When Doctors Prescribe Weight Loss: Thoughts from a HAES Therapist in St. Louis, MO

A few years ago, I started having some bad shoulder pain.  I was newer to the STL region at the time. So, I didn’t have a doctor yet. And, without much to go on, I picked a doctor and made an appointment to get my shoulder checked out.  Now, keep in mind that at this time I was playing sand volleyball weekly, going through yoga teacher training, was back to weightlifting at the gym, and in general, was way more active than I had been in years.  The doctor did not hear any of this though.  He looked at my weight, BMI, and shoulder. He came to the conclusion that the cause of my shoulder pain was my weight.  His instructions were nothing about reducing activity or icing my shoulder after use. But, involved me downloading the My Fitness Pal app and counting calories.  And despite what he thought about my BMI, I am a straight-sized female with consistently low blood pressure and nothing alarming in my blood work. 

So seriously, WTF.  

I’m not going to lie, there are VERY few things that upset me more than doctors prescribing diets and weight loss.  Especially when that prescription is ignoring the reason a person has come to see the doctor anyway.  Look, I understand that as a person in a straight-sized body, I receive a lot of privilege around that. But, if it is happening to me, I can only imagine what is happening to others.  Unfortunately, I don’t have to imagine too hard. I hear from my clients regularly about their experiences going to the doctor.  

When Diet Culture and Medical Care Collide

An MD behind your name doesn’t make somebody immune from experiencing fat-phobia or being influenced by diet culture.  Doctors live in the same world we do, are fed the same messages we are and are just as susceptible to buying in.

Can doctors prescribing diets really be that bad?

Doctors prescribing diets for weight loss can cause serious harm.  It can influence somebody to not follow up. Or, to not come back because they fear being shamed for not losing that weight.  It can result in a relapse of disordered eating behaviors.  Or, and this is the scariest of all, a doctor may be so focused on weight loss that they miss what is actually going on inside a person.  There are far too many stories of life-threatening issues like cancer being missed because the doctor chose to focus on weight being the issue rather than looking for other causes.  

But how do I protect myself??

So where do we go from here?  I have some thoughts…

1. We can refuse to be weighed.  Yep, that’s a thing.  You don’t HAVE to step on that scale despite being asked so nicely by the nurse.  Of course, there may be reasons why a doctor may feel it is necessary to your treatment, at which point, this can be explained to you and you can give informed consent.  If setting this boundary at the moment with a medical professional feels difficult, take one of these cards with you to help make it a bit easier.  Or if your dietitian or therapist is monitoring your weight already, you can share this information and offer to sign a release of information for them to talk.

2. If stepping on the scale is going to happen, step on the scale backward so you cannot see the weight.  Express to the nurse that you would rather not know the number.  Or, ask that the weight be taken in kilograms instead of pounds.

3. If the doctor chooses to focus on weight or weight loss, don’t be afraid to speak up about HAES.  Maybe even bring some HAES information along with you to share.  Lindo Bacon (author of Health at Every Size) has some great resources specifically for physicians.  There is also a letter for patients to take to their physician in the back of Health at Every Size.  If you are up for it, maybe even ask for peer-reviewed studies that back up claims that long-term intentional weight loss is effective.  Or, ask your doctor what they would prescribe to a patient in a thin body for similar symptoms.  Here is a blog post that includes some printable material to take with you to help with this.  And remember, you know your body. If something is wrong and is not being addressed beyond a weight loss prescription, insist that they look beyond weight. And, that your symptoms and request are both included in your chart.

4. If you continue to face weight discrimination or are uncomfortable with your treatment, consider finding a new doctor.  Talk to your therapist or dietitian about HAES providers in your area.  Or consider using the HAES website or ASDAH’s directory to find one on your own.  And if all else fails, ask around.  There are groups on Facebook that could be a great resource for this.  

At the end of the day, you deserve to be seen as more than your BMI and your weight.  You deserve weight-neutral care that sees you as a person with symptoms that need to be addressed.  You deserve better.

You don’t have to figure this out alone!

As a HAES therapist, I specialize in working with folks navigating all things body image and eating disorders. I offer therapy for folks struggling with anorexia, binge eating, atypical anorexia, and compulsive exercise. I also offer therapy for perfectionism. All of the services are offered through online therapy in Missouri or online therapy in Wisconsin. Currently, my St. Louis based counseling clinic is closed. If you're ready to start working with me, follow these steps:

1. Contact Embodied Self Counseling

2. Meet with me, Erin, for a 20-minute consultation

3. Set up your first appointment to start working through your "stuff."

Other Therapy Services at Embodied Self Counseling

I became a HAES therapist because I believe all bodies are good bodies. We have to rid ourselves of diet culture and the perfect image. If you’re struggling with this, then contact Embodied Self Counseling’s St. Louis office. If you need additional support, I offer online therapy in Missouri and online therapy in Wisconsin to accommodate your busy schedule. If you have "stuff with food" that others don't get, you could be a good fit for my eating disorder treatment. Additionally, I provide a unique approach to working with atypical anorexia and perfectionism. I offer eating disorder treatment for men too. Additionally, I offer Counseling for Compulsive Exercise, I am skilled with working with athletes and providing Counseling for Athletes. Plus, I provide Eating Disorder Treatment for Men. Let’s challenge the norm together and get you where you need to be mentally. Call now!