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Changing Providers to Receive Weight-Inclusive Care: One Patient's Experience
Navigating both weight and diabetes stigma is exhausting. This patient story explores the decision to seek weight inclusive care.
Ann came into my office and sat down with a heavy sigh. Imagine a tall, well-educated, middle-class woman in her fifties, completely deflating, like an overused pool toy.
“What’s going on?” I inquired.
“My meter isn’t working.”
We chatted for a few minutes, reviewing the customer service number on the back of the device and determining if she wanted me to order a new meter. As the chit-chat slowed, Ann leaned over the table separating us and, in a hushed tone, offered, “I need a new provider.”
“Why?” I asked.
“My current doctor wants me to start on that celebrity weight-loss drug.” Ann continued, “This has been going on for a number of years, and I just can’t go there anymore.”
“You don’t want to talk about weight.”
“Correct. I am sick of this conversation.”
“You want a more weight-inclusive approach to your diabetes care.”
“What did you say?”
“What is that?”
As we talked, I was able to share our view of weight has a spectrum, which ranges from weight-centric to weight-inclusive, with weight neutral as the middle ground between the two views.
Ann inquired, “You mean there is another way to manage diabetes outside of continually trying to lose weight?” Without pausing, she explained the source of her frustration. “For 58 years, I have been trying, and for 58 years it hasn’t worked.”
Discover whether a weight-inclusive approach could work for you.
“So, what would I do differently?” Ann asked.
“Focus on your behaviors instead of your outcomes.”
“Like?” Her question hung in the air.
“Like taking a walk because moving your body feels good, because you want to move, not because you feel you have to change your body.”
“I am not sure I can do that.”
“Agreed. It is hard to shift your thinking from I ‘should’ walk to I ‘get to’ walk. It is easy to forget your intention to keep your body strong (it strengthens muscles and bones). Especially if for 58 years, you have believed walking wasn’t enough because you didn’t lose weight. Your skepticism is justified.”
“My therapist and I have been talking about this. She suggested I ask my doctor, ‘Is this a treatment you would prescribe to someone who has a BMI <25?’”
“It sounds like your therapist is a weight-inclusive provider,” I mused.
“What IS weight inclusive? Can you give me an example?” she asked, adjusting in her seat.
“Sure. Why do you want to monitor your blood sugar?”
“I need to know my blood sugar so I can learn,” Ann replied.
“It isn’t to lose weight.”
“No, it is to see if my diabetes plan works.”
“What is your diabetes plan?” I asked.
“Eating well, taking my medication, and exercising. You know, the stuff we talked about.”
I nodded in agreement and mentioned that those behaviors - a balanced diet, taking medication, and exercise are not attached to weight or weight loss. Additionally, her intention isn’t to stop these behaviors if her weight changes.
She said, “I have just been told these behaviors aren’t enough unless I lose weight.”
“Ouch. You are doing a lot, but your efforts have been minimized because you didn’t lose weight.”
“Yep,” she chirped.
“That would be a weight-centric perspective. A weight-inclusive perspective sees these behaviors are the foundation of diabetes care despite weight.”
“But what if I gain weight? I mean, gaining weight is bad. It makes your diabetes worse.”
I paused and let her words fully sink in before I offered, “A person’s weight changes for many reasons. Understanding why someone’s weight is changing is part of a clinical assessment. It isn’t to point the finger of blame. Are you concerned about your weight changing?”
She raised her leg to show me a walking cast.
I continued, “This injury is causing you to adjust your diabetes plan. You know that weight gain may result, but it may not. When a provider assumes it will, that feels like an expression of fatphobia.”
She looked back toward me, inviting me to continue.
“A good parallel is racism. The opposite of racism isn’t no racism. It is antiracism because we already have racist systems in place. We have to dismantle these systems to have a more just society.
If we recognize that medical care is founded in a weight-centric model, then the opposite of this isn’t to talk about weight but to fight the systems supporting fatphobic beliefs. Because these beliefs are familiar, it is hard to see them as fatphobic. It is easy to ignore them or shame people who have gained weight, reinforcing the false belief that a change in weight is a mistake.
It is common to have fatphobic beliefs. Knowing this means I must work to see my internalized fatphobia, called implicit bias.”
Ann laughed, “Yes! I read How to Be an Antiracist.”
“Good, so you are tracking what I am saying.”
“Fatphobia? It’s a type of oppression, isn’t it.”
I nodded, “Anytime we fear something it is easier for us to hate it. Fatphobia is the fear of fat people.
I paused because I knew Ann’s joke relieved deep pain. “It is easy to see that we have over-identified weight as the cause of all health problems.”
“Right – because everything from a hang nail to my foot problems is because of my size.”
“The habit of over-identification makes it almost impossible to practice self-compassion,” I explained.
“I have been hating myself sick,” Ann’s eyes focused on the floor.
“You want to find a new way to manage your diabetes?”
Ann’s head nodded in agreement, “I need to make some changes and stop my obsession with my weight. It is too exhausting.”
“You want things to be easier,” I offered.
“I am exhausted,” She surrendered.
“You are looking for a plan you can maintain.”
“What ideas are you considering?”
“I want to get a new meter. This one has kept me on track. I am also going to have to shift my exercise.”
“Right now, no,” She confessed as another sigh of frustration left her body.
“You are juggling a lot of alligators,” I reminded her.
“You can say that again!” She added, emphasizing the word ‘again.’
“Deep breath,” I instructed. Our breathing synchronized, and the tension in the room shifted.
She spoke evenly, “Monitoring. New provider. Make self-care a priority without focusing on weight.”
“What will this help you do this?”
“I am not sure, but I think just talking helped. I really appreciate you talking about weight-inclusive care. Thank you.”
“You are very welcome.”
As Ann left my room, I could feel my own anxiety enter. This client came for support to get the care she needed by changing providers. How was I going to document the session? I was trying to sort out the larger issue. Was it diabetes, monitoring, or patient-centered medical care?
Creating space for our clients to be seen and heard, to feel like they belong, to let go of unrealistic weight expectations is the dream, but it is still new for healthcare. There are a lot of questions and concerns because sessions like this don’t fit into a simple metric. There were no SMART goals to check off. Instead, I was left trying to sort out this complex, messy, and emotionally charged session.
I know Ann’s provider is a good person who cares deeply about their clients. This situation isn’t about being right or wrong, good or bad, liked or disliked. It is about listening with empathy, and that is HARD. Like Ann, healthcare professionals need support. They need time to learn, process, and understand their own thoughts and feelings about weight, body image, and diabetes.
Helpful Podcasts & Newsletters
We Should Follow a Weight-Inclusive Approach to Health Care - NCP December 2022
Weight Inclusive Innovators
Weight-Inclusive Podcast, WIND
Breaking Body Bias
Curvy Culture Podcast
No Weight Loss Required (for people with prediabetes and type 2 diabetes)
Rethinking Wellness Culture