every single appointment? I’ve been declining to be weighed for the last year and I recently had a series of many appts in a short time frame across a range of specialties and was struck by how they all seemed so focused on getting me on the scale no matter what the visit was for. Or maybe because I have been declining there’s a pop up that says they need a recent weight on me? Or does that tend to be required at every visit no matter the reason for it?
Thank you for this - as a primary care physician I struggle with this because I work hard to focus on health not BMI and to never shame my patients for their weight or make it the focus of our visit unless that's their explicit goal. Two main issues I run up against:
Sometimes the way to get the thing the patient is requesting covered by insurance is to code it under a weight-related diagnosis (nutritionist services, "exercise" prescriptions that get them free fitness memberships, certain screening tests). In these cases, my fix has usually been to use a BMI code (i.e. BMI 30-31 or whatever their bmi is) because that's a number that already prints out on the patient's visit summary and seems the least stigmatizing option.
It's also challenging that one of the metrics I am evaluated on and that the community health center where I work is evaluated on is whether counseling is documented for all adult patients with BMI over 25. I can disagree all I want, but I also want my CHC to continue to receive funding and remain in good standing with our accrediting bodies. As part of how we deal with this, my whole organization has nutrition information that auto-adds to the visit summary of any non-pregnant adult with a BMI over 25. After reading this, I'm reflecting again on how to handle this better. Very interested to know what others do.
Yes! I have heard in particular at FQHCs this is a huge issue.
I think most important, of course, is how you treat the patient. I also sometimes give patients a heads up if for some reason obesity (or another stigmatizing diagnosis) will be in their chart.
Mine says "well-developed and well-nourished [...] with a BMI of ..." apparently (saw that this morning from an orthopedist I saw for my ankle. He also noted I was extremely pleasant, and that came first, so yay?
Thank you for this-- total aha moment for me! I got that ridiculous paperwork about managing my weight once after an urgent care visit for an ear infection (which I mostly thought was funny/baffling) and saw it in my chart after giving birth (which wasn't funny at all and made me think twice about my otherwise positive interaction with the triage nurse).
This is more amazing than you may even realize. I had a reasonably good PCP appointment. I allowed them to weigh me but my provider didn't mention it. However, when I went to MyChart for the visit summary it said in red all caps: the patient is ob*s*. I'd gotten through the fears about weight during the appointment only to have it in my face on my chart. :-( I dread all doctor visits because of things like this.
We ran into a similar thing with our pediatrician. For babies, tracking weight/height seems to be important in a different way than for adults, but our 2 day old baby had a BMI listed on her chart! We talked to our pediatrician about it and she said her charting software added it automatically.
It's not a big deal now (still under 2) but kids are subject to a lot of weight checks and as she sees more of that, I want to help her understand that it's not something she needs to track or worry about.
Omg two day old baby BMI 🤦♀️🤦♀️🤦♀️
Horrible!
Thank you for this! I stopped weighing my patients and took it off all my paperwork. Luckily, as a chiropractor it is easier to stop than in primary care. As a fat provider and patient I appreciate all of your work. Happy to hear more from you in the future.
Thank you for being mindful of what ends up in the patient’s paperwork! As a patient, it’s frustrating how much of medical care is defined by systems created to accommodate the terrible way we pay for health care in this country. I often feel like providers are (forced to be) checking boxes rather than caring for anything I actually need.
I recently had a routine visit to establish care with a new provider, and I asked not to be weighed. The nurse basically said there was no getting out of it but I could turn around if I didn’t want to see the number, so that’s what I did. When I got home and reviewed my paperwork, there was my weight, boldly printed on the first page. I’ve been declining to weigh myself for years since a bout with disordered eating and obsessive intentional weight loss, and that experience has triggered a lot of old anxieties that make me hesitant to return to care.
Thanks for sharing this. I'm so sorry you had this experience!
Yep. I’ve been through this many times at this point. One doc about 15 years ago literally went out of his way to write my weight in 3 inch high letters on my chart and to sit in a way where I could not avoid seeing it, after I’d declined to look at my weight earlier in the visit. That triggered massive anxiety and food restriction while my family was visiting for the holidays. I had just wanted to make sure that the ankle swelling was seeing wasn’t indicative of an imminent heart attack. Instead he nearly gave me one, and ruined my vacation. Eventually we decided that the swelling was because I had eaten a bunch of chips around my period. He had the gall to say “you didn’t tell me you were on your period.” I responded “you didn’t ask!”
