This website does not provide medical advice. Before using this website for the first time, you must agree to the terms laid out in the medical disclaimer. If you disagree with any of the terms, DO NOT enter this website.
To whom it may concern, I do not consent to the following:
Unless it is clinically necessary (please see below)
Unless I have concerns about weight loss/gain that may be clinically relevant to my presentation today.
I do not wish to pursue intentional weight loss because it fails in up to 95% of people and 2/3 end up heavier than when they first started. In addition, intentional weight loss is associated with many serious side effects and has not been shown to be beneficial beyond 2 years.
This also includes any other similar weight-centric lifestyle programs (such as a weight-centric diabetes education program).
Please ensure that you have made a note in my record so that I do not have to have this discussion again.
How to navigate this page
- If you're new to weight inclusive care, learn all about why people are chosing to say #NOWEIGH
- If you are being told that it is necessary to weigh you but you aren't sure if you can say #NOWEIGH
- If you're in front of a health professional and you want to say #NOWEIGH
- If you have a specific condition or circumstance and aren't sure if you can say #NOWEIGH
Why should I say #NOWEIGH?
There are hundreds of factors that control our weight, including genetics, early childhood experiences, medical conditions, medications, social factors, chronic stress, and ironically, a history of intentional weight loss.
We know that the first law of thermodynamics does not apply to the human body because it is not a closed system. There are simply too many variables.
One study found that people with a BMI of 34-36 had a higher life expectancy than those with a BMI of 18-20. In fact, there is no evidence that overall health status can be confidently predicted by weight.
It is important to remember that association is not the same as causation. It is now well established that people who are “overweight” live the longest. And whilst there may be an association, there is NO evidence that being fat causes ANY long term conditions. Some conditions are seen less often in people in fat people, including several cancers, anaemia and osetoperosis. Other studies have shown higher survival rates in people with cardiovascular disease, heart failure, high blood pressure, COPD and kidney failure.
Whilst weight loss often occurs shortly after starting any type of weight loss program, the vast majority of people will regain that weight within 2-5 years. In fact, studies show that up to 95% will have regained the weight and between one third and two thirds of people will regain more weight then they lost.
Most studies demonstrate a moderate improvement in health in the first 6 months after weight loss. However, these studies usually don’t follow patients up beyond that. Those that do, often find they have relapsed within 18 months.
Studies show that BMI has a false positive rate of around 50% (in other words 50% of people with a BMI over 25 are metabolically healthy). It also has a false negative rate of around 30% (in other words 30% of people with a BMI 18-25 are UNhealthy). This means BMI is only accurate 1 in 3 times!
In April 2020 The house of commons published a report that stated “the use of the Body Mass Index (BMI) in determining if an individual’s weight is healthy should be scrapped immediately”. After 2 years of expert testimony, the committee concluded that “BMI actually contributes to health issues”.
Weight-centric care focuses on weight loss to prevent and treat a number of health problems. At it’s core is the belief that individuals are responsible for making “healthy lifestyle choices” and maintaining a “healthy weight”.
Weight stigma describes the way size bias impacts both individuals and society as a whole through harmful stereotypes and discrimination.
Beacuse of weight stigma, health professionals spend less time with fat patients, often presume their symptoms are weight related without taking a thorough history, undertake fewer examinations and investigations, and are less likely to treat fat patients than they are thin ones.
People who are stigmatised by their health professional, lose their trust in them, struggle to think clearly and communicate effectively with them, and are less likely to follow their advice. But worse still, it may put them off seeking medical advice in the future.
Weight stigma is an independent risk factor for shorter life expectancy and higher levels of disease. It also causes weight gain, creating a vicious cycle that is hard to escape.
There isn’t any real evidence that weight management programs are effective in the long term. In fact, the only people who appear to benefit from weight loss are those who are financially profiting from it.
When NOT to say #NOWEIGH
(When to say YES!)
