For most of Nancy Manther’s life, there’s been a nearly-constant chatter in her brain focused on food and diet. It was an internal noise that often felt impossible to silence.
“I was what you would consider ‘normal’ weight,” Manther said, “but somehow, I took in all of these messages about weight and diets from the media, from hearing adults and other kids talk about it. It just became a thing I was always really conscious of.”
As Manther got older, she began to worry about getting weighed when she went to see her doctor for checkup. “I never wanted to get weighed there,” she said. “The older I got, the more it became an issue. I would not eat before an appointment just to make sure that my weight was as low as possible.”
Later, Manther began participating in a popular weight-loss program, losing so much weight that she was required to get a doctor’s signature to keep participating. That experience only fueled her desire to keep dieting. “Losing weight was addictive,” she said. “I was good at it.”
Then, months spent in isolation during the global pandemic caused Manther, 69, to take another look at her lifelong attitudes about food and dieting. “During Covid,” she said, “I thought, ‘If I get sick, I could get really sick,’ because I was so underweight,” she said. And because Manther wasn’t going to work, she explained, “I wasn’t comparing myself to other people. I decided my behavior wasn’t healthy and I needed help.” She enrolled in an outpatient eating disorder treatment program, where she was diagnosed with anorexia.
The program helped Manther to see the different ways her eating disorder impacted her overall health and well-being, like having elevated blood-pressure readings when she was visiting the doctor and being concerned about the numbers on the scale. Treatment also helped give her the language to explain her eating disorder — as well as the confidence required to ask for what she needed.
When Covid restrictions eased and Manther was able to go back to the doctor for a checkup, she told clinic staff that she had just completed treatment for anorexia and didn’t want to see her weight. “I stood backwards on the scale,” she said. Clinic staffers were good about accommodating this request, Manther recalled, “except when they gave me the after-visit summary, and my weight and BMI were printed right at the top.”
This experience prompted Manther to take action. She didn’t think her weight and BMI needed to be on her forms. Emboldened by her recent eating disorder treatment, she was determined to speak out. “I’ve learned so much about diet culture and everything connected to it,” Manther said. “I can’t unsee it. I can’t unlearn it. It makes me angry the way that people, especially women, are made to feel self-conscious about their body size. It’s become my crusade.”
So Manther fired off an email to Sameer Badlani, MD, executive vice president and chief strategy and digital officer at Fairview Health Services, telling him about her experience and requesting that the health system somehow adjust their policies.
“Is there some way that if a patient either requests to not be weighed or not told the information, could those details be omitted from the printout and/or online chart?” Manther wrote. “It may not seem like a big deal, but to patients struggling with weight stigma, body image issues, disordered eating and eating disorders, it’s a very big deal.”
An ‘amazing’ change
Badlani took Manther’s request seriously and pulled together teams of M Health Fairview employees to address her concern. The change happened surprisingly quickly: As of July 2024, the health system now offers patients an option to change their online medical MyChart settings to indicate that they do not want to discuss their weight during clinic visits.
Jillian Lampert, vice president of communications at The Emily Program, a Twin Cities-based eating disorder treatment and recovery program, noticed the change when she was filling out online forms for an upcoming doctor’s appointment on Fairview’s MyChart platform.
“I just tripped across it,” Lampert said. “I pulled up MyChart, and the first question was, ‘Do you want your weight and BMI included on your after-visit summary?’ I was like, ‘Wow. That’s amazing.’ One of my colleagues also noticed. She asked me, ‘Did you see the thing at Fairview?’ It’s amazing that it happened.”
Lampert, who is in recovery from an eating disorder, said many program clients say that having their weight taken or recorded at a physician’s office is an especially stressful experience. While she understands there are some situations where measuring a patient’s weight is an important part of a doctor’s diagnosis and treatment, most of the time weight or BMI is not important in patient care.
Lampert said she thinks the new policy is a win for everyone.
“To have weight or BMI not be the primary thing that shows up is a win for people. If I go in for an ankle sprain, why do you need to take my weight? It’s often not important. Once, I went to the doctor for an ear infection. The nurse said, ‘Let’s stop here and get your height and weight.’ I couldn’t see why that was important to my care.”
Stress or concern around having their weight taken and discussed causes some people to avoid going to the doctor, Lampert said. “We hear so often from our patients that they don’t go to the doctor because it is so weight focused, especially people who live in larger bodies. They end up not going anymore because so much of the conversation is about weight. I think this change will actually help more people access primary care.”
This policy shift doesn’t mean system patients will never have their weight measured and recorded by health care professionals. The new policy gives patients the opportunity to opt out of discussions focused on weight and BMI measurements, explained Kim DeRoche, MD, a family physician and M Health Fairview president and chief of primary care, but there are still some circumstances where a health care provider will need to record or discuss a patient’s weight.
For health care providers, it’s a balancing act, DeRoche said: “We wanted to be careful to make it clear that we could still collect weight information because it is an important part of many people’s medical care — and we wanted to recognize that the presentation of that information to the patient can be more stressful than it is intended to or needed to be. We wanted to balance the stress to the patient with a data point that can be important to monitor someone’s health.”
This change is an important part of building strong patient-provider relationships, DeRoche said. “In primary care, we want to be able to personalize the care patients receive while still following guidelines in evidence-based care,” she said. She added that, to her, the change feels healthy: “We can enhance the personalization of care because our intention is to be personal in how we interact with patients. Supporting patient mental health is an important part of primary care. It is part of what we do every day.”
Manther said she is pleased to see that the change she advocated for is now a normal part of the way things get done at her health provider. Not that long ago, when she went online to schedule her yearly checkup, she was pleasantly surprised. “I was filling out information online and a screen come up that asked, ‘Do you want your weight and BMI discussed at your appointment?’” she said. “You could check yes or no. I said to myself, ‘I helped make that happen.’ I was so happy.”
Andy Steiner
Andy Steiner is a Twin Cities-based writer and editor. Before becoming a full-time freelancer, she worked as senior editor at Utne Reader and editor of the Minnesota Women’s Press. Email her at [email protected].