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Letter to Healthcare Providers

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Dear Healthcare Provider, 

Thank you for taking a moment to learn about size inclusive care, and for your continual commitment to improving the quality of patient care. 

We are Medical Students for Size Inclusivity, a grassroots advocacy organization dedicated to making healthcare more equitable for patients of all body shapes and sizes. Our advocacy work centers around eliminating the weight bias that patients classified as overweight and obese face every single day. This work is rooted both in patients’ and clinicians’ personal experiences of weight discrimination in healthcare, and on a body of research which demonstrates weight-bias exists in medicine. 

In short, we champion a “weight-neutral” model of healthcare, which emphasizes that there are better ways to assess patient health other than BMI, and more effective health outcomes to focus on, other than weight loss. 

We recognize that the concept of weight-neutral healthcare is relatively new, and can be contentious and controversial to some. We invite you to join us in looking at the research that has been conducted around the concept, as we, too, continue to learn and refine our approach to patient care. We know that traditionally, because high BMI has been associated with poorer health outcomes, it is considered a risk factor for increased morbidity and mortality, and something that needs to be addressed with patients. We’d like to take an opportunity to clarify some of the misconceptions that often arise around this topic:

  1. We are not saying we believe all patients who are overweight or obese are healthy. Rather, we believe that there are markers of health other than BMI that are more predictive of disease risk, and appropriate to use in clinical care. We believe that all patients, regardless of body shape and size, deserve the right to pursue health, and that weight itself is not pathological.
  1. We are not turning a blind eye to our patients’ health needs. Instead, our focus is to encourage health-promoting behaviors and lifestyle choices, without using weight loss as a primary health outcome that we measure to track progress. We believe patients can improve their health and decrease risk for morbidity and mortality, with or without effects on their weight, and have seen evidence based research to support it.  
  1. We are not simply asking physicians to avoid using the words “fat” and “obese.” The issue goes far beyond being “sensitive” around the topic of weight around our patients, or trying not to cause offense. It’s addressing the inequitable health care and biases that patients in larger bodies face. In reality, the word “fat” can be, and is, used by some individuals in a neutral or affirming manner, to describe how they choose to identify themselves. 

Just as clinicians have looked back and realized stratifying health risk based on race was inherently flawed, we hope we can also find enough compelling evidence to incite a large-scale move away from stratifying health risk based on body shape and size. In the meantime, we plan to continue studying and challenging our own biases, in an effort to better serve our patients, and warmly invite you to do so as well. 

Thank you for taking the time to read through this. We truly appreciate it. You can find more resources, including the literature that supports our work, below.


The Students of MSSI

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Our Propositions for Change

  • Do not make assumptions about a patient’s health, diet, and exercise habits based solely on their body weight/shape/BMI. 
  • Do not obtain a patient’s weight unless it is medically necessary to determine their course of treatment. 
  • Ask patients permission before discussing weight, diet, and exercise. Use language that is neutral and preferred by the patient. 
  • Prescribe health-promoting behaviors, rather than weight loss. Work in tandem with the patient to set goals that are realistic and achievable. 
  • Continually assess personal weight biases and learn, ultimately to provide more equitable care to patients in larger bodies. 

Additional resources have been compiled by Dr. Paula Freedman, Psy.D. of HumanKind Psych here, including many of the research articles motivating our advocacy work.