Refusing the Scale during Healthcare Visits: The Role of Body Image

Background: Weight stigma, or stigma associated with body size and shape, is consistently associated with healthcare avoidance among women. One of the reasons women provide for avoiding healthcare is to avoid being weighed at their healthcare visit. Given that some of the avoided healthcare visits could be lifesaving, such as in the case of avoiding cancer screenings, research in this area is warranted. The positive body image movement has promoted the idea that patients can refuse to be weighed at their healthcare visits and this is, therefore, becoming more common and well-known. The current study examines relations between body image and ever refusing to be weighed at healthcare visits.

Methods: We conducted a cross-sectional, online survey of 384 cisgender women over the age of 18 (mean age = 33 years). The women lived in the United States at the time of the survey, were recruited through social media, and were compensated with $5 for their participation. We measured body image with the Body Appreciation Scale (Tylka & Wood-Barcalow, 2015), a 10-item scale, and ever refusing to be weighed with the following item: “Have you ever refused to be weighed by a healthcare provider?” (0=no, 1=yes). We included socioeconomic status, race, age, and BMI as covariates.

Results: Using IBM SPSS 27, we tested our data for statistical assumptions and then ran descriptive analyses and a multivariate logistic regression to test our hypothesis: that better body image would be associated with being less likely to have ever refused to be weighed at a healthcare visit. Half of the respondents reported agreeing with it being okay to refuse to be weighed and almost one-third reported ever refusing to be weighed by a healthcare provider (32.3%). Body appreciation was significantly associated with ever refusing to be weighed (OR = .60, CI = 0.40,0.92) with higher body appreciation related to being less likely to have ever refused to be weighed. Socioeconomic status was the only other significant association (OR = 1.29, CI = 1.17,1.42).

Conclusions & Implications: This is the first known study to examine refusal to be weighed at healthcare visits, a recent phenomenon. The significant, inverse relationship between body appreciation and refusal to be weighed has both clinical and public health significance. If replicated in future research, this finding has the potential to lead to interventions that aim to improve body appreciation. Future research will then be needed to determine if improving body appreciation ultimately causes a decrease in the number of patients avoiding healthcare to avoid being weighed. Medical social workers, as well as public health and mental health social workers can play a role in program implementation to improve body appreciation and advocate for policy changes within healthcare systems (e.g., when and if patients need to be weighed).