Meg Reitmeyer, MD

On very bad on-call days, I have fantasized about giving up my medical career and finding out how to get a job developing catchy acronyms for their studies. It should therefore come as no surprise that I spontaneously invent acronyms in all areas of my life.

It should also come as no surprise that, in the middle of teaching a group diabetes education class, the term "SOD" came out of my mouth. I was discussing the role of exercise and diet and weight loss in glycemic control, and commenting on how people become so obsessed with their scales that they lose sight of the big picture. I warned the group not to become victims of "scale obsessional disorder," or "SOD."

The reality is that the scale is a poor surrogate for the overall health of a patient, yet each pound becomes a marker of victory or defeat. Patients are often more upset about their lack of weight loss since the last visit than they are about the HbA_1c of 9.5 percent or the systolic blood pressure of 150 mmHg or the LDL of 170.

ORIGINS OF SOD

Until the last decade or so, medical professionals focused on SOD in the setting of the underweight individual, but it is now rampant through all ranges of BMI. It starts at birth and runs through infancy, where mothers compete to see who has the best breast milk. If a woman cannot make enough milk to put appropriate weight on her baby, she is made to feel like a failure.

Although I rarely see a patient with full-blown anorexia or bulimia, I often see people—especially young women—who are terrified about gaining weight. Often they are cheerleaders or athletes. They have completely normal BMIs, yet they want diet pills or diuretics or the magic pill to get rid of those fantasy pounds standing between themselves and glory. They will be suspended from the team if they flunk the weigh-in, regardless of their skills and dedication to practice. How did we become a society that uses the effect of gravity on mass to define our well-being and abilities?

No one can argue against a strong connection between weight and health, but there are many overweight and mildly obese people who are otherwise quite healthy by many measures.

How did we get to this point? I believe that people are overwhelmed by the sheer volume of information they get in all areas of life, especially with regard to their bodies. The scale is a simple tool that is easy for lay people to understand. They can buy one at the store and stand on it at home. It is far easier to comprehend than the mysteries of blood-sugar testing or calorie and carbohydrate counting.

The problem with SOD is that it often becomes a self-defeating prophecy. When patients set unrealistic goals for their weight and fail to meet them, they often abandon their focus and give up on everything. They do not see that moods, glucose levels, blood pressure readings, and cholesterol can improve with diet and exercise, even in the absence of weight loss. I have lost count of my patients who have lost inches and pant/dress sizes, but who surrender to despair because they do not reach their target weight. It is frustrating to play cheerleader for these people because they cannot or will not leave their scales alone.