When Dani Donovan went for her annual physical last month, things were a little different. For one thing, she had recently started going to a new office where she felt more heard than at previous appointments. This time in the office, though, Donovan spotted something new: A stack of cards that read, "Please don't weigh me unless it's (really) medically necessary."
For Donovan, who has an eating disorder, being routinely weighed at the doctor's office had always been a "bunch of unnecessary stress," she told TODAY. "I'd heard somewhere that you could refuse or tell them that you didn't want to be weighed, but I had always felt way too intimidated to say it out loud."
But now armed with one of the cards, Donovan met with her doctor knowing that she wouldn't have to be weighed. And, because the office was already familiar with the cards, she wouldn't have to explain her preference either.
"I felt really seen and validated and grateful," she said. And, perhaps most importantly, Donovan now feels like she has a doctor she can trust and return to. She shared photos of the cards on Twitter in mid-December and the tweet went viral. It now has more than 3,600 retweets and nearly 27,000 likes.
A simple tool designed to empower and protect patients
Ginny Jones created the cards back in 2019 and estimates that this is actually the third time they've gone viral on Twitter, a testament to their enduring appeal. Individuals and providers can order the cards from her site in packs of five or 100.
"I myself recovered from an almost lifelong eating disorder. And when I did, being weighed at the doctor's office was very stressful," Jones told TODAY. "I knew that, especially among people with a history of eating disorders, being weighed is not a helpful way to begin every medical appointment."
Being preoccupied with weight is a symptom for many people with eating disorders, according to the National Eating Disorders Association. So being reminded of one's weight or being asked to step on a scale can be triggering for those in recovery.
Jones, who is also the founder of the eating disorder resource site More-Love.org, began asking not to be weighed at doctor's appointments as part of her recovery but realized that not everyone knew that was an option. "I knew I was doing this and I knew it was very stressful — but it also worked," she said. So creating the cards was really a spontaneous thing, she explained. It came from the urge to say, "I do this and you can do it too."
Weight stigma and the anxiety it creates can keep people out of doctor's offices
Whether or not someone has an eating disorder, the thought of being weighed at the doctor’s office can cause enough anxiety to keep them from getting the medical care they need and deserve. And that’s especially true among those with higher weights, who are more likely to experience weight-based stigma in medical settings.
"That's the first thing we do when we step into a doctor's office — we hop on a scale," Jeff Hunger, assistant professor in the department of psychology at Miami University, told TODAY. So rather than setting the tone of the appointment with our health behaviors, our mental health or our chronic illnesses, everything is primed with weight.
In many cases, that leads to a feeling that doctors blame far too many health problems on weight — and frequently prescribe weight loss as the ultimate blanket solution.
Although being weighed on its own isn't necessarily an instance of weight stigma, "it really does open the door for centering the conversation around weight," said Hunger, whose research focuses on the consequences of weight stigma. "If it brings to mind their weight in this specific environment, it's going to make them really concerned about you know, 'What's the doctor going to say about this number?'"
Ultimately, "that anxiety is what maybe drives people to avoid health care altogether," he continued. Down the line, that can lead to worsening health conditions and delayed diagnoses.
In Donovan’s case, she experienced chronic knee pain for more than a decade. But whenever she asked doctors about it, they would tell her she just needed to lose weight. “I’d felt so dismissed for so long because there was such a focus on that one thing, this one solution that will magically fix everything,” she said.
It was her current provider — the one with the cards — who finally diagnosed Donovan with Ehlers-Danlos syndrome, a connective tissue disorder that can cause joint pain, and referred her to a specialist. Donovan recalled crying in her car after the appointment because she finally felt listened to and validated.
Although there are some situations that require weight monitoring, like for certain medications or prior to surgery, it's certainly not necessary at every appointment, Ann Wieseler, a family nurse practitioner and Donovan's primary care provider told TODAY. Wiesler said her office started offering the cards over a year ago after being introduced to them by a therapist that her practice partners with frequently.
In her practice, every patient gets asked whether or not they want to be weighed that day — with or without the cards. If it's necessary to get their weight, the patient may have the option to turn around so they don't see the number, she said. But the key is to open up a dialogue about what the patient is and isn't comfortable with, and the cards help facilitate that.
"Patients have really appreciated it," she said. "It almost instantly creates that connection and that environment where they do feel safe (to open up about issues regarding being weighed)."
Dissociating weight and health is a positive step for overall well-being
The cards’ enduring popularity is really a sign that “so many people are avoiding going to medical appointments or feeling incredible stress and anxiety leading into medical appointments,” Jones said. “I knew this personally, but seeing the demand for these cards really tells me that we have a major issue with weight stigma in our health care system and it’s negatively impacting people’s health.”
And the cards can be a valuable tool in starting a conversation about the need to dissociate our concept of health from weight, Bracha Kopstick, a registered dietitian who frequently works with children and teens, told TODAY.
Kopstick uses these cards as well as More-Love's "Please don't talk about my child's weight" cards to start discussions with clients and their parents about unhelpful comments kids may receive regarding their weight at doctor's appointments. Because doctors carry so much authority in kids' lives, a comment about needing to eat fewer sweets, for instance, may stick in children's minds and contribute to damaging thoughts around food and bodies, Kopstick explained.
"When this conversation around weight influences how kids or teens are eating negatively and problematically, that really shows me how risky it is to talk about weight, or even to take the (child's) weight necessarily," she said. Instead, she prefers to focus on helping her clients develop health-promoting behaviors such as eating a variety of foods, finding forms of movement they enjoy, managing stress effectively and getting quality sleep — without emphasizing weight.
"We've been really trained to believe that our weight and our health are the same thing, and by losing weight we can improve our health," she explained. "So I think we really need to have a conversation about what is health and what is weight, but being very clear that they're not the same thing."
Seemingly small choices can make medical settings more welcoming places — for everyone
In so many cases, being weighed at every appointment is simply what Jones calls a "medical ritual." And "if that is causing stress, then we don't have to follow the ritual just for the sake of ritual," she said. "Nobody has needed my weight since I've started not being weighed. It has not actually been a problem."
Donovan echoed that sentiment: “They tell you to do it and you do it. And you’ve done it for so many years that you don’t necessarily stop to question it — even if it makes you feel bad.”
The goal is not necessarily for no one to be weighed ever, Jones said. It's about understanding that what's considered a routine event at a doctor's appointment can actually cause harm. Allowing patients to request not to be weighed or to even opt into being weighed (rather than opting out), like in Wieseler's office, is one small but impactful way to make doctor's offices more inclusive and welcoming spaces for people in all bodies.
Other things providers can do include making sure the seating in the waiting room accommodates a range of body sizes (with and without armrests, for instance), having a variety of sizes of blood pressure cuffs available and stocking gowns for larger body sizes, Krista Handfield, director of size-inclusive health care at Thundermist Health Center in Rhode Island, told TODAY.
"It's very much about what kinds of visual clues and physical clues are happening that make people know when they walk in that their body was considered," Handfield said. These signals make it more likely that people feel welcome — and more likely that they'll come back.
Practitioners may not even realize what an impact these simple changes can have on their patients. But Handfield said that it’s a surprisingly great way to build the kind of honest, trusting rapport doctors are looking to develop with patients.
Even a tool as simple as the "Please don't weigh me" cards can stimulate a discussion about the impact of weight stigma in a patient's life that may "really be a game-changer for how a person understands or cares for their health," Handfield said.
"It's just advocating for the patient to help them feel comfortable," Wieseler said. "Because you should feel comfortable at the doctor's office."