Medications in the UK that require weight monitoring include:
- Oral anticoagulants like Apixaban, Dabigatran and Rivoroxaban
- The Combined Contraceptive Pill (NOT the Progesterone Only Pill)
- Emergency contraception
- Anesthetic medications
- Specialist medications
- Most medications in patients with kidney failure
- Some medications in patients with liver failure
This is common in people with heart failure, kidney failure, or any other condition that could impact fluid balance within the body.
YOU CAN ASK NOT TO SEE OR BE TOLD YOUR WEIGHT. YOU CAN ALSO REFUSE TO DISCUSS IT.
Unintentional weight loss should NEVER be ignored. If you think you might be losing weight, it is important that your health professional keeps an eye on this.
YOU CAN ASK NOT TO SEE OR BE TOLD YOUR WEIGHT. YOU CAN ALSO REFUSE TO DISCUSS IT.
If so, have you explained why it is essential to weigh me, what would happen if you did not weigh me, and what my other options are (including the option of doing nothing)?
YOU CAN ASK NOT TO SEE OR BE TOLD YOUR WEIGHT. YOU CAN ALSO REFUSE TO DISCUSS IT.
When to say #NOWEIGH
There is no need to be weighed for any of the following reasons:
- A routine appointment or visit
- As part of a clinical or medication review (unless weight is needed to adjust your dose)
- Prior to a referral
- During pregnancy
- Because the “computer is asking for a weight”
- As part of lifestyle modification
- Because the doctor or other health professional says so
Focusing on weight as opposed to symptoms is dangerous. Weight is not an accurate measure of health and can be deceiving. Bringing up weight in the consultation is stigmatising and usually serves no purpose (unless you are presenting with weight gain/loss which may represent an underlying medical condition that needs further assessment). Remember you can always ask for a blind weight.
Health professionals should provide equal healthcare for all. They should never discriminate against their patients and should offer you the exact same examination, investigations and treatment that they would a person in a smaller body.
Domain 4, Section 57 of GMC Good Medical Practice states that “the investigations or treatment you provide or arrange must be based on the assessment you and your patient make of their needs and priorities, and on your clinical judgement about the likely effectiveness of the treatment options. You must not refuse or delay treatment because you believe that a patient’s actions or lifestyle have contributed to their condition.”
If you are being denied treatment based on your BMI, it is up to your healthcare professional to provide reasonable proof that the treatment would be ineffective based on your weight alone. If they cannot do this, then they are failing in their duty of care to you.
Health professionals should record their work clearly, accurately and legibly. They should include everything that was discussed during the consultation and you have a right to access your medical records at any time.
Patients are always entitled to ask for a second opinion, and one should be provided in a timely manner. Patients also have the right to complain about any treatment that they have received, and can ask any member of the healthcare team to see a copy of their complaints procedure.
You can still say #NOWEIGH if...
A lot of musculoskeletal pain is put down to weight, when there is no evidence that fat itself causes pain.
Pain can be:
- Pathological – there is something physically wrong with the affected part of the body
- Functional – the body is not functioning as it should but there is no obvious underlying pathology
- Psychosomatic – the pain is very much real but is caused by the brain as opposed to the area of the body affected
Pathological causes of pain such as osteoarthritis or muscle/ligament/tendon injuries are not caused by being fat (see below). Nor will they improve with weight loss, since weight loss is unsustainable for most and has not been demonstrated to improve pain in the long term.
Functional conditions such as Fibromyalgia and Irritable Bowel Syndrome are still very poorly understood. Whilst there are studies that suggest an association with larger bodies, this could be due to a number of reasons including inflammation/allostatic load as a result of chronic stress and internalized weight stigma.
Our mind and bodies are very much linked together. In fact, the word “mind” actually refers to brain function and there are a number of studies that link pain to our mood and a history of previous trauma. Any pain management plan that ignores the emotional/psychological and social components of pain is failing to consider two extremely important components and most likely setting an individual up for failure.
Weight stigma, intentional weight loss, and weight cycling all have profoundly negative impact on a person’s emotional and social well being. It is therefore almost certainly the case that intentional weight loss causes more harm than it does good when it comes to pain management.
For further information on weight-inclusive management of joint pain, you can visit the HAES health sheets library or watch this webinar by Dr Asher Larmie, the Fat Doctor. You can also download this letter for your healthcare team that explains why you have chosen to say #NOWEIGH.
