p r e s i d e n t ’s m e s s a g e
Shannon Connolly, MD, CAFP President
EveryBODY for CAFP I remember presenting a patient to one of my attendings when I was a med student. I listed out her medical problems, which ranged from diabetes to hypertension, and explained my rationale for selecting each medication. The final problem I listed was obesity, and my treatment plan involved an exercise program and consultation with a dietician.
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“I’m gonna stop you right there,” my attending said. “Don’t waste your time. People who are fat don’t want to change.” Discrimination against people with larger bodies is widely acceptable in our culture. We see it in popular media, as evidenced by the trope of the “fat villain” (think of Ursula from The Little Mermaid). Thin people are perceived as more disciplined, competent, and morally superior, and this has implications for job hiring, advancement, and even salaries. Perhaps most concerning, weight stigma continues in healthcare, and medical professionals discriminate against people who have excess weight frequently. These patients are more likely to be viewed as noncompliant, lazy, unintelligent, or as my attending would have me believe, “a lost cause.”
shows an error reading because it is not able to measure a weight over 500 lbs. You are brought into an exam room, and the MA has to leave the room to get a “thigh cuff” because the large BP cuff does not fit your arm. You’re given a gown to change into, but you soon discover that it is too small and leaves your breasts exposed. Things only get worse when the physician arrives to do your pap smear. The leg rests do not support your thighs. The speculum is the wrong size and the doctor struggles to do your pap. The clinical team has to “troubleshoot” at every step because there are no existing processes in place to ensure a patient-centered experience.
Family doctors can transform our clinical spaces into places of healing, comfort, and health promotion for people of all body types by changing the very culture of care delivery.
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Imagine you are a patient arriving at your doctor’s office for a routine pap smear, and upon entering the waiting room, you discover that all the seats have armrests that make it impossible for you to fit in them, so you must stand. A medical assistant calls you to the back and then attempts to weigh you on a scale in the hallway….except the scale
Now imagine that you are also a person who has experienced childhood sexual trauma (because childhood sexual trauma is twice as common in people with obesity), you are a person of color, you have a long history of struggling with body image, and you have a mental health condition that requires that you take a medication that causes weight gain. This scenario is a nightmare. It is also the daily experience of many people living with obesity. Recently, my organization launched an initiative we call the EveryBODY Project to try to address this. We are educating our staff, examining our policies and procedures, creating physical spaces that accommodate people of all body sizes and types, and ensuring that we have the medical equipment and knowledge to take care of our patients in ways that are affirming and do not cause shame. I’m inviting
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California Family Physician Fall 2021
