In The Doctor's Office You Can Always Say "No, No Thank You, Never, Not Today Satan"
“Since the medical system and most of its providers and staff are not able to provide a trauma informed, strengths-based, weight neutral, fat supportive, disability justice and healing space then I'll do everything I can to make that happen for myself.
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I used a content note above because some of the topic areas I discussed in the blog post could be activating or upsetting to readers. By using a content note at the beginning of the post it allows readers a way to know what topics will be discussed and that gives the reader the choice of whether they want to continue to read. The reader can decide if they are in the right emotional and psychological space to read about those topics. It should also be noted I did not use a “trigger warning” as that can preemptively activate (trigger) readers and alert the amygdala, the brain’s danger alert system. I suggest content notes and not trigger warnings.
Content Note: mentions of being weighed, medical fatphobia, eating disorder
It wasn't until I got tired of being bullied and retraumatized at medical appointments that I realized I could, wanted to and had to for my mental health--that I started standing up for myself and laying down boundaries and expectations with medical providers and staff.
I'm sure I had heard other fat activists talk about medical providers and patient rights. That I could say no to being weighed every time I went into the doctor. That's were it all started, refusing to be weighed for no reason other than they wanted to write it in a chart.
For medical providers, BMI, is about tracking a number on a scale and I'm pretty sure there is a rule that they have to do it for insurance purposes. Let me just get this out right here that BMI has never and will never be a good indicator of health or body fat. It's also steeped in racism and eugenics and most adults only really need to be weighed for specific medications, specific health problems, procedures/surgeries and certain equipment weight limits.
For me being weighed is fraught with anxiety, shame, potential relapse in eating disorder behaviors and hours, days or weeks of internal emotional flashbacks. It can take days or weeks to recover depending on my mental and emotional state, my experiences afterwards with the provider and other stressors in my life. And that's just from the action of getting weighed and not from the weird microaggressive or aggressive comments from the medical assistant or upsetting comments and pressure from the provider afterwards.
Feeling overwhelmed by all the different kinds of advocacy I knew I wanted and needed to do for myself, I started with tackling refusing to be weighed. My first step was researching patient rights and making sure I understood my rights so I would feel more confident in advocating for myself.
This research had me thinking about all the medical trauma I've experienced and wishing providers and the medical system was more trauma informed. Knowing that wasn't going to happen anytime soon I decided to think about what I say to my clients and parents that I was providing advocacy services for. What questions do I ask them when it comes to building agency and self-determination? We would often talk about how they can see themselves and their families from a strengths-based perspective instead of a deficit. Which is challenging when the systems and society around you constantly points out your problems and deficits. I also asked myself about trauma informed practices and what I needed to reduce retraumatization and increase empowerment and emotional safety navigating medical systems.
Since the medical system and most of its providers and staff are not able to provide a trauma informed, strengths-based, weight neutral, fat supportive, disability justice and healing space then I'll do everything I can to make that happen for myself. Yes, it's a lot of emotional labor to do and yes I shouldn't have to, yet that's the world we are living in.
Since the medical system and most of its providers and staff are not able to provide a trauma informed, strengths-based, weight neutral, fat supportive, disability justice and healing space then I'll do everything I can to make that happen for myself. Yes, it's a lot of emotional labor to do and yes I shouldn't have to, yet that's the world we are living in.
Here are a few examples of my reflections at that time:
New Belief/Thought: I am not a deficit and I have many fantastic and powerful skills, talents and resources.
Action: I made a list of my skills, talents and resources I would want a provider to know about me.
New Belief/Thought: I have specific identities that create a lot of oppression and barriers for me. I have certain words or phrases I don't want associated with my body. Instead I want a provider to use these words and phrases
Action: I made a list of my identities, prohibited words for them to use in connection with my body and other words instead.
New Belief/Thought: What do I need for a provider to do and not do so that I feel more comfortable in my appointments? What do I need from my provider so that I know they are taking my concerns seriously and providing the best care possible?
Action: I made a list of what I needed and what I did not want from providers including conversations, comments, procedures, etc. during my visits. For example, intentional weight loss will never be apart of my health and wellness goals.
