Are you looking for an honest answer to a medical question? Dr. Mara Gordon, a family physician in Camden, N.J., answers reader health questions monthly. Write us at: thrive@npr.org.
Question: I'm sick of hearing about my weight when I go to the doctor. I've heard that body mass index isn't even that helpful in determining how healthy I am, but my doctor still zones in on my BMI. What other metrics should my doctor and I be using to assess my health?
Unfortunately, it's pretty common to meet doctors who nag you about your weight.
As an anti-diet primary care doctor who takes a size-inclusive approach with my own patients, I often hear from people who feel belittled and shamed by this narrow focus on their body size.
"Every single time I would go into the doctor's office, it was: 'She's overweight,'" Jessi Rice Greenlow told me. "'You need to get her into sports. You need to reduce her food.'"
Now Greenlow is a health coach who helps families navigate weight stigma. But as a child, Greenlow said, every doctor's appointment turned into a discussion about making her smaller.
"That shaped what our home life looked like and what I was allowed to think about myself," Greenlow said.
Luckily, there are lots of other science-backed metrics you can focus on instead. In fact, BMI has some serious limitations when it comes to assessing how healthy you are.
When I work with my own primary care patients, I find that focusing on more evidence-based metrics — including blood pressure, glucose tolerance, mobility, and mood — is much less stigmatizing. And it's more scientific, too.
Here are some conversation starters you can use to nudge your doctor into having a more helpful conversation — and the key health metrics and goals I'd encourage you to focus on instead of your weight.
Know that BMI has limitations
In 2025, the Lancet published a major report on obesity, and the very first line acknowledges that BMI provides "inadequate information about health at the individual level."
BMI can be useful for tracking population-wide trends about body size, but it's often too blunt of an instrument to give you actionable information about your own well-being.
That's why in 2023, the American Medical Association passed a resolution noting that BMI has "significant limitations" when used in clinical practice.
Every day in my own clinic, for example, I care for patients who have a so-called "normal weight" who have advanced diabetes and cardiovascular disease. Then, my very next patient might be active and thriving with a BMI in the obesity range, with no evidence of heart disease or diabetes.
And weight loss isn't always positive. Someone else with a supposedly normal BMI might have lost weight because of cancer treatment.
You can skip the scale
You don't have to be weighed at every doctor's appointment. While many practices include weight as part of their routine workflow, that doesn't mean you have to do it. A polite refusal — "I'd prefer not to be weighed" — is often all it takes.
Sometimes doctors do need accurate weights to manage certain medical conditions. Chemotherapy dosing can be weight-dependent, for example, and there are heart conditions sensitive to minor fluctuations in fluid levels, which can be caught early by accurate weight measurement.
I also like to know if my patients experience a rapid weight loss or weight gain, which can be signs of underlying medical problems. For otherwise healthy people, I usually like to get an updated weight at least once a year.
Your doctor should be willing to explain why they need to measure your weight. If they really need to but you find it distressing, you can ask the medical assistant not to disclose the number.
Push for the conversation you want
If your doctor initiates a discussion about weight that doesn't feel welcome, Greenlow suggested having what she calls "pocket phrases" ready to turn the conversation towards these other health metrics and habits.
"Practice beforehand," Greenlow said. "When you go into the office blind, that can be kind of challenging, and you might freeze up."
Here are a few of the phrases she's used with doctors:
"I'm not comfortable talking about my weight every appointment."
"What else can we talk about?" or "What other tests are available that would be a success marker?"
Most doctors, I hope, would be happy to broaden the conversation beyond body size.
Focus on your health goals, not your size
When my own patients come in for a checkup, I usually like to start with this question: "What are your goals?" What it means to be "healthy" is different for every patient, so I try to take the time to explore what a full, flourishing life looks like for them.
For example, many of my patients want to add more vegetables to their diet and cut back on ultraprocessed foods. This is generally a great plan to feel good and reduce the risk of cardiometabolic disease. But for a person in recovery from an eating disorder, focusing too much on diet can be psychologically distressing. It might be healthier for that patient to take a break from worrying about food.
