Beyond the Scale: A Size-Inclusive Approach to Health
The article addresses common patient concerns regarding doctors' focus on weight and Body Mass Index (BMI). Dr. Mara Gordon, a family physician, advocates for a size-inclusive approach to health assessments, moving beyond a narrow focus on body size.
Limitations of BMI
BMI is acknowledged to have significant limitations in assessing individual health, despite its utility for population-wide trends. The American Medical Association passed a resolution in 2023 noting these limitations in clinical practice. For instance, individuals with "normal weight" can have advanced diseases like diabetes, while others with "obesity range" BMIs are active and healthy. Weight loss can also be a symptom of serious conditions, such as cancer treatment.
BMI has significant limitations in assessing individual health, with the American Medical Association noting these limitations in clinical practice.
Electing to Skip Routine Weigh-Ins
Patients are not always required to be weighed at every doctor's appointment and can politely decline. However, accurate weight measurements may be necessary for specific medical conditions, such as chemotherapy dosing or monitoring fluid levels in heart conditions. Doctors typically require an updated weight at least annually for otherwise healthy individuals and to detect rapid, unexplained weight changes. Patients can also request the medical assistant not to disclose their weight if it causes distress.
Shifting Doctor-Patient Conversations
Patients can guide conversations toward broader health metrics and habits using "pocket phrases" if discussions become solely weight-focused.
Suggested phrases include: "I'm not comfortable talking about my weight every appointment," or "What other tests are available that would be a success marker?"
Focusing on Health Goals and Habits
Instead of size, doctors and patients can focus on individual health goals, which vary per patient and can change over a lifetime. Key areas for discussion include:
Mental Health
Screening for depression and assessing social connections are crucial components of overall well-being. Effective treatments like therapy and medication are available for mental health conditions.
Movement
Regular physical activity, even small "movement snacks" like gardening or walking, is beneficial for mood and bone health. Assistive devices are available for individuals with mobility limitations.
Sleep
Adequate sleep is fundamental for both physical and mental health. Evidence-based treatments, such as cognitive behavioral therapy for insomnia, are effective.
Key Health Metrics to Monitor
Beyond weight, several science-backed metrics offer a more comprehensive view of health:
Glucose Tolerance
Tests like a glucose test or Hemoglobin A1C (preferred for its non-fasting convenience) monitor blood sugar levels. An A1C of 6.5% or above indicates diabetes, while elevated A1C levels below this threshold (prediabetes) may warrant regular exercise to prevent progression.
Cardiovascular Disease Risk
Risk for heart disease and stroke is assessed using calculators such as the Pooled Cohort Equations or the newer PREVENT calculator. These tools inform decisions regarding cholesterol medications like statins. Coronary calcium scoring, a CT scan, can also help evaluate plaque in heart arteries, providing further insight for patients with elevated LDL cholesterol.
Cancer Screening
Regular screenings are recommended based on age, medical history, and family history. Key screenings include those for cervical, breast, and colon cancers, typically starting at age 45 for colon cancer.