From reflecting and answering these questions about my needs I began to deeply internalize that I deserve effective and compassionate care that centers my boundaries and needs. That I seek services and experiences within the medical system that are free of abuse, bullying, pressure to intentional loose weight and instead being a collaborative member of my medical decisions and conversations with the provider. That I no longer want to access providers that constantly argue with me about intentional weight loss or weight loss surgery, but providers that are able to support and adhere to my boundaries and expectations for care. Sounds doable right?
My First Time Saying No:
Walking into the wound care appointment at Emmanuel Hospital my ancestors told me to be on guard because this appointment was going to be challenging. I decided this would be the appointment I was going to say "no thank you" to be weighed. I had just had surgery on my leg over a month ago and was just at another wound care appointment at another hospital across town earlier that week. They didn't need my weight anyway. I was there to get fitted for compression leggings to help with wound healing after surgery.
As I anticipated the medical assistant brought me to the digital scale and this is how the interaction went:
Me: No thank you. I was just weighed a few days ago at Good Sam in my other wound care appointment.
Medical Assistant: Well we need your weight anyways so please stand on the scale.
Me: I told you no.
Medical Assistant: You have to be weighed for this appointment.
Me: This is the third time I'm telling you no. I know my rights as a patient and I don't want to be weighed today. If you continue to harass me about being weighed I'll walk out right now and then file a complaint against you. No means no.
Medical Assistant: (paused) Okay, I'll let the wound care team know you refused.
I can tell you that it was like there was a ball of fire that came from my belly and out my mouth when I was refusing and standing up for myself. This was a common occurrence for years after that moment when I would go up against a medical provider or staff member. There was a molten, fireball of powerful words that supported my advocacy and self-determination.
The rest of that appointment was a nightmare with no less than five more fat microaggressions and unprofessional comments from the nurse practitioner and other staff. But that's a story for another day.
Before that appointment I had a year of lowered eating disorder and disordered eating struggles. After that appointment my eating disorder was triggered and I struggled for months with harmful and negative internal thoughts from that eating disorder voice.
What happened with that "do no harm" oath?
Since then I have refined my practice of refusing to be weighed and have only ever had another situation with a medical assistant causing problems for me in regards to refusing to stand on the scale. She was easy to redirect and she gave up easily. I suspect I give off energy to not mess with me. Be the honey badger--don't give a shit about their feelings, but that's another story too.
My current boundary with being weighed is that I only do it if it's medically necessary such as medical procedure where I need to be under anesthesia or weight limit on medical equipment such as a CT scan machine.
Become familiar with our patient rights. You have the right to refuse ANY procedure, exam, written documentation or provider conversation. In some resources I've read being weighed before an appointment is considered a procedure.
Here are a few different ways to address being weighed at the doctor's office:
If you have an eating disorder history or become activated (triggered) from being weighed or knowing your current weight let your provider know and they can add into your chart that you are not to be weighed during appointments. You can simplify it and just say being weighed is retraumatizing--you don't have to tell them why.
If you have to be weighed or you want to avoid the hassle with our doctor or the medical assistant you can stand on the scale backwards or close your eyes so you don't see the number. Tell the medical assistant and your doctor you don't want to know your weight. You can also have them change the readout on the digital scale to kilograms instead of pounds.
Just remember that your weight will be recorded onto your digital medical record and it might show up on your discharge papers or if you use an app to see your medical records and appointment summaries.
To avoid the whole conversation of refusing to be weighed in front of the scale, when the medical assistant calls your name let them know you are not interested in being weighed today.
Navigating being weighed many reasons I decided to make a four page pdf with my expectations for care as I navigate medical systems. It's a powerful tool in setting expectations early on and giving providers a view into who I am beyond a "deficient" that I'm often seen as. If you are ready to take the step to think about the boundaries and expectations you have for providers please see my DIY Health Document Template at the bottom of the Body Sovereignty page of this website. It's free to use and can work really well not only for people experiencing fatphobia, but also trans and non-binary folks, folks with disabilities and anyone else who finds themselves needing to provide clarity and clear boundaries to their providers.
Resource Links: Coming Soon!
