Quick Guide – Creating a Size-Accommodating Office

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During the Q&A at a recent talk at a medical conference a healthcare provider at the end said “there is so much to do, what would you suggest is a good place to start?”

There are plenty of places to start, but one that jumps to mind is in creating an accommodating office.

An accommodating office, from my perspective, is one where people of all sizes can feel comfortable and receive excellent care. Of course, accommodation goes far beyond size to include many marginalized identities. Here I’ll just be talking about size, but I want to note that there is much more to do. Here are some places to start with that.

In each of these situations, if you aren’t able to be accommodating then you should be clear about that. For example, if you utilize a specific procedure chair and it has arms that cannot be raised, know how wide the chair is and communicate it on your website and when making appointments.

Also communicate the ways in which your office IS accessible on your website and when making appointments. If you’ve done the right thing to make sure that patients of all sizes can be accommodated, then make sure that patients of all sizes KNOW about that!

Finally, if you can’t accommodate a patient, proactively create a list of facilities that can. Then:

• Apologize (even if it’s not your fault personally)

• Blame the facility, not your patients’ body (ie: “I’m so sorry, these chairs are older and don’t work for a lot of people.” NEVER “You’re too big for these chairs.”

• Provide them with the list of facilities that do accommodate them

Seating

Do you have sturdy seating that will accommodate people of all sizes?
Do you have that seating everywhere someone might need or want to sit down?

This begins in the waiting room. Having plenty of sturdy armless chairs, extra wide chairs with arms, and loveseats. There are some people (of all sizes) who do need arms, so a mix of chairs is best, especially given the tendency of thin people to take the larger chairs so that they can spread out with all of their stuff. As in a lot of size-inclusion, options that accommodate higher-weight people will also accommodate most thinner people.

The waiting room is the start, but it’s not all. Other places you may have where people need to sit include:

Vitals area – besides all the other issues with failing to have accommodating seating, sitting in a painful, too-small chair can create artificially high blood pressure readings.

Treatment rooms – this includes chairs for patients as well as their friends/family/advocates. If you work with specific procedure chairs (dental, phlebotomy, etc.) and the chairs don’t have armrests that lift and/or aren’t the widest available the goal should be to replace them as soon possible and, in the meantime see if there is an alternate option or an accommodating practice to which someone can be referred.

Check out – if it may take a while to get patients checked out, make sure that there is sturdy, accommodating seating in the checkout area.

Blood Pressure Cuffs

Make sure that you have the largest blood pressure cuffs (ideally troncoconical cuffs) in every area where blood pressure is taken. Having just one or two that people have to look around for each time they have a higher-weight patient leads to those taking blood pressure simply using a smaller cuff in order to save time. This creates many problems for the patient.

Gowns

Have the largest possible gowns. Never tell a patient to try to wear two too-small gowns at once, you can take my word for it that it doesn’t work or go ahead and try it yourself. In general, consider whether gowns are really necessary or if patients could be given the option to wear their own clothing.

These are just the basics and there is certainly much more to do. Here are more resources:

I have a full audit for creating a size-inclusive office here.

I have best practices for imaging including x-rays, MRIs and CT scans here.

Maybe you’ve asked/advocated for accommodation and someone try to derail that conversation by saying “But what about fat people’s health?” My workshop this month is about exactly that…When we argue for equality and fat civil rights, a common response is “but what about fat people’s health.” In this workshop (created based on popular request from our workshop survey!) we’ll discuss how to talk about what the research says about weight and health without compromising fat social justice and civil rights, and what to say when someone tries to derail a conversation about equal rights and treatment with “But what about fat people’s health?” There is a pay-what-you-can option and all participants will received a video of the talk and Q&A. Details and registration are here: https://danceswithfat.org/monthly-online-workshops/

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More research and resources:
https://haeshealthsheets.com/resources/

*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.