In this issue:

• Call for Art Submissions

• NEW: The Weight Inclusive Healthcare Guide

• Interview with Dr. Christine Wood

• Evidence-Based Archives

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Call for Art Submissions

We are excited to announce a new initiative aimed at celebrating the beauty and diversity of all bodies through art. MSSI invites you to submit your creative works—whether visual art, poems, reflective stories, or any other form of expression—that capture the essence of living in and caring for diverse bodies.

Our goal is to highlight the experiences and triumphs of individuals within the body liberation movement, and the unique perspectives of medical providers dedicated to inclusive and compassionate care. This is an opportunity to showcase the beauty, strength, and resilience found in all body types, and to inspire others within our community and beyond.

Submission guidelines:

• Who can submit their art: MSSI members and advisors

• Accepted formats: Visual art (paintings, drawings, photography), poetry, short stories, personal reflections and any other creative expressions!

Selected pieces will be featured in our upcoming newsletters, shared on our social media platforms, and potentially included in a special online gallery. We believe that your art can spark important conversations and bring a deeper understanding of the importance of size inclusivity in healthcare 🙂 

Please submit your work to the Google Form below. We look forward to seeing your beautiful and powerful contributions!

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The Weight Inclusive Healthcare Guide (& Author Interview)

Check out this free resource created by the Weight Inclusive Healthcare Initiative through the Institute for Healing and Justice in Medicine!

Student Authors: Divya R. Alley, Divya Vemulapalli, Annika Ballantyne, Laurel M P Neufeld, Sophia Harris, Varsha Venkat (MD), Lenora Goodman (RDN), Ayomide Ojebuoboh (CPT)

From the Authors: This is an open access educational guide for patients, healthcare professionals and students that challenges healthcare’s weight centric approach to health created by the Weight Inclusive Healthcare Initiative through the Institute for Healing and Justice in Medicine. We explore racism and eugenics of BMI, the pathologization of size, weight stigma in healthcare, nutrition and eating disorders in a diet culture era and joyful movement. This guide is our offering to make healthcare a more just and healing place for those in larger bodies and historically marginalized people.

Q&A with co-author, Annika Ballantyne, MD Candidate, UMN Medical School Twin Cities

Tell us about yourselves and this incredible project!

We are a group of interprofessional students from across the country, representing a diverse range of backgrounds and perspectives. This 3 year project led to the development of an open access educational guide for patients, healthcare professionals, and students that challenges healthcare’s weight centric approach to health. We explore the racism and eugenics of BMI, the pathologization of size, weight stigma in healthcare, nutrition and eating disorders in a diet culture era, and joyful movement. This guide is our offering to make healthcare a more just and healing place for those in larger bodies and historically marginalized people.

What was the inspiration and driving component behind it?

Many of us that worked on this project are medical students that were alarmed by the weight-centric curriculum taught at our schools. Some of us have experienced weight bias and eating disorders ourselves and/or have witnessed the harm of fatphobia in healthcare spaces. All of these experiences drew us to this work, and we ultimately came together to create an educational tool that would serve as an introduction to the topic of weight inclusive healthcare. Our goals were to center the voices of historically marginalized groups, challenge the dehumanizing weight-centric approach to care, and re-imagine healthcare as a safe space for people of all sizes.

What was the process of creating this resource like?

We divided the project into 5 sections, as listed above. Each section had a few student authors that worked on writing the initial draft. We then had each section reviewed by a professional within the field of medicine and/or nutrition/dietetics. These reviewers gave us constructive feedback, which we then incorporated into the final draft. Finally, our amazing graphic designer and fellow medical student, Sydney Lo, added in her own drawings and art to help bring our work to life.

How do you see this guide being used?

Going forward, we hope this guide will be accessed by a wide audience including medical students, academic physicians/teachers, healthcare professionals, and even patients. Our work is accessible on the Institute for Healing and Justice in Medicine’s website. We hope through a variety of networks within the weight inclusive healthcare sphere, we can continue to disseminate this work! 

