To weigh or not to weigh. What is most likely to protect you against excess weight?

Women tend to gain weight during their 40s, which increases the risk of obesity and related conditions like hypertension, diabetes, heart disease, stroke, and certain cancers.

That’s the reasoning behind new recommendations from a federally-backed group of OB-GYNs, family physicians, and other healthcare professionals. They urge doctors to counsel patients aged 40 to 60 who are normal weight or overweight on ways to prevent obesity.

Not everyone likes to be weighed. Some patients and healthcare professionals are concerned that overemphasis on a woman’s weight could lead to harmful effects, including anxiety, stress, weight stigma, avoidance of doctor visits, and even the development of eating disorders.

Some patients may go to great lengths to lose weight or prevent weight gain, said psychologist Christine Peat, director of the National Center of Excellence for Eating Disorders at the University of North Carolina at Chapel. Hill.

“Sometimes they end up resorting to behaviors that are actually eating disorders or things that can be very risky,” Peat said. These include restricting calories to dangerously low levels, inducing vomiting, and overusing laxatives or diet pills.

The recommendations, published in August in the Annals of Internal Medicine, were developed by the Women’s Preventive Services Initiative, a national coalition of healthcare professionals and patient representatives. The group, which advises the federal government, said middle-aged women gain an average of about 1.5 pounds a year due to factors including aging, physical inactivity and hormonal changes of menopause.

Primary care physicians are advised to talk to women between the ages of 40 and 60 who have a normal or overweight body mass index or BMI about maintaining or limiting their weight to prevent obesity. BMI takes weight and height into account.

A normal BMI is 18.5 to 24.9, an overweight BMI is 25 to 29.9, and an obese BMI is 30 and above.

Dr Kimberly Gregory, co-author of the recommendations, said BMI can be calculated for middle-aged women when they are weighed as part of their wellness care.

Although she has never seen a patient refuse to be weighed, she said patients always have the right to refuse.

“I think I would take this as an opportunity to understand why,” she said. “Does she have any concerns about her weight or her eating habits? [I would] emphasize the importance of healthy eating and exercise.

The goal is to try to avoid serious illness, not to upset women about their weight, said Gregory, professor of obstetrics and gynecology and vice president of Women’s Healthcare Quality and Performance Improvement at Cedars. -Sinai Medical Center in Los Angeles.

More than 70% of American women between the ages of 40 and 60 are overweight or obese, she said, and the group wants to make sure women are aware of the risks.

“I understand that sometimes we are uncomfortable or embarrassed [being weighed]but we can’t change or improve things we don’t measure,” Gregory said.

Not just a number on a scale

A former nurse turned writer, Monica Romano, 55, of Bellingham, Washington, knows that sometimes weight checks are necessary.

But as someone who considers herself overweight and is recovering from binge eating disorder, she refuses to be weighed every time she visits the doctor, as the practice can lead to anxiety and shame. .

“I don’t like it when we just focus on numbers,” said Monica Romano, who lives in Bellingham, Washington. “It’s just a measure of health.”Monique Romano

“It felt daunting for a long time and was reminiscent of old-fashioned diet culture and Weight Watchers meetings where you got weighed in front of everyone,” Romano said. “And then you’d either be celebrated for the weight loss or met with a look of indifference or no eye contact if the number didn’t change or go up. Weight doesn’t define me. It’s just a measure of health.

The guidelines state that counseling may include individualized discussions about healthy eating and physical activity during visits to healthy women and that “more intensive interventions may be used, where appropriate, and may include referrals” .

In making the recommendations, the group reviewed clinical trials of nearly 52,000 middle-aged women that compared various behavioral interventions to no intervention to prevent weight gain and obesity. Four of the five counseling trials showed “favorable weight changes”, with weight loss ranging from 1.9 to 5.5 pounds. The studies varied in their interventions, intensity, and follow-up, so the group could not determine the optimal counseling methods or the number of sessions needed.