Polycystic Ovary Syndrome (PCOS) is a metabolic condition that includes any combination of hyperandrogenism, ovulation disorders, and the presence of multiple cysts within the ovaries.
Hyperandrogenism refers to the overproduction of male sex hormones (testosterone, androsterone and androstenedione) in a person with ovaries. This can lead to symptoms such as hirsutism and acne. It can also cause irregular or absent periods (oligomenorrhoea or amenorrhoea).
We do not know what causes PCOS. Theories include a combination of genetics, experiences in utero (prior to birth) or just after birth, and possibly low birth weight. However, we do know that PCOS usually manifests itself around the time of puberty, and that it is linked to insulin resistance.
Insulin resistance causes weight gain (see section on diabetes). It is therefore almost impossible for people with larger bodies and PCOS to lose weight. Furthermore, weight loss is unsustainable for the vast majority of people and weight cycling can worsen insulin resistance. So even though most guidelines recommend weight loss to reduce symptoms of PCOS, there is no evidence that this is effective in the long term.
Instead, treatment should focus on managing symptoms and reducing the risk of long term complications. People with reduced or absent periods should be prescribed either the Combined Contraceptive Pill, a cyclical course of the Progesterone Only Pill or have an IUS fitted to reduce the risk of endometrial cancer (people with PCOS have a higher risk of cancer of the womb if they aren’t treated).
Insulin resistance can be treated with medication, such as Metformin, and people with PCOS should be offered regular screening for diabetes and other associated conditions irrespective of size.
For more information on weight-inclusive management of PCOS, you can visit HAES health sheets or watch this webinar by Dr Asher Larmie, the Fat Doctor. You can also download this letter for your healthcare team that explains why you have chosen to say #NOWEIGH.
Osteoarthritis (OA) is a degenerative joint disease that affects more than 25% of the adult population. According to NICE, OA is “a disorder of synovial joints which occurs when damage triggers repair processes leading to structural changes within a joint.”
Nobody knows why these repair processes may alleviate symptoms in some people, but in others they cannot fully compensate for the joint damage, and symptoms of pain and stiffness then occur.
We do know that OA has a genetic predisposition, and is associated with ageing, chronic inflammation, sports injuries, and “ob*sity”. However none of these have been demonstrated to cause OA. Furthermore, the inflammation seen in people with larger bodies that is thought to account for the association with OA could be explained by weight stigma and/or weight cycling.
Many people argue that OA is caused by “excess force” on the joints. If that were the case, Lebron James would have severe joint space narrowing! Running increases the force on our knee joints between 4-8 times the amount we sustain when standing, but running does not cause OA.
The critics claim that this is because people in larger bodies carry their weight with them all the time, but those who exercise take breaks in between. Since we all spend the majority of our day either sitting or supine, this theory does not hold water either.
Most experts believe that the association between OA and larger bodies is due to chronic inflammation. However, we do not know what causes increased inflammation in larger bodies. It would be perfectly reasonable to argue that weight stigma, weight cycling, and weigh-based oppression are responsible for this association.
Weight loss is often the first thing recommended to people with arthritis with larger bodies. However, the evidence suggests that whilst skeletal muscle mass is associated with joint space width, there is no consistent association between joint space width and fat mass/BMI.
Since intentional weight loss inevitably leads to skeletal muscle mass loss, this can negatively impact joint space and worsen symptoms. Treatment should therefore focus on muscle strengthening and addressing the psychological and social factors that could be impacting pain.
For information on weight-inclusive management of Osteoarthritis you can visit HAES health sheets or watch this webinar by Dr Asher Larmie, the Fat Doctor. You can also download this letter for your healthcare team that explains why you have chosen to say #NOWEIGH.
Please visit Fat Positive Fertility for more information.
Please visit Body Happy Org for further information
Please note that this section will be continually updated and added to over time. If you have a particular condition that you would like Dr Asher Larmie to cover, please fill in the contact form and don’t forget to check the HAES Health Sheets Library.
