President’s Message EveryBODY for CAFP Shannon Connolly, MD

president’s message

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. “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.” 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

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 Family doctors can transform our to “troubleshoot” at every step because there are no existing processes in place to ensure a clinical spaces into patient-centered experience. places of healing, Now imagine that you are also comfort, and health a person who has experienced promotion for people of all body types by changing childhood sexual trauma (because childhood sexual trauma is twice as common in people with obesity), you are a person of “ the very culture of care delivery. 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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you to join me in this work! 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. There are many opportunities to do things better. We can train our medical assistants on how and when to take a patient’s weight, and how to respond when a patient expresses discomfort at getting weighed. We can learn how to frame conversations about healthy nutrition and physical activity in ways that are confidence-promoting and harness each individual’s personal strengths. We can educate ourselves about the causes of obesity, which are often rooted in social, educational, economic, political, and environmental factors. We can explain to our staff that people who have experienced and continue to experience high levels of toxic stress are more prone to obesity than those who do not. This is perhaps why there is such a strong correlation between trauma and obesity. In my organization we also learned that we needed to systematically evaluate our physical spaces and equipment to ensure that we could accommodate any body. We realized that we needed different furniture in the waiting rooms, scales that could weigh people of any weight, gowns that fit a diversity of body types, different ways of measuring blood pressures, and different equipment for gynecological exams. We also needed to educate our staff on anticipating the needs of people with diverse body types and automatically adjust to accommodate them in a way that does not call attention to their bodies.

Perhaps most importantly, we learned that almost every day we identify a new way in which our processes and spaces are not working for our patients, and each of these “aha moments” teaches us to that we must continue to do this work because we have not yet achieved our goal. The work of the EveryBODY project makes my heart full because it is one way that we can push back against body shaming narrative that is so prevalent in our society. I believe family doctors can lead this cultural shift. We can be more compassionate in health care. We can do better by our patients and promote healthy habits in ways that empower and do not cause shame. We can change our culture to be kinder, more compassionate, and more inclusive.

UCSF Fresno Family Medicine

UCSF Fresno and CCFMG are recruiting physicians to join our teaching faculty. We have core and clinical tracks in both inpatient and outpatient settings. Our positions provide an opportunity for teaching, clinical research, and community practice. Each physician holds a faculty appointment from University of California, San Francisco at UCSF Fresno.

Located in the heart of California, Fresno County has a diversity of natural beauty and recreational opportunities. Fresno County is close to three national parks and other wilderness areas. From the cultural diversity displayed in museums, restaurants, and festivals, to recreational opportunities in the region’s numerous lakes, rivers, foothills and mountains – Fresno County has it all.

Stephanie Delgado, Physician Recruiter 559.443.2689 Stephanie.Delgado@ccfmg.org UniversityMDs.com