Handling Weight in the Doctor's Office

Health experts and advocacy groups agree that good medical care should not be dependent on a patient's girth. Here are a few tips they offer patients for improving doctor-patient discussions of body weight and separating that issue, when warranted, from other health concerns.

- If you're sensitive about your weight, ask that your doctor weigh you in a private area -- and enter your weight in your chart without comment.

- If clothing or equipment doesn't fit or is uncomfortable to use, ask if your doctor can change it. Larger exam gowns, blood pressure cuffs and other equipment are available from many medical suppliers.

- Be open to respectful discussions of body weight that don't assign blame. Your doctor or nurse may have helpful suggestions you haven't tried.

- Consider pre-screening physicians.

Says Cathy Grinels of Alexandria: "I go in and make an appointment -- I'm with Kaiser, so it only costs me $15 -- and I'll say, 'I'm trying to choose a new [primary care provider] and I just wanted to sit down and talk to you and see how we would work together.' I'll then say, 'You can look at me and see I'm a fat woman. How do you feel about that?' Usually the doctor will say, 'Well, I don't think it's healthy.' I agree with them; there is no way in the world you can tell me with the arthritis on my knee that putting 300 pounds on it will help. But what I want to know is: If I come in with an earache, how are you going to treat me? I usually ask them how they will treat arthritis, digestive problems and earaches. Arthritis and digestive problems are things they will relate to my weight, but my ear is not related.

"It's not a black-and-white issue. I don't want a doctor who is going to ignore my size. But I also don't want them to make assumptions. I do not have high blood pressure. I don't have sugar diabetes. I don't have any of the things they expect me to have. Every time I go in to get my blood pressure checked, they pump that thing up again and again, and they keep thinking they've missed it."

Some Medical Establishment Resources:

-"Medical Care for Obese Patients: Advice for Health Care Professionals," American Family Physician, January 2002, http://www.aafp.org/afp/20020101/81.html.

-"Toward Sensitive Treatment of Obese Patients," Family Practice Management, http://www.aafp.org/fpm/20020100/25towa.html.

Some Advocacy and Policy Groups:

- The Obesity Society, Silver Spring, 301-563-6526. http://www.naaso.org. Committed to preventing and treating obesity as well as improving the lives of those who are obese.

- Council on Size and Weight Discrimination, Mount Marion, N.Y., 845-679-1209, http://www.cswd.org.

- National Association to Advance Fat Acceptance, Oakland, Calif., 916-558-6880, http://www.naafa.org.

- Rudd Center for Food Policy and Obesity, Yale University, New Haven, Conn., 203-432-6700, http://www.yaleruddcenter.org.