Hacker News Reader

Comment by salawat | Hacker News Reader

This has to be the most daft idea ever.

Medical science relies on so many crucial data points based on mass, which is most easily determined via measuring weight.

Without your weight: A Doctor cannot safely prescribe anything. A Doctor cannot verify whether changes in your weight may containdicate a pre-existing course of treatment. Second-opinions to sanity check a physician making a high impact diagnosis is right out.

What is wrong with people? Valuing avoidance of being confronted with an objective fact that makes you feel bad over not dying or not being treatable?

I just don't understand.

You can be squeamish with just about everyone else. Never your Physician.

View on HN

I am not overweight, but I can understand this. I don't entirely agree with it.

If you want to stick with something objective: if your biggest association with going to see a doctor is being made to feel like crap about your weight, then you will see your doctor less.

I already avoid going to the doctor more than I should, and that's mostly based on inconvenience. If it were a miserable experience, then I know I would procrastinate even more aggressively.

But setting that aside, I think there are a number of reasons why this could make some amount of sense. Doctors do over-focus on weight, not bothering to look for any specific causes because they've supposedly already figured out the problem. Which means the patient leaves with an instruction to lose weight, they don't, and nothing changes. And being fat isn't as highly correlated with health outcomes as people—including doctors—assume. There are plenty of healthy fat people and unhealthy thin people.

There are many other legitimate reasons to control how your doctor approaches an issue. You may have tried the common fixes and know that trying slight variations is unlikely to be fruitful. You are an expert on your own body, with massive gaps when it comes to medical knowledge and details. Your doctor is an expert on human bodies in general, with massive gaps when it comes to specific patients' bodies.

I'm not going to argue that the right answer is to not weigh at all. There are a lot of other options, like not telling the patient the weight. And/or skipping the sermon on weight. Bringing up weight only in the context where it matters. Being specific about what aspect of weight is relevant. (Is it really the mass causing mechanical failure, or are we talking about fatty tissue? Endocrine problems?)

In a perfect world, measuring weight wouldn't be an issue because your doctor would be sensitive yet persuasive, and patients wouldn't be hung up on it and would be making rational choices (eg "I'm fat because it's a side effect of doing things that make me happy and this is what works for me right now.") We don't live in a perfect world. We need to do the best in the actual situation, and handing over all power to the doctor does not have that result.

It's interesting that they then go on to scare-stories where the physician had assumed that weight was a largely contributing factor.

Does anyone believe that not weighing them will change this? If you're large enough that the doctor assumes it's a primary medical concern, they can probably reach the same conclusion without the scales.

Not trying to be anti-anyone, just .. not sure it's solving the right problem.

The very top image in the article shows the card:

> Please don't weigh me unless it's (really) medically necessary. If you really need my weight, please tell me why so that I can give you my informed consent.

Not as "daft" as the headline, is it?

It still is. No doctor / nurse weighs you for fun. They have better things to do while running a 12-16 hour shift.

> They have better things to do while running a 12-16 hour shift.

One way to view this is as a component of bedside manner. Some patients need to be educated (and perhaps won't need the card after certain things have been explained to them). Patients with hard-earned sensitivities need a little extra hand-holding. For example, people with phobias of needles need some extra hand-holding. The doctor/nurse doesn't "have better things to do" in that case -- most have training to mitigate the patient's anxiety in that situation. Why should this be different?

How about it's always medically necessary?

But it's always medically necessary, because weight changes are a leading indicator of many issues, and the long-term trend is needed to see these. If people feel that they don't understand why it's necessary, maybe better communication and education is needed, but I don't think these cards help that.

Wouldn't there be an implied consent to routine data collection during a physician visit? A clinician may also make notes on patient appearance or mannerisms that they feel may be relevant to the diagnostic process, not to mention non-invasive tests based on touch.

This is interesting because improved weight management would probably the HIGHEST medical impact intervention for tons and tons of people, both in quality of life and disease / illness.

Reading this you realize that folks who are fat may not know (or don't want to know) just how many correlations there are between issues with weight and illness / disease, including mental health issues

I actually wish they'd do things like tie weight screening into things like a mental health referral for depression / self esteem etc support.

Bottom line, obseity is associate with large decreases in life expectancy and higher incidence of early mortality. Given the billions spent on other areas of health (including end of life care) there is probably a fair bit of bang for the buck in actually being more aggressive here.

Just like they want to mandate employers force shots on all staff, you might have strong outcomes if they forced employers to mandate all staff exercise 2x per day for 30 minutes (fitness / stretching etc) - monitored eating during the day to healthy diet etc.

I'm not saying this should happen, but the crazy lockdowns due to COVID for kids (massive impact, modest benefit) - they might not be focusing on areas of greatest payoff.

Shots were not forced on staff. There was informed consent, and staff were allowed to quit their jobs in lieu of getting the shot. The card is asking for informed consent. It is not a flat refusal to being weighed. Patients are exposed to a lot of misinformation, and that needs to be addressed by healthcare professionals. It is unfortunate, but that's the world we live in. For all the play that vaccine hesitancy gets on HN, it's really interesting how ferociously people have responded to a different treatment hesitancy.

> This is interesting because improved weight management would probably the HIGHEST medical impact intervention for tons and tons of people, both in quality of life and disease / illness.

Yeah, and if I know I'm going to get a lecture about my weight that I've already heard, I'm going to put off going to the doctor.

What is the difference in outcomes from going to the doctor timely vs waiting 3 months?

Also, consider that the medical industry does a pretty bad job of adapting to the bodies people have, and all of the downstream data that drives. For example, you need a proper size blood pressure cuff to get an accurate measurement, but the larger and smaller than 'regular' cuffs are usually not immediately available, so medical staff just tries to wing it when presented with a larger or smaller arm.

I feel like there is a lot of context to this that each of us can easily miss that can make discussing this hard.

From my experience, I don't get weighed by unrelated medical practitioners but when it is relevant for tracking my health. Unless there are cases outside of my life experience where people are being weighed, that context adds an implication to the card's existence and text that most of these existing weigh-ins are not medically necessary and that you need to justify each time you do do a weigh in.

With that said, as I read the article more, I can understand receiving accommodations specifically dealing with body image and eating disorders (as well as improvements with how doctor's deal with weight). How to make those accommodations while also tracking vitals important for your health is tricky. Needing to deal with unhealthy habits and unhealthy weight is a real thing. Its also a real thing when doctor's dismiss patients as lying when they are living healthy when it turns out there are other underlying conditions (like PCOS). None of this is in my life experience but I've been slowly hearing from more friends who have had to deal with this, like a very active folk dancer who eventually found out she had PCOS no thanks to her doctors that accused her of lying about her habits.

Reply on news.ycombinator.com