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Practical Strategies for Creating Health Care Environments That Welcome Patients of all Shapes and Sizes


Health care providers need to be conscious of the environment they create for patients with obesity or overweight, obesity medicine expert Ethan Lazarus, MD, explains.



Health care providers, whether they work from an office, a clinic, or a hospital, should seek to provide compassionate care for all patients and visitors. This includes creating spaces that are physically comfortable and emotionally welcoming for people of all shapes and sizes. From office furnishings and medical equipment to the attitudes and language used by office staff, health care providers need to be conscious of the environment they create for patients with obesity or overweight.

The comfort and care of people with a higher body mass index (BMI) should be taken into account when practitioners choose their office furnishings and equipment. For instance, waiting room chairs often are not designed for people of higher weights and standard blood pressure cuffs can give inaccurate readings if they do not fit properly on a patient’s arm. And one especially distressing and embarrassing experience for larger patients is when their hospital gown does not cover them appropriately.

These are examples of indignities that people with obesity often face when they enter a health care provider’s office. Not only are the experiences painful and disrespectful, but they can also have a harmful impact on patient outcomes. When patients feel unwelcome, they are more likely to skip follow-up appointments or even stop reaching out for medical attention. Patients who feel physically uncomfortable may seek out providers with more weight-friendly environments.

What are some common mistakes that providers make when it comes to the language they use?

The emotional welcome that patients experience in a health care environment can have a significant impact. First, we need to stop calling people "obese." People have diseases but they should not be defined by those diseases. Using person-first language—a person with obesity, for example—is strongly recommended to avoid alienating the patient.

Further, obesity itself is a stigmatizing term. Instead of focusing on obesity, providers should consider basing weight-related discussions on the risks associated with higher BMIs and the goal of lowering those health risks. This language is less likely to embarrass the patient and thus, may be more likely to encourage the desired changes.

Many health care providers also instruct a patient to lose weight without giving them practical help and support on this journey. Comprehensive obesity treatment calls for intensive lifestyle intervention, structured nutritional intervention, structured physical activity prescriptions, and medical management.

If these tools are not all being offered, the patient is not receiving proper evidence-based treatment. Simply telling a patient to lose weight is as unhelpful as telling the patient with depression to "think happy thoughts."

Practical options for creating positive health care environments for all patients

Here are some practical suggestions for creating physical spaces that welcome all patients, including those with higher BMIs.

  • Ensure office and waiting room furniture comfortably accommodates larger people and that there is sufficient clearance to move around easily.
  • Weigh patients in a private setting, not in a hallway or waiting room.
  • Have a scale that goes up to 600 lbs in order to accommodate higher BMI patients.
  • Use blood pressure cuffs and exam tables that are sized and rated for larger patients.
  • Have appropriately sized gowns for the patients you treat and the procedures you perform.
  • Make sure all staff members eliminate any disrespectful comments about weight and that they receive training in using people-first language.
Is there specific technology providers should leverage to make the patient experience more welcoming?

Using a body composition scale provides patients with much more helpful information than simply their weight. These smart scales send an imperceptible current through the patient’s body to generate a bioelectrical impedance analysis. Muscle, fat, bone, and water all conduct electricity at different rates. These rates of resistance are measured by the scale and processed along with data about gender and age to calculate fat and fat-free weight, skeletal muscle, and visceral fat.

Practitioners can also consider providing patients with easy-to-use online reports that they can use to graph their weight loss progress, improvements in body composition numbers, and nutritional and exercise goals.

Finally, consider offering patients virtual visits via phone or video in a HIPAA-compliant portal. These have been especially helpful tools during the pandemic, but they also make it easier for patients to access health care from home at any time.

Whether from home or in a health care location, the goal for providers should be to create the most effective and welcoming experience for all patients.

Dr Ethan Lazarus has practiced full-time obesity medicine since 2004. He has served on the Board of the Obesity Medicine Association since 2013, and also serves as the association’s delegate in the American Medical Association, where he played a pivotal role in the AMA’s historic decision to recognize obesity as a disease. Dr Lazarus is a highly sought-after speaker on a national level and has provided CME lectures at OMA, AMA, AAPA, OAC, TOS, Dannemiller, and many other organizations. His areas of expertise include current concepts in obesity medicine, practical pharmacotherapy, pre-packaged treatment plans, nutrition, and more.

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