BMI surveillance is ubiquitous in medical settings and medically focused technologies. BMI is assessed at nearly every touchpoint in primary and specialty care. BMIs are often included in electronic health record work flows even when not relevant. Payors and clinic or hospital quality-improvement policies incentivize clinicians to assess, categorize, and intervene upon BMI at most encounters.
Yet, a growing body of research on weight stigma in medicine has identified routine BMI assessments as a key barrier to care for people living in larger bodies and for others experiencing weight-based shame. Studies and patient stories tell us that anticipating being weighed in medical settings leads many to delay or avoid medical care altogether, resulting in missed preventive care or worse. When patients do arrive to care, a focus on BMI can cause more problems than it resolves. Clinicians’ focus on BMI can lead to unproductive weight-related conversations that fracture the doctor-patient relationship and may introduce mistrust. This can lead to patients opting not to follow physician advice, even when that advice is not weight-focused, and not pursuing follow-up care due to faltering trust — a vital element of effective doctor-patient relationships. Additionally, misplaced BMI assessments can unnecessarily divert clinician focus to weight, an easy default but often misguided explanation for various signs and symptoms, and can result in missed diagnoses, sometimes with grave consequences.