The group noted that a study looking at the psychological effects of counseling did not find patients to be more depressed or stressed.

But Samantha Slaven-Bick, 51, a publicist in Los Angeles, said she wouldn’t appreciate such advice. She is well aware that she has gained weight over the past decade. At 5 feet, 2 inches tall and 107 pounds, she is not overweight but still weighs more than she did in her 20s and 30s.

She believes a patient’s weight can be medically important information for a doctor, but she doesn’t want to know the number when being weighed at the doctor’s office. In fact, she turns her back on the scales and isn’t interested in discussing her weight or obesity prevention.

It’s important that we don’t just look at the number on the scale or a BMI number to tell us who is healthy and who isn’t.

Christine Peat, University of North Carolina at Chapel Hill

“I’m not overweight, but I would still be triggered by this conversation and it would still hurt me,” said Slaven-Bick, who follows a healthy diet, strength training, runs 9 to 12 miles per week and cycled another 40-50. “I’m carrying about 10 pounds more than I used to, and that might not seem like a lot, but on my body, that’s definitely extra padding that I should completely starve myself out of. to get rid of me.”

Rather than focusing on an individual number, UNC’s Peat recommends doctors focus on behaviors that are modifiable and good for everyone, such as eating a variety of healthy foods, moving and getting enough sleep.

“I think it’s important that we don’t just look at the number on the scale or a BMI number to tell us who’s healthy and who’s not,” she said.

Is the BMI accurate?

BMI is a common tool for measuring obesity, but it’s not perfect. For example, it doesn’t differentiate between body fat and muscle, which is why bodybuilders may have an obese BMI even though their body fat percentage is low.

BMI figures do not necessarily correlate with good or bad health because BMI does not take into account factors that can influence health such as diet, exercise and genetics. This is why a person with an overweight BMI but a healthy lifestyle may not have any medical problems, while a person with a normal BMI may have high cholesterol or other problems.

Dr. Mary Rosser, an obstetrician-gynecologist and director of Integrated Women’s Health at Columbia University in New York, supports the new recommendations and said it’s important to discuss a healthy lifestyle with patients of all ages. .

But she wouldn’t insist on weighing a patient who didn’t want to step on the scale.

“I’ve never been punitive about it with a woman who doesn’t want to be weighed in because I know there must be something behind it,” she said. “And that’s not my goal, to make anyone feel bad.”

Instead, she says, conversations about healthy living can discuss weight in ways that patients may find less objectionable.

“You can talk about the fit of clothes and how they fit or don’t fit, and what people think of themselves, and where they think the best weight is for them,” he said. she declared.

“Don’t Weigh Me” Cards

Some doctors have started offering patients the option of using cards that say, “Please don’t weigh me unless it’s (really) medically necessary.”

The group making the cards, More-Love.org, argues that most health conditions can be treated without knowing a patient’s weight and that talking about weight as if it were a problem perpetuates weight stigma. and may cause some people to avoid doctor visits.

Many people struggle to lose weight.

Melissa Prestipino, 47, a physical therapist in Sparta, New Jersey, learned firsthand that advising to eat better and exercise more doesn’t always make the pounds melt away.

She was “stuck” at 150 pounds for years. At 5-foot-2, that put her BMI in the overweight category. Doctors told her to eat better and exercise, but she was already leading an active and healthy life. She later discovered that she had a condition called insulin resistance which was the cause.

“I went on my own personal journey with such a disheartening number and didn’t get the right healthcare until a doctor really listened to me and realized my body wasn’t doing what it was supposed to. was supposed to do,” Prestipino said. “But other practitioners kept saying, you know, eat better, eat well, thinking I’m doing something wrong because of my number.”

Now on medication for insulin resistance, she’s lost 15 pounds and has a normal-weight BMI — and she’s happy.

Prestipino wishes the number on the scale wasn’t so important to her emotionally.

“We’re sticking with the numbers, and I feel like if we hadn’t, I might not have been so upset with my weight before or so happy now just because the scales are dropping.” , she said.