Is there anything else you’d like to say about this work?

This guide only begins to scratch the surface on the topic of weight inclusive healthcare, a field that is ever-evolving. We hope that this project will serve as a useful and accessible educational tool that fosters ongoing conversations and advocacy work on the topic of size inclusive medicine! Thank you to MSSI for their support on this project. 

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Q&A with Dr. Christine Wood

Content warning: Medicalized fatphobia, ob*sity, anti-fat language, eating disorders

Dr. Christine Wood (MD, CEDS, FAAP, CLE) is a pediatrician, Certified Eating Disorder Specialist, researcher, author, and speaker who currently oversees physician training within the eating disorder division of the Center for Discovery. Previously, she operated an independent private practice caring for children and teens with eating disorders. Dr. Wood is passionate about increasing education on eating disorders in medical training and supporting those in medicine dealing with food and body image concerns. Formerly involved in public health work on childhood obesity, she transitioned to eating disorder care when the harms of obesity messaging became apparent in her work as a pediatrician.

We had the opportunity to chat with Dr. Wood about her career and her advice on practicing weight-inclusive care as a pediatrician.

Responses have been edited for clarity and length.

Q: Can you tell us about your initial work in obesity medicine and what motivated you to transition into eating disorder care?

A: In the late 1990s, I got involved with local schools, and a lot of them asked me to speak about wellness to parents, students, and teachers. At that time, childhood obesity was headline press. Our local San Diego group was called the San Diego Childhood Obesity Initiative, and I chaired that. We were doing a lot of wellness events for schools and examining food insecurity in the community, which I really enjoyed.

In my own private practice, I also started seeing a lot of patients who were “overweight”. I put that in quotes because in my mind now, that is a very tough term. As I was going through one-on-one counseling with families and patients, I started to recognize that some of these patients really had an eating disorder. I started to recognize that the messaging was not always what was needed, especially coming from a medical office, because patients looked to us. And we’ve been saying, “your BMI is too high. You need to be X on the BMI curve, or you need to lose X amount of weight.” That was how we were trained, particularly in the early 2000s. And I started to see the fallout of that.

So I started to make a shift, and I became very involved with an organization called the International Association of Eating Disorder Professionals. I started to meet therapists, dieticians, and other professionals working in the eating disorder field, and I started seeing eating disorders everywhere, because I was asking the right questions.

It led me down a path of becoming very passionate about trying to find patients with eating disorders, because I think that in the health profession, many of these patients go under the radar. I have had many patients who swore up and down to their parents and to me, “I don’t purge.” And then we find evidence, or something comes to light, and they finally admit, yes, I purge. It turned my career in a very different direction. In 2013, I got hired to work at an eating disorder facility. It’s a residential, 6 bed facility. And I manage all the medical problems there. I’ve been doing that for 11 years. That experience has really opened my eyes to how sometimes, particularly in the health profession, we may be saying the wrong things or promoting the wrong messages to patients, and it turns them towards full blown eating disorders. I can’t tell you how many times I’ve heard a patient say, “My doctor said I needed to lose weight, and I was going to show them I could.” So they did, and they became medically unstable. I’m very passionate about trying to find the right balance in healthcare where we can promote true health and nutritional well-being for our patients, because, unfortunately, I’ve seen the extremes. That’s kind of how I landed where I am today.

Q: How do you think medical professionals can better approach conversations about weight and health without causing harm, especially in pediatrics?

A: In pediatrics, we are trained to look at that growth curve and to say, this is where we think you should be. We look at that 25th-75th percentile on the BMI curve, and we go, “That’s normal.” But if you are looking at a child, say a 5 year old, who’s always been 90th percentile on the BMI, and you say, oh, you should really be at the 50th percentile, that is a message that goes awry. That patient may have been genetically programmed to be at the 90th percentile. They may have bigger bone structure, maybe a different ethnicity, etc, etc. There’s so many factors. There could be a few exceptions, but in general, changing the BMI curve of a patient who has always been at a certain BMI is not the right approach to be taking in pediatrics.

