Worrying About Weight Stigma at the Doctor’s Office

In medical settings, clinicians or medical assistants typically weigh patients and record blood pressure at the start of a visit. Blood pressure is an especially important measurement because chronic high blood pressure, also known as hypertension, can occur without symptoms and play a role in heart attack, stroke, and heart failure. Hypertension is caused by factors such as genetics, underlying illnesses, and diet. 

Temporary spikes in blood pressure, however, differ from hypertension and can be caused by a number of stressful experiences. Some individuals even experience temporary high blood pressure in healthcare settings, a phenomenon known as “white coat syndrome.”

Incollingo Rodriguez and her research team sought to identify whether being weighed was a specific trigger for stress and higher blood pressure. They recruited WPI students for a study that was described as an effort to examine medical appointment procedures. (Students learned about the true focus of the research after their appointments.)

The researchers furnished a campus lab to resemble a healthcare setting and wore white coats when interacting with students. Students were randomly assigned to one of three groups that differed by how and when they were weighed. Over the course of appointments, students had their blood pressure measured twice. They also provided saliva samples three times so that levels of cortisol, another measure of biological stress, could be measured as well. 

Consistent with white coat syndrome, all students had slightly elevated blood pressure at the start of their sessions. Among students who weighed themselves or were weighed by researchers early during appointments, blood pressure remained elevated, suggesting a stress response. In contrast, blood pressure dropped among those who were not weighed until after blood pressure was measured. While the weighing experience influenced blood pressure, it did not appear to have any effect on cortisol levels.

Incollingo Rodriguez said the study results raise questions about whether and when information about weight should be collected during medical appointments. The relationship between weight and health is not entirely straightforward, so it is worth considering on a case-by-case basis if a patient needs to be weighed for all medical appointments, especially if their weight is not relevant to the healthcare interaction or clinical goals, she said.

“If a patient’s weight must be documented, it might be better to weigh the patient at the end of an appointment,” Incollingo Rodriguez said. “This change-up to the typical order of operations could be especially impactful in prenatal care. Perhaps pregnant patients could be reassured by the sound of their baby’s heartbeat before having blood pressure or weight measured. These results open the door to an important conversation: Maybe we can change the healthcare experience in a way that could potentially cost nothing but meaningfully reduce patient stress, promote size inclusivity, and yield more accurate physiological measurements.”