Then there were the times that I was forced to deal with that number at the allergist’s office. I’ve had allergies to dust my whole life, but never had exercise induced asthma. Nevertheless, my (newish) allergist insisted that my asthma would be so much better if I’d just lose weight. I pointed out that my very mild allergies/asthma had literally never changed from the time I was a kid, through the times in my 20’s when I was Irish dancing for 4+ hours a week and weighed close to “normal,” up to now, at my present “OMGFAT!” weight. I had a hard time seeing how losing weight would affect those very mild symptoms when those exact same symptoms had been present at all those differing weights.
And yeah, I HATE that they INSIST on putting that information up front and bolded in our chart, even when we request to not make a note of it. Or read it out loud “just to make sure I’ve got it right.” Doc, your tech just took that weight a few minutes ago; why are you checking with ME? Do you not trust your staff? 🤦🏻♀️
It is infuriating, and literally damaging to my health. My blood pressure spikes, and I start to panic, and become hyper vigilant or obsessive about food and exercise … or I quit exercising altogether because now I am
hyper aware of that number, and I can’t bear to be seen to be “a fat person exercising in public.”
There is just nothing good that comes out of forcing me to track that number.
I have post-concussion syndrome. I have weight cycled from the time I was a tween, and the incident that caused my undiagnosed concussion happened at the low end of a cycle. Then exercise started causing massive headaches, nausea etc so I stopped and I gained weight rapidly. I went undiagnosed for 10 years because practically every doctor would tell me the problem was my lack of exercise. It still makes me so so angry that I suffered for years due to a basic cause and effect logical error.
Oh also, while every visit in America would require a weigh in, this has not been the case in Canada. It makes me so much more likely to seek preventative care.
It is fantastic that you don't include "obesity" on your patients' charts. It really is so refreshing, especially as I imagine that you are one of very few. Also, the billing & coding guide is so infuriating... Especially the part about "morbid obesity due to excess calories". How would a doctor even know? They would probably just assume, which is such a dangerous assumption, of course (and even if they were correct, if a patient truly is eating excess calories, then maybe binge eating disorder would be a more appropriate diagnosis).
Yep, that's an icd10 pop up there!
Do you think there’s a connection between what you describe here with pressure to code for higher reimbursement and the seeming obsession with weighing us at every single appointment? I’ve been declining to be weighed for the last year and I recently had a series of many appts in a short time frame across a range of specialties and was struck by how they all seemed so focused on getting me on the scale no matter what the visit was for. Or maybe because I have been declining there’s a pop up that says they need a recent weight on me? Or does that tend to be required at every visit no matter the reason for it?
Thank you for this - as a primary care physician I struggle with this because I work hard to focus on health not BMI and to never shame my patients for their weight or make it the focus of our visit unless that's their explicit goal. Two main issues I run up against:
Sometimes the way to get the thing the patient is requesting covered by insurance is to code it under a weight-related diagnosis (nutritionist services, "exercise" prescriptions that get them free fitness memberships, certain screening tests). In these cases, my fix has usually been to use a BMI code (i.e. BMI 30-31 or whatever their bmi is) because that's a number that already prints out on the patient's visit summary and seems the least stigmatizing option.
It's also challenging that one of the metrics I am evaluated on and that the community health center where I work is evaluated on is whether counseling is documented for all adult patients with BMI over 25. I can disagree all I want, but I also want my CHC to continue to receive funding and remain in good standing with our accrediting bodies. As part of how we deal with this, my whole organization has nutrition information that auto-adds to the visit summary of any non-pregnant adult with a BMI over 25. After reading this, I'm reflecting again on how to handle this better. Very interested to know what others do.
Yes! I have heard in particular at FQHCs this is a huge issue.
I think most important, of course, is how you treat the patient. I also sometimes give patients a heads up if for some reason obesity (or another stigmatizing diagnosis) will be in their chart.
This is a good idea. Thank you.
Mine says "well-developed and well-nourished [...] with a BMI of ..." apparently (saw that this morning from an orthopedist I saw for my ankle. He also noted I was extremely pleasant, and that came first, so yay?
😜
Thank you for this!!