Bringing Weight-Inclusive Care to Health Care

In a post-op appointment, a nurse who had been working with me for 40 minutes apologized for taking so long.

What was fascinating to me is that my immediate thought before she made that comment was, “Wow, it's so nice that somebody is spending this much time with me.”

As a person in a larger body, it is a gift to spend time with a medical provider. That gift is weight-inclusive care.

What is weight-inclusive care?

Research has shown, and I have experienced, that folks in larger bodies are often dismissed by providers, rushed out, sent away with some kind of weird diet advice, thinking that the only thing that will fix what's ailing them is to drop pounds.

While practicing weight-inclusive care is a work in progress, it’s a journey worth taking. We're unraveling assumptions. We're unraveling decades, if not centuries, of assuming what a body can do and what a body needs just by its appearance, rather than looking at the internal parts of it and what's going on for people.

Elizabeth Wassenaar, MS, MD, CEDS-S, regional medical director at Eating Recovery Center, and Kaila Peak-Rishel, LCSW, LMFT, CEDS-S, clinical director of binge eating disorders at Eating Recovery and Pathlight At Home, recently connected to talk about weight-inclusive care and what it means for providers and patients. Dr. Wassenaar shares:

“Everyone should feel safe to seek health care, everyone should expect that their concerns will not be dismissed or minimized. And everyone should expect that the main treatment suggestion for any health care or consumer concern should not be weight loss. The goal is to really take care of the entire person in front of us and not make assumptions and not miss things, major diagnoses, myths, things that impact people's experience of living their best life.”

Right now, according to Dr. Wassenaar, we have a healthcare system that is focused on a weight-normative approach.

“What that means is that it focuses on the idea that there is a linear relationship between size and disease. Therefore, in a disease-based model, when we have a disease, we need to have treatment interventions. So, when we have a person who is in a larger body who has this disease of the larger body, then the advice is to not be in a larger body.”

Dr. Wassenaar explains that when patients ask for help with an ailment, from an ear infection to a sprained ankle, a treatment suggestion is provided. When people in large bodies ask for help for an ailment, the treatment suggestion is often to change the size of their body.

Weight stigma in health care

Heartbreakingly, we're seeing more national guidelines coming out advising health care providers, especially physicians, on how they should intervene for people with larger bodies. This includes collecting weight data and then making assumptions about that data as it relates to disease state -- either present or potential future disease state -- and interventions related to weight loss.

We know that when any one of us seeks care in a stigmatized environment, we can then internalize that stigma. That internalized weight stigma causes both body shame and appearance monitoring, and we know that internalized weight stigma impacts psychological and physical health.

Internalized weight stigma

Weight stigma increases the experience of feeling that your health concern is dismissed by your provider. It is a stressor that activates the nervous system and triggers counterproductive health behaviors, including lower physical activity, maladaptive eating patterns and delays in seeking health care.

Weight stigma increases the odds of experiencing blood pressure issues, glucose issues, thyroid issues, arthritis and other pain concerns, infertility and self-stigma. Shares Dr. Wassenaar:

“If your treatment environment is not size inclusive, you're sending a message that patients in larger bodies are not welcome, or will not be accommodated, reinforcing the narrative that they cannot receive care. So I think it's very important that we take a really hard look around our spaces.”

To address weight stigma and foster weight-inclusive care, health care providers can consider these questions:

• Does my space communicate that all patients and all bodies will be met without shame or discrimination?
• Is my space accessible?
• Does my furniture fit all patients?
• Is weighing done automatically, regardless of the reason the person has come in? And does it need to be?
• When is weighing necessary?
• If weighing is necessary, can it be done in a private and supportive way?
• Do I respect that my patient might not need or want to see that number?
• Have I addressed weight stigma with my staff?
• Can my staff encourage each other to be as open and weight inclusive as possible?
• Will I accept feedback from my patients on weight biases, experience and stigma from my practice?

Creating a weight-inclusive health care space

Peak-Rishel echoes the need to have weight-inclusive health care spaces, as typically “the world is not set up for people in larger bodies.”

So that means having examination tables, gowns, chairs, blood pressure cuffs and more to accommodate folks in larger bodies.

Peak-Rishel says that in a weight-inclusive care environment it is important to focus on behaviors over body weight. What are the barriers to wellness? Is the person getting enough sleep? What is their socioeconomic situation? How are they functioning at work? What’s important, she explains, is to take a holistic view of each person.

“We’re focusing more on the context and the story of the person than that one data point. There's so much politics right now around our bodies, and it's different for each person.”

This is such an important topic because weight-inclusive care means better care for folks in diverse bodies. If health practitioners are so focused on the number on the scale, they may miss issues and diagnoses. Says Peak-Rishel:

“I’ve heard so many horror stories of patients being told, you just need to lose weight and your pain or this issue can go away.”

Weight stigma can even spill into eating disorder treatment. Peak-Rishel has met folks who were told they didn’t look like they had an eating disorder -- when, of course, eating disorders flourish in all body types.

Also, weight stigma extends to folks with larger bodies thinking that they simply have an issue of willpower and weight. This contributes to the shame, suffering and idea that “I can just fix this on my own,” shares Peak-Rishel. She continues:

“There’s a delicate balance of education and validating the shame and trauma.”

In the group setting of folks with eating disorders, such as Eating Recovery At Home’s virtual intensive outpatient programs, individuals learn this is all too common of an experience and they aren’t the only ones.

In treatment, folks are supported by a multidisciplinary team to build resilience and skills in their everyday lives. For example, they practice communication and emotion regulation skills so that they feel empowered to advocate for themselves when they seek care in the future.

To hear more from Dr. Wassenaar and Peak-Rishel on weight-inclusive care, use this link and code WeightInclusivity to access their full webinar. If this is your first time using our portal, you will receive a confirmation email from ERC Pathlight Continuing Education Events with a link to log in. If you have an existing account, once you’ve completed the form, you can log directly into your account to access the webinar.

Related Reading

• What is Weight Stigma?
• Why Weight Inclusivity in Health Care Is So Important
• Our Response to the AAP Guidelines on Care for Kids in Larger Bodies
• 5 Self-Advocacy Tips for Fat Folks in Eating Disorder Recovery

Free Download: Our Kids Deserve Weight-Inclusive Care

This piece was clinically reviewed April 2023 by National Family Outreach Manager for Eating Recovery Center and Pathlight Mood & Anxiety Center, Maggie Moore, MA, LMFT, a licensed marriage and family therapist.