Andrea Westby, MD

Approach to care

• What does it look like for you to provide care to patients in larger bodies? How is, or isn’t, your approach different from how you care for patients in smaller bodies? If you work with children, how is or isn’t your approach different when working with children?

  When I work with patients in larger bodies, I take extreme care to try to counter the negative messaging they have received about their bodies, habits, and health, and work to help them regain a positive relationship with food, movement, and their bodies. I take into account past experiences with health care and ensure that their symptoms are investigated appropriately.

  With children, I am very intentional about interrupting diet culture messages and helping them trust their bodies and exert their autonomy as developmentally appropriate.

• What is your perspective on how weight is or is not related to health?

  The experience of living in a larger body in our world exposes an individual to weight stigma and discrimination, and many folks in larger bodies have experienced extreme diets and weight cycling, all of which do impact health. Weight loss or gain can be an indication of a change in health status but there is no universal weight that is healthy for every person.

• Finish this sentence: “Fat people are…” 

  fully human, complex, and deserving of dignity, respect, and care.

• How do you, your clinic, and the healthcare system you work in use BMI (i.e BMI cutoffs for accessing certain services, BMI on charts and printouts, etc)? Is this flexible?

  I do not use BMI for diagnoses or treatments and I ask my staff not to request weights during the rooming process unless medically indicated (weight restoration with eating disorder management, heart or kidney failure, etc).

  My health system does prompt staff to collect weights and providers to address weights/BMI. We use Epic as an EMR and if a weight or BMI is collected/measured and documented, it does show up in a patient's MyChart and on their printout, unless we specifically use a workaround to document weight trends for medically indicated reasons but the patient doesn't want to see the number.

• If a patient declines to be weighed, how do you and/or your staff proceed?

  Normally

• If a patient declines to discuss weight loss, nutrition, and/or exercise, how do you proceed?

  I discuss the evidence-based treatments available to them for their condition and symptoms.

• What does the physical accessibility of your office space look like? What kinds of accommodations are present for people in larger bodies? Are there things you wish were in place that are currently not? 

  My office and exam rooms are on the main level (no stairs) and have wide doorways and space to accommodate mobility devices. Some chairs have arms (others do not).

  We do not currently have troncoconical blood pressure cuffs but are working on it.

• What do you do to allow fat people to feel comfortable and welcome in your office? 

  Our clinic uses a self-rooming program, where patients are able to move to the exam rooms they are assigned at their own pace. If a weight is medically indicated, our scales are located in our exam rooms so are private. I explain my weight inclusive approach early on when establishing with patients. I also wear buttons that I practice weight inclusive care.

• If you’d like to use this space to talk about any identities (gender, race, size, sexuality, etc.) you hold and how this relates to your care, please do so.