I’m very careful when I coach parents. They ask me, “we think [our child’s] BMI is too high, what do you think?” I really try to educate them on what else is going on. What’s your child’s relationship with food? What’s the family’s relationship with food? What’s the family’s relationship to exercise? What’s the family’s relationship to their own bodies? If you have a mother who’s telling a 6 year old that she’s constantly on a diet, that 6 year old is probably going to think, “I need to look a certain way,” or “I need to be on a diet, because mommy diets all the time.” These are the kinds of damaging things that I see in the big picture. The answers to these questions are more important than what number is on the scale.

If I’m talking to a parent about a patient, and they’re worried about where their child is on the BMI curve, I will often not even discuss that in front of the patient, because I don’t want to make them feel uncomfortable. I have had parents say, “I think they weigh too much. Don’t you think they should lose weight?” I will sometimes just say, “You know, I’d rather not have that conversation right here.” I’ll call the parents after the visit if there are things that we need to straighten out, but I do not want this kiddo to feel shamed into thinking, “my mom thinks I’m overweight. Now, what’s the doctor going to say?” I really, really try to avoid that conversation in the room with a family.

Sometimes I will ask parents, “tell me what you’re worried about before your child comes in.” And I can say, okay, these are things we can discuss. This is something I should talk to you about later. It can be about many topics, not just weight. I usually try to get an opportunity to talk to the parent alone, just for a few minutes, just to see what’s on their agenda.

Q: What specific changes or improvements would you advocate for in medical education regarding eating disorders?

A: So a couple things. One is tackling weight bias in medicine, which really hurts our patients. Studies show over and over again that “dieting” is not effective. So how do we get people to be happy with where they’re at? And how do we also rid the health profession of that weight bias? It’s a big can of worms, because obviously there are health professionals who feel that there are all these medical health consequences tied to weight. I’m not going to deny that there can be. But for the most of our population, it is not in that realm. It is really just the health professional, looking at a number on the scale and saying, “This is where we think you should be.” We have to look at our own weight bias, because we look at people a certain way, and we may treat them a certain way because of what we see in front of us.

The other thing that’s really important is to get more community collaboration and knowledge to our trainees, medical students, residents, etc.

I think it would be great to have residents or medical students shadow an outpatient or residential eating disorder facility. It is very eye-opening to see how patients with eating disorders are reacting to the medical system, and to see that the reality for these patients is so different from how people who don’t have eating disorders see them.

The final thing is to just learn about existing resources in the eating disorder field. A lot of people don’t know that there are dieticians and therapists who specialize in eating disorders. If you are going into practice, you should know what the resources are in your community, because you really learn from your colleagues. When I was treating patients as an outpatient physician, I really relied on my dietitians and therapists with eating disorder expertise. This is a collaborative effort, and professionals who are interested and trained in this are a really important asset.

Q: What advice would you give to medical professionals or trainees in eating disorder recovery who are navigating a weight-centric healthcare system?

A: There was an article in Pediatric News last year about how there’s actually a high incidence of eating disorders among medical students and doctors.

I think that’s very interesting and telling, because you, as students, get educated on health and what that looks like. And maybe you think you should be a certain BMI, whatever it is. If you look at the typical medical student, trainee, or health professional, they are high achieving. They’re people-pleasers. These kinds of traits can sometimes build into an eating disorder.

There’s been a clear increase in the number of health professionals with eating disorders. And that makes a big impact. Because you think you’re okay. But malnutrition leads to brain fog, lack of concentration, lack of focus, anxiety, etc. All these stressors really start to add up. I tell people this is a serious mental health illness with even more serious medical consequences. And unfortunately, patients often don’t feel that. They come to my office and they go, “I feel fine,” or “my doctor said my labs are normal. I don’t really have a problem.” And yet these patients can be incredibly sick. I have had patients in the ICU with pericardial effusions and scans that have shown shrinkage of the brain. And these are the realities of what can happen to some individuals with eating disorders.

