Is wellness optimization culture making some of us skip the doctor?

Have you ever pushed off an annual physical because you wanted to lose a few pounds first or change your eating habits in an effort to get one of your biomarkers “optimal”? If so, you aren’t alone. We are living in a culture obsessed with optimizing everything. (I’d be glad to never hear or read the word “maxxing” again.) But according to psychotherapist Jessika Fruchter, LMFT, that short-term pressure can keep us away from the care that is meant to protect us in the long run. 

This outlook is rarely something clients bring up on their own, says Fruchter. More so, it gets uncovered when she begins to explore why folks may be putting off appointments. What surfaces, almost every time, is the same fear: judgment. "It's almost always because they worry they'll be judged for their weight or BMI and/or metabolic health markers," Fruchter says. 

💡A 2018 study in Body Image backs this up, finding that weight stigma, and the shame it creates, is directly linked to women delaying or avoiding healthcare altogether.

The instinct to optimize isn't the problem on its own. It's what happens when optimizing becomes the standard we’re graded against. "This is such a big issue, and it causes a lot of anxiety, which has its own physical implications," Fruchter says. "It's one thing to be mindful of your protein, fiber, and other macronutrients, as well as sleep and movement. It's another to be tracking to the point where you feel you've succeeded or failed." 

A 2024 longitudinal study agrees, finding that mobile food-tracking apps can provoke disordered eating behavior, and a qualitative study in BJPsych Open found similar effects from diet and fitness apps more broadly. These conversations need more nuance and the ability to look at our relationships with our bodies. Ideally, we aren’t operating from a place of control but, instead, one of support and nourishment for our bodies.

If this pressure feels newly intense in your 40s and 50s, that's not a coincidence. Fruchter says midlife can absolutely make this feeling worse.

Her recommendation is to find people you trust to help you sort through it. "It's really important we build relationships with healthcare professionals we trust to get appropriate guidance that supports our unique makeups," she says.

One place to start building that trust: know what you're allowed to say no to. Fruchter's most concrete piece of advice is also her favorite to give. "You can absolutely decline being weighed, and it's something I've done myself," she says. "You can say politely (or however you please, really) 'I'd rather not be weighed.' That's it. No further explanation necessary." In her experience, that boundary is rarely challenged.

Setting this first boundary helps establish confidence for the ones that come after—the question you ask without apologizing for it, the second opinion you request, the appointment you stop putting off.

Fruchter is skeptical that a mindset reframe is what most women actually need here. "I'm not sure reframing is helpful for most people, because they already know the benefits of going for screenings," she says. What helps more, in her experience, is permission to name the anxiety out loud, to yourself and to your provider. 

Beyond that conversation, she points to a short list of supports you can try:

Research backs up two of these directly: a randomized controlled trial found that having a family member present measurably lowered patients' anxiety before a procedure, and a separate study on diaphragmatic breathing found it meaningfully reduced anxiety as well.

So what does it look like to care about your health without the guilt? Fruchter doesn't offer a formula for this on purpose. "I'll always meet clients where they are on this one and follow their lead," she says. For some, that means working directly with thoughts and behaviors, using tools like mindfulness or replacement behaviors. But when clients are open to it, she likes to go a layer deeper: exploring their relationship with their own bodies and health, and how they'd like that relationship to evolve. "Compassion and trust are almost always missing from the equation," she says.

The main takeaway this week is that we don't have to be optimized to deserve good care. If your current healthcare provider makes you feel that way, it might be time to find a new one.

The information provided about wellness and health is for general informational and educational purposes only. We are not licensed medical professionals, and the content here should not be considered medical advice. Talk to a doctor before trying any of these suggestions.