T1D: Ban the Scale, Build Rapport

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Photo by Gesina Kunkel on Unsplash

Let’s talk about scales.

Weighing scales.

This is a topic I am not a fan of at all, but it’s a topic I feel I must discuss – if only to rid the world of the so-called necessity of them, especially for the type-1 population.

I recently had an appointment with my new endocrinologist, who, for the most part, is the perfect fit for me:

  • He has type-1
  • He’s super active
  • And he’s just generally pretty freaking cool 😀

Throughout the course of this appointment, he gushed over my optimal HbA1c and my previous two-week time in range. He loved the flat lines of my readings. He was “ridiculously amazed” by my cholesterol, as well as the rest of my lab work. He beamed when I spoke of my level of physical activity.

I did inform him that my story likely would have been a whole lot different had he seen me during exam time or the one week of the month I notoriously struggle through menstruation – to which he shrugged and said “That’s okay.”

Pretty sure that was the moment I declared him my endo BFF.

But, like most BFFs, he’s not perfect and his one glaring imperfection had me leaving his office completely crushed instead of beaming.

Why?

Because as amazing as this endocrinologist is, he did something I had hoped he would be the first not to do.

He weighed me.

This is a HUGE issue for me and for a lot of others who’ve lived years with T1D.

Because I was diagnosed in the 1980s when diabetes knowledge was still fairly new in the grand scheme of things, I grew up in a life of restriction. That restriction and pressure to be the perfect diabetic had lasting effects, which I’ve previously written about. And no matter how knowledgeable I am in this area, those years of struggle still manage to find a way to rear their nasty little head.

I don’t know if that will ever go away.

Yet…

I am fit – with diabetes.

I am healthy – with diabetes.

Pretty much, I am all out awesome – with diabetes 😉

What the hell does my weight matter?

It doesn’t.

The number on a scale shows body weight at a specific time.

It doesn’t identify overall health.

It doesn’t distinguish between lean/muscle mass and fat mass.

It doesn’t show changes in body composition.

It doesn’t factor daily activity, nutrition, age, genetics, etc., etc., etc..

But what it can do is contribute to weight stigma, disordered eating, shame, yo-yo dieting, and diabetes distress – which is going to mess with diabetes management a helluva lot more than a few pounds on a scale.

It also creates a sense of judgement.

Sitting with my endo BFF, I saw the scale off to the side of the office about halfway through the appointment. As soon as I saw it, my mind started racing:

When did I last eat?

How much water did I drink before entering the office?

How much does the Omnipod and Libre attached to my body weigh?

Why didn’t I wear a lighter weight skirt or running shorts today?

I felt as soon as he saw the number on his scale his former assessment of me would be tarnished.

It likely wouldn’t, but that was the state of my mind.

Weight stigma can happen at any size and it’s linked to so many psychological and physical health outcomes that are so incredibly hard to overcome.

But by taking weight checks out of the appointment, the dynamic for the patient changes. The perceived judgement goes out the window and rapport begins to be established – so you all can be the perfect BFFs you were meant to be 😀

Repeat after me healthcare professionals: Ban the scale. Build rapport.

Related Posts:
https://katiebartel.ca/2019/08/08/eating-disorders-and-t1d/

References:
1. Goebel-Fabbri, A. (2017). Prevention and recovery from eating disorders in type-1 diabetes: injecting hope. New York, NY: Routledge Publishing.
2. Powers, M., Richter, S., Ackard, D. & Craft, C. (2016). Diabetes distress among persons with type 1 diabetes: associations with disordered eating, depression, and other psychological health concerns. The Diabetes Educator, 43(1), 105-113. https://doi.org/10.1177/0145721716680888

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