And your health goals can change over your lifetime. Exercise may be really challenging if you're caring for a young child, and sleep will take priority. But in the menopausal transition, exercise may be your top goal if you're looking to prevent bone loss.
Greenlow said she recently started seeing a doctor who asks her questions about her health goals and the habits she wants to work on, rather than simply telling her to lose weight.
"For somebody who thought of size as being synonymous with health … it's a new mental mindset to allow yourself to see wins away from the scale," Greenlow said. For her that includes a focus on getting better sleep so she has "stable energy throughout the day."
Here are a few key goals and habits to discuss with your doctor:
Mental health:
As I work with my patients to define their health goals, mental health is a critical component. It's often challenging for people to think about their physical wellbeing without the foundation of a positive mood.
That's why most primary care doctors screen their patients for depression. If you've been feeling down, don't hesitate to ask your doctor about treatment options. There are very good treatments for depression — therapy and medications can work wonders! — and I don't want to miss an opportunity to help my patients. Another question worth considering is how often you see the people you love, since there's a wide body of evidence that shows robust social connections can help prevent disease and early death.
Movement:
It's no secret that regular exercise is great for everything from improving your mood to protecting your bones — and even a little goes a long way! I like to reframe exercise not as punishing 3-hour gym sessions but rather as little movement "snacks" that can fit in throughout your day, things like gardening or a daily walk with a friend.
Of course, mobility can be a challenge and you shouldn't feel bad if you have mobility limitations. If that's your situation, ask your doctor about assistive devices like canes, walkers, and wheelchairs which can help people do what they want to do.
Sleep:
Sleep is the foundation of everything! It is critical for both physical and mental health. I try to check in about sleep habits and find out if my patients are struggling. If you are, ask your doctor about evidence-based treatments. Cognitive behavioral therapy for insomnia is very effective and medication-free!
Metrics to watch: glucose tolerance
I test most of my patients for signs of glucose intolerance, which can be a precursor to diabetes. That's usually done by checking a glucose test or a Hemoglobin A1C. I prefer the A1C because it can be completed without fasting, which makes it much easier for my patients to get it done.
It gives my patients and I a sense of what their blood sugar levels have been over the last few months. A diagnosis of diabetes – that's an A1C of 6.5 or above – warrants treatment right away to prevent complications. If you have an elevated A1C without being at the diabetes level (also known as pre-diabetes) that's often a good reason to focus on regular exercise. Daily walking can help prevent prediabetes from progressing to diabetes, even if you don't lose weight doing it.
Understand your cardiovascular disease risk
Understanding your risk for developing cardiovascular disease — and then reducing that risk, through diet, exercise, and medication — is a key part of wellness.
Traditionally, most primary care doctors have estimated that risk using a calculator called the Pooled Cohort Equations, commonly known to doctors as the Athersclerotic Cardiovascular Disease Risk Estimator. It looks at the factors that put patients at risk for heart disease and stroke. The American Heart Association recommends that people usually start a cholesterol medicine called a statin if their 10-year risk of a heart attack or stroke is 7.5% or above.
But now there's a new calculator in town: the PREVENT calculator, which many doctors are now turning to because it was developed using more data and can be used for younger people. Research suggests it's a better tool to estimate risk, though it hasn't yet been formally adopted by the AHA guidelines about statin use.
If your doctor recommends medication based on a risk calculator, it's worth talking to them about which calculator they used and which variables it includes.
Another tool I sometimes recommend to estimate risk of heart disease is called coronary calcium scoring, a CT scan of the heart that measures calcified plaque in the arteries of your heart. If your LDL cholesterol (the "bad cholesterol") is elevated but you don't quite meet criteria to start a medication, a coronary calcium score can help evaluate if you might benefit or not.
Stay on top of cancer screening
Make sure you're up-to-date on the cancer screening that's recommended for your age. Talk to your doctor about the specifics of your medical history and family history, but the big ones are as follows: cervical cancer for anyone with a uterus, breast cancer screening for women and colon cancer screening for most people starting at age 45.
Dr. Mara Gordon is a family physician in Camden, N.J.. She writes the Substack newsletter "Your Doctor Friend."
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