How can a doctor treat my obesity if they can't weight me?

As part of ObesityWeek 2013 new guidelines for the treatment of obesity were released. The media has stated the guidelines are encouraging doctors to "get tough", "be aggressive", "take serious action" when treating obese patients. The actual guidelines do not use such harsh language, and it is bothersome that the media puts the "let's get tough on the fatties" spin to the stories. As a patient who is obese, I believe the guidelines leave out two very important pieces to the treatment of obesity: identifying the cause of the patients' excess weight and ensuring healthcare offices can adequately access and monitor obese patients. 

Focus on the patient, not their weight.

I have always been frustrated by doctors who blamed my medical issues on my weight, yet never offered real options for losing weight. So the suggestions that doctors get serious about a patients weight and go beyond the obvious "you need to lose weight" and actually offer and prescribe nutritional counseling and activity for how to lose weight will be helpful to many patients. However, I believe dietary changes and exercise should be recommendations to ALL patients with heart disease, diabetes, high cholesterol, and high blood pressure. While excess weight can increase risk for these conditions, they are not exclusive to individuals with a high BMI.

What causes obesity?

Diagnose before offering treatment. There are many conditions and medications that can cause excess weight, doctors need to thoroughly examine the patient and address the actual cause of the obesity.

Yes, this is where I get on my Lipedema and Lymphedema soapbox. Both conditions are noticeable to the trained eye, the problem is there are not enough physicians who are trained to make a proper diagnosis. Instead, many patients, such as myself, are told to lose weight and when we do not lose weight as expected we are deemed non-compliant. And that label affects the way we are treated for all health issues. All my health vitals are normal, and should indicate that I live a somewhat healthy lifestyle, however there is still a focus my weight. For years, my weight increased while the actual cause of my weight, Lipedema, was not diagnosed and progressed to a stage further complicated by the development of Lymphedema. While the my health vitals, were normal, the Lipedema and Lymphedema was very much affecting my overall health. I developed severe cellulitis, and often required hospitalization for IV antibiotics and eventually needed a medi-port. During the hospital stays I contracted MRSA in the medi-port, that goes directly to my HEART. This greatly affected my mental and emotional health, as did the limitations on my mobility the conditions caused and the frustration of not getting any other explanation for what was happening with my legs than "it's your weight".

Accuracy is VITAL

As much as I was told the issues with my legs were because of my weight, the fact was my weight was unknown. The doctor's office did not have a scale that could weigh me, nor did she attempt to locate a scale that could. On my own, I went to a local junk yard to weigh myself. No patient should have to make the effort to get their own vital health statistic. While that was ten years ago, I find today's doctors offices are not any better equipped to care for patients with high BMIs.

In order for doctors to take obesity more seriously, they will need to have an accurate weight for patients. Currently, none of my doctors have scales to weigh me, yet, they all document the known incorrect weight. One office's scale has a 300lbs limit, but it does at least register 328ish when I step on it. So the nurse documents that as my weight, even though I tell her that is not correct, and verbally give her my weight from my home scale. Again, this isn't an issue in just ONE office, I encounter this problem is probably every doctors office I visit, expect for the bariatric surgeons office.

After the game of guess my weight, comes the torture of having my BP checked. Yet, another VITAL health statistic that is often not correctly taken nor monitored in obese patients. If the BP isn't taken correctly, it is not an accurate reading, and thus monitoring inaccurate data serves no purpose. The blood pressure cuff needs to properly fit the patient's arm. Cuffs that are too tight will give inaccurately high readings. Doctors' offices need to have large cuffs, even thigh cuffs available, and staff need to know the where the cuffs are kept so patients can have their BP taken correctly.

Also, stop relying on BP machines, they are not accurate, especially on FAT arms. Every time my blood pressure is taken with a machine, it has to inflate twice then reads high. Again, I will let the nurse know the information is not correct, yet it gets documented in my medical record. My last employer's wellness program was told I had high BP and I was put on a "plan" to reduce it", which thankfully I did rather quickly by having my regular doctor submit my REAL blood pressure, which she gets by manually taking my BP using a thigh cuff. In addition, staff should be trained on how to take a blood pressure reading on the lower part of the arm, in case no cuff is available to fit the upper arm. Also, wrist blood pressure cuffs should be utilized.