You need to heal yourself first. You really need to look at resources to get the help you need. Because what we know with eating disorders is that the earlier you treat it with the right level of care, the better odds you have for recovery. I screen patients all over the country who are trying to enter residential eating disorder treatment facilities, and some of the saddest reports I have read are from 50 and 60 year old people who have been dealing with this for years.

So that’s my advice. Just be real with yourself. I tell patients, if you have strep throat, you want help. You’re going to want to get the right antibiotic. And if you have an eating disorder, it’s the same thing. When families are resisting me, I tell them, “If I told you your child had cancer and you needed to go to the hospital right now and get the proper treatment, would you do that?” They would all say yes, and it is the same with eating disorders. People just don’t see it as being the same, and that has a lot to do with the lack of education about eating disorders within both our medical and local communities.

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Evidence-Based Archives

MSSI is excited to present our fifth installment of “Evidence-Based Archives,” our monthly column highlighting and summarizing seminal research in the field of size-inclusive healthcare. In this section, we hope to celebrate our scholars, empower each other with knowledge, and stock up on citations for the next time we’re called upon to justify size-inclusive healthcare in the classroom, clinic or wards! 

Content warning: Medicalized fatphobia, ob*sity, anti-fat language

Disclaimer: We use the terms “ob*sity” and “overweight” in our summaries when it is otherwise impossible to accurately describe findings from certain studies, due to the language and descriptors chosen by researchers. We acknowledge the inaccuracies and harms that these labels have perpetuated in medicine and society. Please keep your mental health in mind when reading, and feel free to reach out to us with any feedback or suggestions at any time!

This month’s highlight: 

This narrative review published in 2015 aimed to highlight the ways that weight stigma may interrupt the healthcare process and impede many healthcare providers’ goal of providing equitable high-quality care.

Some of their findings about healthcare providers include:

1) Primary care providers engage in less patient-centred communication with patients they believe are lazy, undisciplined, weak-willed, and not likely to be adherent. These are common explicitly endorsed provider stereotypes about patients in larger bodies.

2) Primary care providers are more likely to spend less time with patients in larger bodies. In one study of primary care providers randomly assigned to evaluate the records of patients who were either “ob*se” or “normal weight”, providers who evaluated patients who were “ob*se” were more likely to rate the encounter as a waste of time and indicated that they would spend 28% less time with the patient compared with those who evaluated “normal-weight” patient.

3) Physicians may over-attribute symptoms and problems to “ob*sity”. In one study involving medical students, patients with shortness of breath were more likely to receive lifestyle change recommendations if they were “ob*se” (54% vs. 13%), and more likely to receive medication to manage symptoms if they were “normal weight” (23% vs. 5%)

Some of their findings about how this impacts patients’ health include:

1) Patients who experience identity and/or stereotype threat or felt and/or enacted stigma may experience a high level of stress which can contribute to impaired ability to effectively communicate their symptoms and needs.

2) Accumulated exposure to high levels of stress has several long-term physiological health effects, including heart disease, stroke, depression and anxiety disorder.

3) Patients that perceive their body weight will be a source of embarrassment in a clinical setting are more likely to avoid care. There is evidence that women in larger bodies are less likely to seek recommended screening for some cancers

The medical community’s view of ob*sity as an avoidable or modifiable risk factor is impeding our ability to treat and prevent disease. Reviews like this one are great to keep in our back pocket next time we are challenged about the impacts of weight stigma in healthcare.

Have thoughts?
We are open to feedback and interested in the lived experiences of our MSSI members. Have you referenced this article in your clinical work, used it to guide patient counseling, or used it to communicate with your colleagues? How did it go? 

Feel free to share your stories, reflections, expertise, and advice using the link below. With your permission, we may publish reflections in future installments of this column.

If you have a favorite article you’d like us to highlight in our next installment, feel free to submit it for consideration, also by using the link below! We look forward to hearing from you.

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This newsletter was authored by Jay Liu and Sophie Lalonde-Bester, MSSI members and medical students (Stanford University and University of Alberta, respectively).