Shirah Vollmer MD

The Musings of Dr. Vollmer

Should Eating Disordered Patients Know Their Weight?

Posted by Dr. Vollmer on August 4, 2015

Doctors weigh their patients. Patients own their charts. For some sensitive people, knowing their weight is a trigger to disordered eating. As such, should doctors not weigh patients who could be prompted to re-start their disorder, or should doctors make a point of weighing eating disordered patients as a way of desensitizing them about weight? Once again, there is no answer, only strongly held beliefs which get promoted by “experts”. My opinion: the doctor should obtain consent for weighing the patient so that the patient can take control of his or her mental health. Blood tests, although certainly more expensive than weight checks, can give health information and so obtaining weight is not critical to medical care for these patients. On the other hand, eating disordered patients do need to heal and accept themselves and that includes accepting their weight. However, in the course of the illness, patients may be too sensitive to deal with their weight and so it might make more sense to avoid that trigger, if possible. Should the psychotherapist inform the primary care doctor about whether to weigh the patient? Maybe, but I would prefer that the therapist work with the patient directly so that the patient can inform the physician about whether it makes sense to be weighed. After all, eating disorders are so often about control, returning control to the patient, in big ways and in small ways, is a major step of healing the disorder, in that the more control the patient has in his life, the less important it is to control eating. Like all self-abusive behaviors, we have no clear path of intervention. We have to use our best guess. That is the state of the art. Big data does not help us here. I can live with that.

2 Responses to “Should Eating Disordered Patients Know Their Weight?”

  1. Shelly Tannenbaum said

    I don’t know how it is in the US any more but from 20 years ago I remember that the results of blood tests go to the physician who ordered them. In that manner, the patient doesn’t see the result so she doesn’t have control over the information and the impact of her weight on het body. I suppose that is one of the reasons you suggested it–weighing someone means she gets immediate results which affects her self worth whereas blood tests tells you the impact of her weight on body functions without the judgement issue.

    • Yes, that is correct. Now that our medical system has moved to electronic medical records, there is much greater transparency allowing patients to see their lab results promptly. The weight-as you say-has associations to self-worth, whereas someone’s hemoglobin value does not. The question is how much should the physician be sensitive to this issue versus making it a one-size fits all, where every physician visit means there is a documented weight. Clearly, with electronic medical records, we are moving to a one size fits all model, which will be good for most, but not all people. I would say one size fits most is the short answer.

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