Managing a Patient Who Refuses to Be Weighed
Respect the patient's refusal, document it clearly in the medical record along with their concerns, and focus on building trust through weight-inclusive communication strategies rather than forcing the issue. 1
Understanding Why Patients Refuse
Refusal to be weighed typically stems from prior stigmatizing experiences with healthcare providers and legitimate concerns about weight-based discrimination. 1 Research demonstrates that patients with higher body appreciation are 40% less likely to refuse weighing, while those with weight-related distress commonly cite negative emotional impact, shame, embarrassment, and lack of provider trust as reasons for refusal. 2
Immediate Response Strategy
Never force or coerce weighing, as this reinforces stigma and damages the therapeutic relationship. 1 When a patient refuses:
- Document in the medical record that the patient declined weighing, the specific concerns they expressed, and whether a self-estimated weight was obtained. 1
- Note the clinical rationale for weighing, including any clinical considerations that make weight measurement particularly important (e.g., heart failure monitoring, unexplained weight changes, medications requiring weight-based dosing). 1
- If weight estimation is needed for medication dosing, use the patient's self-reported weight—this is more accurate than clinician estimates (median difference of 0 lb vs. -5 to -6 lb for clinicians, with 90.6% of patients estimating within 10% of actual weight). 3
Environmental and Communication Modifications
Ensure privacy during weighing by situating scales in a private area or room, not in public hallways or waiting areas. 1 The clinical environment should accommodate patients of diverse body sizes, including chairs without restrictive armrests, appropriately sized gowns, and scales that can accurately measure higher weights. 1
Use people-first language (e.g., "person with obesity" rather than "obese person") and avoid stigmatizing terms like "fat" or "morbidly obese." 1 Consider using more neutral terms such as "unhealthy weight" instead of "obesity" when documenting and discussing with patients. 1
Building Trust for Future Weighing
A long-term trusting relationship between patient and clinician eases weight discussions. 4 Clinicians report that linking weight discussions to relevant medical concerns helps make the topic less interactionally difficult. 4
When discussing weight becomes necessary, speak delicately: 5
- Forecast upcoming discussion of weight with strategic use of hesitation and delicacy markers
- Frame advice as relevant and personalized to the patient rather than generic information
- Avoid making patients feel "on the back foot" with blunt terminology 4
Clinical Contexts Where Weight Is Critical
For patients with type 2 diabetes, weight trajectory informs treatment decisions and helps assess response to interventions. 1 However, consider deferring weighing for patients who are emotionally fragile or in acute mental health crisis, as this may cause more harm than benefit. 1
Common Pitfalls to Avoid
- Never weigh patients in non-private areas, as this violates dignity and increases distress. 1
- Avoid using objective BMI measurements or "the computer says" as a shield to distance yourself from the conversation—while clinicians report this makes them more comfortable 4, it can undermine the personalized relationship needed for long-term behavior change
- Don't assume refusal means the patient is resistant to health discussions—explicit resistance to weight conversations is actually relatively rare and often relates to sensitivity around unknown patient awareness rather than the topic itself 6