Part 2: Weight, Scales and T1D

My talk of banning scales last week created quite the heated discussion on at least one social media platform. And I’m glad – because it opened the conversation.

There were many people with diabetes who felt weight monitoring was necessary for optimal health (it isn’t). There were others who felt as long as endocrinologists don’t add negative comments to the process, it’s okay to get a weight from their patients (with or without comment, the process of stepping on a scale can still elicit strong emotions). And then there were those who shared similar stories to mine of feeling crushed by the simple process of having to stand on a scale (and that’s just wrong).

So, let’s continue this conversation.

Weighing patients has been a long-standing practice of healthcare professionals across the spectrum.

Ever since I was diagnosed with type-1 diabetes, at the ripe age of nine, I’ve been subjected to regular weight measurements.

Back then, I didn’t blame the endocrinologists.

I didn’t blame the dietitians.

I didn’t blame the GPs.

It was the hospital way.

And I get it.

If you’re sick or newly diagnosed, weight fluctuations can be helpful in monitoring deterioration of health, or a body’s response to new medical regimes, or child development.

But for a healthy adult, with or without a chronic disease, I don’t agree with it.

There are so many variables to measuring weight. The process from one appointment to another is not standardized, which completely messes with the validity:

• The scale used may be different
• The person doing the weighing may be different
• The time you’re weighed is likely different
• What you ate from one appointment to another is likely different
• If you were retaining fluids
• If you had a bowel movement or not, etc., etc., etc..

All those things contribute to that number on a scale, as do so many others (see previous post).

Slowly, things are beginning to change.

There are healthcare practitioners who actively oppose weighing their patients.

I had an inspiring prof who proclaimed we throw the scales away.

I job shadowed a public health dietitian who physically cringed when we came to the room with the old-school scale in it as he toured me around the office.

“I wish we’d just get rid of that thing already,” he said.

But change is slow.

Incredibly slow.

Students learning to become healthcare professionals, including dietitians, are taught with a weight-based focus.

My first clinical nutrition course focused heavily on Body Mass Index to determine underweight, normal weight, overweight and obesity – despite BMI being a terrible predictor of health.

BMI was created by a mathematician, not a healthcare professional, to analyze populations NOT individuals.

It only considers 2 factors – weight and height², nothing else. Yet, our bodies and our health are way more than just weight and height.

So much of my clinical education had a weight focus, and I get it – we were learning about the sickest of the sick. But in populations of health, we’re transferring over those same practices and that’s not right.

Health Canada uses BMI as an indicator of health, and Diabetes Canada advocates weight loss of 5-10% for “overweight” or “obese” individuals with diabetes.

The reason: it will help with glycemic control and insulin sensitivity.

Hold up, let’s take a moment to unwrap this.

First: Rugby players, basketball players, power sprinters, football players – often have large, muscular frames and are super fit, but according to BMI many would be classified overweight. Furthermore, many non-caucasian populations don’t fit in the BMI classifications either. And just like scales, BMI does not distinguish between lean mass and fat mass.

Second: Losing weight is an outcome, not a behaviour. Working on behaviour and increasing fitness will have a way greater effect on diabetes management than putting someone on a diet.

Plus, diets just don’t work. Research shows that 95% of diets fail and oftentimes people regain more than they lost within 5 years [1].

We need to get past the weight.

We need more healthcare professionals to veer away from a weight-focused centre of care and look more at the person as a whole.

We need individuals to veer from the weight as well – and that’s hard.

Living in this thin-is-best diet culture, where we have Beyoncé promoting an essentially no-food diet and Weight Watchers encouraging kids to get on the diet wagon, continues to be the major barrier.

But we need to fight it – even if it means fighting our trusted healthcare team!

Again, repeat after me: Ban the scale. Build rapport.

References:
1. Mann, T., Tomiyama, A. J., Westling, E., Lew, A.-M., Samuels, B., & Chatman, J. (2007). Medicare’s search for effective obesity treatments: Diets are not the answer. American Psychologist, 62(3), 220–233. DOI: 10.1037/0003-066X.62.3.220