5 Questions With Mara Gordon, MD

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If you are a regular reader, you know about the 5 Questions With… series where we learn a bit about experts in the field. Previous interviewees include Dr. Lesley Williams, Mikey Mercedes, Aaron Flores, Dr. Gregory Dodell, Lisa Du Breuil, Dr. Asher Larmie, members of Medical Students for Size Inclusivity, Chrissy King, Jessica Jones, and Leslie Jordan Garcia.

This month’s interview is with weight inclusive physician Dr. Mara Gordon!

Tell us a bit about yourself and your work

My pronouns are she/her, and I'm a family physician and a writer based in the Philadelphia area. I practice size-inclusive medicine in my work as a clinician and I like to advocate for weight-neutral care in my work as a writer. Body acceptance, body liberation. It's interesting that I do struggle with what kind of terminology to use in the work that I do. I think because it's so multifaceted. I like body liberation because the work I do as a clinician and as an advocate and an activist is designed to help people feel at home and their bodies and feel safe in their bodies, and feel liberated in their bodies.

How did you learn first about the concept of weight-neutral or body-affirming or body liberation care?

It really started through reading. I admit that I have not always practiced medicine in this way. I trained in a model, namely the US Medical Education System, which is extremely fatphobic and very, very centered on body mass index as a really important metric in the way that we take care of patients. And it's taken me a long time to unlearn it. And honestly, I'm still unlearning it. I have a lot of work to do. And so for years, I thought that I was doing the right thing. I was taking good care of my patients by saying, oh, hey, have you thought about losing weight? Have you thought that cutting back on the Oreos might improve things for you? And I always thought, I was like, Hey, I'm here as a resource, I'm not judging you.

And it took me a long time to start to understand that that was a really, really harmful approach and also has very limited scientific basis. So what got me interested in body affirming care as a clinician was reading the work of fat authors, fat memoirs, nothing medical honestly, by Roxanne Gay, Lindy West, and Kiese Laymon were the first ones that really got me interested in this. And these memoirs were just  about life and fat bodies, but also interspersed were a sprinkling of healthcare experiences. And the doctors were just never the good guys. It was just negative experience, after negative experience, after negative experience. And I just started thinking, what if I'm doing something wrong? And it was a slow process. It wasn't a magical lightning bolt. And just over time I just kind of stopped talking about weight, and it was subtle.

I did start to acknowledge more that, when I brought up body size, it usually didn't go well. It didn't seem to achieve the goals that I thought it would achieve. And when I stopped doing it, people seemed to trust me more. And so it was a very gradual unglamorous process. And I think it's really important for me to acknowledge the harm that I participated in prior to my learning about size inclusive medicine, and likely that honestly, I'm still involved in some ways. I mean, there's just a lot of fatphobia in US healthcare, and I think I'm complicit in it by being a part of our healthcare system. So there's a lot to think about. So I had been thinking about this issue for years and had just subtly changed the way that I practice medicine.

And last fall in 2023, I wrote an essay for NPR about practicing medicine as a size inclusive doctor in the  new era of Ozempic, of GLP-1 agonists as you write about so eloquently very frequently in your newsletter. And it just kind of flowed forth for me. I have typically done more traditional journalism and less essay writing, and I had just been jotting down notes about this transition to practicing more size inclusive medicine. And I realized I had a lot to say, and I was a little nervous when it came out that there's a lot of fatphobia on the internet as we all know. But interestingly, the response was extremely positive. People came out of the woodwork, sent me direct messages, sent me emails, saying thank you so much for saying this, and sharing fatphobic experiences that they had had in healthcare. And it made me realize that not only was it important to treat my patients with a weight-neutral approach in that sacred, quiet clinical space, but that also as an advocate and as a writer, I could really make change and be a voice from within the healthcare system to try to make our field more welcoming to people of all body sizes.

How do you you apply these concepts in your practice?

My clinical practice is a very broad-spectrum family medicine clinic. I see adults and children, and we take public insurance. So I'm not a boutique practice of people seeking out size-inclusive medicine. We really see everyone. So I think at its most basic level, when I'm talking to students, I define size-inclusive medicine as not yelling at my patients to lose weight, right? That's  the core, and everyone kind of laughs, but then they're like, wait, so other doctors do that? And I'm like, absolutely, yes. So I think at its most basic, I don't direct my patients towards weight loss. I don't bring up their body size in discussion with them with very, very few exceptions. For example, there are times when people lose a lot of weight really rapidly that I think it's important to discuss with patients.