Better scales and larger BP cuffs are not expensive items for doctor offices to purchase, and yet are very important tools to properly diagnosing, monitoring and treating patients.

Have you had similar experiences with scale and BP cuffs? Or exam tables....gowns.......

I find the fact that your doctor's office doesn't have a scale that goes over 300lbs ridiculous. I've never been in an office with a scale with that low a limit.  I have had to ask for larger cuffs and gowns, but every place I've been has had them.  It's still embarrassing to ask.  The weirdest one I had was getting a vaccine in college.  There were two of us in line, and they guy ahead of me was probably only about 100lbs.  The nurse went, got the shots ready, gave him his, then turned back to me and stated that she would have to go get a different needle to make sure my shot was intramuscular and not subcutaneous.  Really?  You couldn't tell I was more than twice the other guy's weight just by looking at me?  You had to go, get the wrong needle, then announce the need to switch them out?

I do not understand why they do not have a better scale, first it is a reiteratively new hospital based physician office, the building is less than 5 years old I would say, def less than 10 years old because it was not here when I lived here 10 years ago. New office, so you'd think newer scale, and the scale is an electronic part wall mounted scale. Also, the gym to which I belong is associated with the SAME hospital and they have scales that go past 400lbs in each of the locker rooms and in the personal trainer area. So the expense can't be SO high if they...the same hospital has 3 for the gym. Also, obesity is very very common in this area, the need for over 300 lbs scale exists. I am also bothered by why they just wouldn't take MY verbal weight, it's not as if I'm trying to tell them LOWER, I am trying to give them accurate information for my medical record. Also as someone who works in healthcare admin, the new meaningful use guidelines for the electronic health records require doctors to have weight and height and BMI for patients. 

When I had my pre-op testing done, I had some real mobility problems. Fortunately, they had a staffer to push me around in a wheelchair.

They took me to the first testing station in a wheelchair, which they then took off to move someone else. When they came back to get me, they brought a wheelchair that was sized for a child---and a small child at that. (*grin*)

Now, even if they staffer hadn't read my orders to know that I was having pre-op testing for WEIGHT-LOSS SURGERY, any idiot should have been able to look at me and see that I was NOT going to fit in that wheelchair, and I said so. His reply? "Well, it's not far."

I said "So---which half of me do you want to take first?"

He went and got another wheelchair.

Oh, and another one! Pre-op, I could NEVER get a gown big enough. When I had a mammogram this summer, they gave me a gown big enough to go around me twice. It boggles the mind.

Even at my lowest weight regular gowns would be too tight on my arms, fit fine else where but arms are too sensitive. Even at my current weight the large drown me...there is no happy medium. At my mammogram this past June, it was my first, I just took the gown off completely during the test, I had my bag with shirt in the room with me so afterwards I just put it on with sweatshirt over it and walked out....didn't even hassle with the one arm out, one arm in of the gown stuff.

Hi Sarah!

Yes, I had the same issues when I went to my primary care physician when I was over 350 pounds.  Their scale only went up to 350 and I knew from my scale at home that I weighed over 360.  Also, they would use the blood pressure cuff on my forearm and I didn't feel that this took an accurate reading.  My blood pressure was super high every time they took it but at my surgeon's office, it was always much lower.

As much as an epidemic that obesity is in America, doctor's offices should be able to accommodate patients that are obese.  At least, they should have a scale that goes above 300 and a larger blood pressure cuff.  That doesn't seem like too much to ask!

I agree about the tight arm cuffs! My doctor (who had to clear me for surgery) would use a normal cuff on me and measure a ridiculously high blood pressure. She refused to clear me for surgery until I got my blood pressure under control! I ended up printing something out from the internet to TEACH her that tight arm cuffs caused inaccurate readings. I even had to buy my own blood pressure monitor with a larger cuff and take it into the office to show her that my blood pressure was not as high as she was saying it was. It was so frustrating!!!

As soon as I had surgery, I switched to a different PCP. 

We as patients should not have to go to such extremes to get proper care....BP is not that complicated and as you point out...you got your own cuff and reading at home why can't a doctor office do the same? Also they need to be aware that a cuff too big on a small arm can read too low. Accuracy is important.