Discover The Chief Complaint about Providing Weight-Centric Diabetes Care
This eye-opening interview with weight-inclusive primary care provider Mara Gordon, MD, provides clear steps to understand why higher-weight clients dread most medical visits.
This month, I had the pleasure of interviewing Mara Gordon, MD, for the Voices of Inclusion section of the Inclusive Diabetes Care newsletter. I “met” Mara after reading an article she wrote on Substack. She is a family physician and an accomplished writer whose work has appeared on NPR, in the New York Times, the Atlantic, the Philadelphia Inquirer, STAT News, and elsewhere. Her newsletter, Chief Complaint, reflects on medicine, parenting, gender, and fatphobia.
Q. Inclusive Diabetes Care talks about the felt experience of belonging. Can you share some ways healthcare providers can or have made you feel like you (personally) belong?
A. “So much of my medical training and medical training in general has an underlying level of competition. For example, medical students compete with each other. This starts before they enter the training system and continues from medical school to residency. After becoming a physician, I wanted to move out of this fear-based culture.
In my current practice, I work with three other physicians and our office staff who really feel like friends and colleagues, part of a team dedicated to taking care of patients.. The familiar fears from my medical training that “I’m not as smart enough, I’m wrong, I might be caught” have healed. Feeling safe to ask for support, assistance, or guidance has been vital for me. I really feel a strong sense of belonging in my practice.
I hope that sharing the ways that my colleagues make me feel like “I belong” can help all health care providers learn to make our patients feel like they belong, too. We all need trust and psychological safety to show vulnerability. And showing vulnerability is critical to getting the kind of care that all people deserve.
Q. Ease is a basic human need, yet many don't experience it. What/How can healthcare providers and organizations do to create a sense of ease at a medical session in general or specifically for higher-weight clients with elevated blood glucose?
A. “It starts with the built environment. Having chairs and blood pressure cuffs that fit people of all body sizes. Having front desk staff and medical assistants who show empathy to patients, and are attuned to special needs that patients might have. If patients need to undress for particular types of medical appointments, having gowns or sheets that fit a range of body sizes. These are the basics.
The second key is understanding the psychological framework for patients and providers. As a weight-inclusive provider, I usually don’t initiate conversations about weight. This doesn’t mean that I refuse to talk about weight because many of my patients do want to discuss their body size. But I usually don’t bring it up because that can feel really stigmatizing and can turn the conversation away from the patient’s goals. I’ve heard so many horrible stories of patients who go in for something like a broken wrist and end up getting lectured by the doctor about their weight! That’s what my advocacy work is fighting against. I want health care to feel safe for people of all body sizes.
I also teach medical students about size-inclusive medicine, which is really fun. My students are really ahead of the curve when it comes to understanding body diversity, and they teach me so much about how the culture is changing how we can move away from diet culture in health care.
Q: Feeling seen and heard is essential in healthcare. How can a weight-inclusive provider help clients with prediabetes or diabetes feel seen and heard at a medical appointment?
A. “Here is a quote that I think summarizes this question well. “The secret to caring for the patient is caring for the patient.” Basic communication skills are a prerequisite for providing care that is welcoming to people of all body sizes. You have to listen to the patient and let them set the agenda. What do they want to accomplish? What are their goals?
In my training, I worked with a wonderful physician, who we will call Dr. M. This person was intuitively weight-inclusive, and many higher-weight clients sought her out for medical care. One day, a patient shared, “I came here because you are a Health At Every Size, HAES doctor.” Later, after the patient left, Dr. M pulled me aside and asked, “What is HAES?”
I love that story because it illustrates that at its core, size-inclusive medicine is about showing our patients respect and letting them define their own health goals. Dr. M went on to get more involved in size-inclusive medicine and now has a thriving HAES practice. However, her basic instinct was there before she learned about the specifics of the HAES approach: trust patients to be the experts on their own bodies.
Helping our patients feel seen and heard is much harder than it seems. Health care is increasingly corporate, and we physicians are under pressure to get patients in and out as quickly as we possibly can. But I’ll keep doing my best to slow down and let my patients set the agenda.
Q. If you had one wish for providers and diabetes professionals to know/realize about weight-inclusive healthcare, what would that be?
A. It is possible to provide diabetes care without focusing on our client’s weight. There are other metrics than body mass index that we can use to care for our patients, including glucose control, blood pressure, mood, and mobility. My wish is to realize that excellent care isn’t dependent on BMI. You don’t have to push having a BMI under 25 to be healthy.
Q: Could you share some insights about the inspiration behind your newsletter, The Chief Complaint? Additionally, what vision do you want readers to see after reading It?
A. I’ve always been a writer, and in medical school, I started writing professionally for outlets like the New York Times and the Atlantic, trying to understand what I was seeing in the hospital as a student. I’ve continued that process – essentially, trying to dig into some of the injustice that I witness in health care, trying to put a name to it – during a fellowship I did at National Public Radio after my medical training and in the following years as a freelance writer.
I started Chief Complaint as a way to have a little more fun with my writing, and get a little more personal. It’s a way to explore and understand the things that make me angry and frustrated, and to celebrate the things that make me feel fulfilled. Writing makes me a better doctor, and being a doctor makes me a better writer. I’m very fortunate to do both.
I’m now in the early stages of writing a book about size-inclusive medicine, and it’s amazing to have a community of readers on Substack who give me feedback, who help me understand new perspectives. I’m so grateful for everyone here.