So in general, I don't direct my patients towards weight loss. I don't bring up or discuss their body size, and honestly, I don't even usually look at their weight as listed in the chart unless it's something that the patient wants to talk about. I have a dedicated following of folks who come to me specifically because interested in size inclusive medicine and we work together to lay out the ground rules for them about why they want a doctor who doesn't bring up body size. A lot of people have a history of disordered eating. Many people have a lot of traumatic experiences in the US healthcare system and we work together to establish a framework for how they'd like to be cared for.

For some people that means not being weighed when they come to the office. For some people it means that they're weighed, but they just don't look at the number. Some people really want to be weighed and that’s totally fine. Every patient is a little bit different in the way that we negotiate the details. Now, as I said, I have a very general practice, so for every patient who comes to see me specifically for size-inclusive care, I have ten who are products of diet-culture in a society that really, really emphasizes and prizes thinness and associates thinness with health. So I have a lot of patients who want to lose weight, and it's been really challenging. It's two level work for me to figure out, well, how do I apply this framework to people who really are not divested from diet-culture?

For some people their first thought upon coming to see the doctor is, what's my weight? They associate a visit to the doctor with an audit of their body size and an audit of their overall health. And this is rampant. I mean, I teach an elective for medical students called Size Inclusive Medicine, and I taught it for the first time this spring. I was  worried that people might not want to talk about weight or body size, and I shouldn't have been afraid because the very first day, my very first student, the first five patients were there for completely unrelated issues to anything even having to do with metabolic health, period.

Somebody was there for shoulder pain, somebody was there for anxiety, and just so much emotion poured out from literally the first five patients in a row having to do with body size. Like, Hey, Dr. Gordon, am I a healthy weight? Hey, Dr. Gordon, I really feel really negative about the way I've been eating recently. What can I do? And so it was disappointing in the sense that we have a lot of work to do, but I realized that my student was going to learn so much within the first two hours of primary care clinic. This is just so ingrained for so many people that dieting and shrinking our bodies, that it's part and parcel of coming to see the doctor. So that’s challenging, and it's the majority of what I do. And I think my approach to caring for those patients with a framework of size-inclusivity and weight neutrality is to meet them where they're at, to try to ask probing, respectful questions that help dig into their anxieties about their body size, help them understand my approach, where I'm coming from, and why I think it's a more justice-oriented framework than focusing narrowly on weight.

What is one thing that you wish that people who are still working from a weight-focused paradigm, like other practitioners, for example, what do you wish they could learn or know?

Yeah, I get a lot of questions from fellow doctors, and for the most part, they have been respectfully curious. And I think that the vast majority of doctors want to do right by their patients, want to have positive, respectful relationships with their patients. And also a lot of people sense that a narrow weight-focused emphasis is harmful. And I would say lots of doctors who do not ascribe to an explicitly size-inclusive approach still sense that something's wrong. And so I think I've been heartened by a lot of conversations I've had with people who are curious about the work that I'm doing.

I think there's a lot of folks who sense that a really narrowly weight-focused approach is causing harm, but they still have not totally embraced a completely weight-neutral approach. And for those people, I'd say, try it out. See what it feels like to not bring up weight with your patients and see how your patients respond and see what kind of relationships you build, see what kind of trust you earn. And I think a lot of practitioners will be very surprised at how those relationships can shift from physician as judge and jury or physician as accountant or auditor or something to a feeling of partnership and mutual trust and respect. I'll also add, I think a lot of doctors don't understand how much harm a weight-focused approach can cause, and they haven't experienced that themselves when going to the doctor, and they haven't experienced what it feels like to remember years after the fact. An offhand comment to a teenager like “oh, have you thought about losing a little bit of weight?” can cause lifelong body dysmorphia, lifelong disordered relationship with food. And I think they don't sense how much power some of those comments can have and that they can really cause lasting harm.

Where do we find you in your work?

I'm on social media at MaraGordonMD and I have a website with a lot of my work, maragordonmd.com, and I write a Substack newsletter, which is maragordonmd.substack.com. And I'm actually working on a book about body liberation and fatphobia and medicine. So it's in the pretty early stages, but I would be thrilled if people would be interested in checking it out when the time comes.

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More research and resources:
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*Note on language: I use “fat” as a neutral descriptor as used by the fat activist community, I use “ob*se” and “overw*ight” to acknowledge that these are terms that were created to medicalize and pathologize fat bodies, with roots in racism and specifically anti-Blackness. Please read Sabrina Strings’ Fearing the Black Body – the Racial Origins of Fat Phobia and Da’Shaun Harrison’s Belly of the Beast: The Politics of Anti-Fatness as Anti-Blackness for more on this.