Steps for Practitioners to Advocate for Higher-Weight Patients/Clients

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I often get asked by practitioners what they can do to become better providers and advocates for their higher-weight clients. I conceptualize this as a four-step progression.

Level 1: Fat people are humans and deserve respect and healthcare

This is where it starts. If you are still struggling with this idea, if you still think that it might be reasonable for fat people to have to become thin(ner) before they deserve full access healthcare (and research and lived experience tell us that you are definitely not alone,) then it’s time to do some work to unpack and dismantle your own weight stigma and bias. Make sure that you are working with reputable anti-stigma providers and not folks from the diet industry who are co-opting the weight stigma conversation to sell weight loss!

Level 2: Using the information and tools that we have to help me care for higher-weight patients/clients

This stage is about examining the evidence for the weight loss vs weight-neutral paradigm. It’s about admitting that pathologizing higher-weight bodies, making weight a proxy for health and focusing on weight loss as healthcare has absolutely failed and, in fact, done tremendous harm. It’s about shifting to a weight-neutral paradigm that seeks to support patients/clients in the bodies they have. You can find an evidence bank to explore this here.

It’s also about looking around to find  out how you can better accommodate higher-weight patients right now, using any power/privilege/leverage you have, and then starting to make plans and gather allies for bigger changes. There is a guide for creating a size-inclusive healthcare office here.

Level 3: What don’t I know about or have access to in order to care for my higher-weight patients/clients?

This is what I mean when I talk about the difference between weight -neutral and weight-inclusive care.  Moving to a paradigm that seeks to support the health of fat people rather than trying to make them thin is something that is largely achievable now. To be truly weight inclusive will take a lot more time and work. At level three, it’s about realizing everything that we don’t have in terms of caring for higher-weight clients/patients.

It requires an understanding of how much of the research that forms the basis of things like medical/surgical best practices, medication dosing, durable medical equipment creation etc. is based on thin bodies. Currently what we have is a healthcare system that was made for thin people and excludes (and is sometimes hostile toward) fat people. Fixing that requires a commitment to change, requires research that comes from a perspective of supporting the health of fat people rather than trying to eradicate existing fat people and prevent more from existing, and it requires creating (and purchasing!) tools that support higher-weight bodies. This level is about a commitment to creating a healthcare system that is equally accessible to people of all sizes, and realizing that there is also similar work to be done around those with other marginalized, and with multiple marginalized, identities.

At this level you are proactively identifying ways that your higher-weight patients/clients are not having the same experience as your thinner patients.

Level 4: Advocacy

At this level you are actively advocating, using whatever power/privilege/leverage/resources that you have to move to a weight-neutral, and eventually weight-inclusive paradigm. You are continuing to do your own work to dismantle your weight bias, as well as working to make systemic change. You are centering the voices of higher-weight people, and those with less privilege than you have.

There is no shame with where you are on this ladder, we all started somewhere. But keep in mind that the lives and quality of life of your higher-weight patients depend on you doing the work to advance through the steps.

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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 Belly of the Beast: The Politics of Anti-Fatness as Anti-Blackness for more on this.