When students walk into the USC's Center for Health and Well-Being for an appointment, they may have to record their blood pressure, measure their height and step on a scale that shows their weight.
But since January, students can now find cards reading "please don't weigh me" waiting at each check-in station.
On the cards are two boxes students can check before handing them to a healthcare provider during their appointment — one asking for a blind weigh-in and another asking not to weigh them at all.
In January, the Center for Health and Well-being started the “please don’t weigh me” initiative at USC. The Eating Disorder Consultation Team — made up of members from the psychiatry and counseling, primary care and nursing departments — brought the idea forward, said USC dietitian Katie Graham.
Graham works within Healthy Campus Initiatives, a branch of the university's health center that includes balanced eating, STI screening and wellness coaching. She is also a member of the Eating Disorder Consultation Team within the health center.
Graham said weight bias and weight stigma can prevent people from getting the care they need.
“We found that for some students, it was an obstacle to get healthcare if they knew they were going to be weighed,” Graham said. “So that’s where we started this initiative so that we could provide body-inclusive care.”
Moving towards all-inclusive care
Weight-blind sessions are standard in eating disorder treatment and care, said Madeline Moran, a licensed professional counselor for Soda City Counseling.
Moran said that from a treatment perspective, the number on the scale can be triggering to a patient with an eating disorder.
"Whatever the number is, it brings up really big emotions about our body, about our relationship with food," Moran said.
Students could still ask their healthcare providers for blind weigh-ins or to forgo weigh-ins entirely before the "please don't weigh me" initiative, Graham said. But some students may have not felt comfortable bringing up the topic.
Graham said that by advertising optional weigh-ins, the health center can take away an obstacle to students seeking healthcare on campus.
“Then (students) can focus on what they're really here to do,” Graham said. "Maybe we're here because we have to have a medical (evaluation) related to an eating disorder and seeing that weight can be activating (for eating disorders).”
The Eating Disorder Consultation modeled the “please don’t weigh me” initiative after other universities, such as UC Davis in California, as part of a wider movement toward more inclusive campus healthcare, Graham said. Body inclusivity is one of the main goals of the Weight Stigma Collective — a group of universities, including USC, that meet to discuss body-inclusive care and how to support students across campuses.
“The goal of the group is to make sure that we're all providing body-inclusive care at campuses across the U.S.,” Graham said. “And so we kind of get together to talk about best practices, and brainstorm ideas and things like that.”
Breaking diet culture
Between 8% to 17% of college students are estimated to have eating disorders, according to the National Library of Medicine. Moran said diet culture plays a prominent role in students' eating disorders.
She said that recently society has moved away from body neutrality and body positivity movements towards a weight-loss-centered approach to healthcare. Body positivity focuses on loving all body types while body neutrality focuses on appreciating what the body can do.
"Now socially, we're kind of headed more toward — there's a lot of conversation around Ozempic ... quick weight loss, things like that," Moran said. "And I think that's really unfortunate. I think it does play into students' mental health, into really everyone's mental health."
Conversations online have highlighted the prominence of this transition from the acceptance of all bodies to diet culture, she said. Moran has seen celebrities and influencers who have previously been part of the body neutrality movement now often use weight loss medications, such as Glucagon-like peptide-1, a hunger suppressant.
"I feel like I see it kind of in general," Moran said. "At least (on) my 'for you' page and lots of different platforms, there's just a lot more talk about wanting to be in specific bodies (and) using weight-loss medications."
Psychology club President and third-year criminal justice student Brianna Christmon said she also sees social media as a perpetuator of negative body image.
“When people see things on social media (about) college (they think), 'Should I look like this?'” Christmon said. “They probably feel like, 'Oh, I shouldn't eat so I can fit in this, or be more skinny or look like a Victoria's Secret model.'”
Changing healthcare approaches
Graham said that historically the Center for Health and Well-Being has taken on a weight-loss-centered approach to improving healthcare. But recent studies have proven that most diets fail, she said.
After 12 months, most individuals gain back the weight they lost on their diet, according to the National Library of Medicine.
“We know that promoting dieting and quick, unhealthy weight-loss behaviors is not helpful,” Graham said. “So instead, that's where we switch that focus to 'Okay, what are some health behaviors that we can adopt for lifelong changes and to benefit our overall health?'”
The "please don't weigh me" initiative is representative of the Health at Every Size Approach that the health center has taken on in the last five years. Health at Every Size is an all-inclusive framework of care for eating disorder treatment, according to the Association for Size Diversity and Health — an organization that provides education on weight-centered bias and advocates for change.
“It is something that I think we're still learning more about,” Graham said. “How can we best practice that, and how it relates to promoting overall health, both for college students and everyone.”
Moran said the transition is important because health is about more than the weight, size or shape of people's bodies.
"There's so much more that plays into health and wellness," she said. "I'm glad that they're taking more kind of an overall approach to health and wellness, rather than focusing on one piece of our health and wellbeing that truly doesn't actually impact our health."
USC’s Student Nutrition Group President and third-year public health student Gabby Shupard said that there is a need for students to become more aware of such as nutritional counseling if they don't already have those resources.
Without the support and direction of their parents, it can be difficult for students to make an appointment at the health center, Shupard said.
"I think that's probably one of the main obstacles — seeking help, not just on college campuses, but everywhere," Shupard said. "College campuses specifically can be a little harder, because, like I said before, you're not at home anymore. You don't have your parents there, and you have to navigate, 'Oh, how do I make an appointment at the health center?' if you choose to do that."
Addressing the stigma
A general lack of knowledge and education about signs, symptoms and support of eating disorders leads to misconceptions about them, Moran said.
"There's not a ton of information out there about what it looks like to get help," she said. "Some of the things you read (about eating disorders) are really intimidating, or scary."
Shupard said the stigma around eating disorders may keep people from reaching out for help.
“It’s just seen as shameful and like you're not in control,” Shupard said. “And I feel like that's a lot of the idea around eating disorders like, ‘Oh, you're just not strong enough.’ Like, ‘You just do these things, and you can't stop yourself.’”
Shupard said the “please don’t weigh me” cards are a great start to supporting students with eating disorders on campus. But she would like to see more nutritional facts displayed, she said.
While it’s important to have the amount of calories available, Shupard said it could also be helpful to advertise the protein or vitamin content of the food instead.
“In my experience and the experience of others, that can be triggering,” Shupard said. “Just seeing the calories right there when you’re just trying to look at the food.”
Christmon said she’d like for the university to create a mandatory class to educate students about positivity and negate stereotypes.
“They just need to understand that (mental health) shouldn't be ignored,” Christmon said. “Because people, they think they can just ignore things, and that makes it worse.”
Moran said anyone of any size can be experiencing an eating disorder. Community support is crucial to eating disorder recovery, she said.
"If you already have a primary care doctor that you really trust, things like that, that's going to be the biggest factor in terms of somebody receiving the support that they need, is if they have that positive social support," Moran said.