Bailey Weirens, RD, LD

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?

  I think my overall approach is led by an understanding that we live in a society that overtly harms folks in large bodies. With that, my goal is to listen and lead with compassion - given I exist in a midsize body, I will not be able to understand each experience fully, but I can hold space and validate.

  Systems work is crucial for providers, it is impossible to be fat positive and not understand the inter-workings of the systems that are meant to oppress folks. I also do not think this is a framework that I only use with folks in larger bodies, it is also educational and information I bring into all sessions with clients in a variety of bodies.

  My nutrition approach is to use an addition lens, not a restrictive lens when it comes to food changes and that is true for all clients I see.

  With children, it feels especially important to be mindful of how weight is discussed (if even appropriate at all), as the kiddos who experience a hyper-fixation on their weight by parents, providers, etc. tend to become my adolescent and adult clients. My goal is to support adequate growth and development in a fun and inclusive way, not a restrictive way.

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

  I approach care from a HAES-informed lens therefore I understand that health is complex, often misunderstood, overly simplified and cannot be tied to the basic, black + white idea that weight is the sole determinant of health. Traditional approaches like to view weight loss as a solve-all to navigating a client's presenting concerns and what I know is more times than not weight cycling is far more harmful than existing at a higher weight.

  I think that more often, environment, weight bias, stress, access to food, access to healthcare, support/community, finances, etc. impact health and those are the places that we should be starting.

• Finish this sentence: “Fat people are…” 

  people - who just like all people, deserve safe spaces, affirming care and compassionate support.

• 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 in my work aside from if billing insurance with a BMI code would improve the coverage outcomes for clients, thus reducing financial stressors. I do not do this without consent from the client, and it is an open conversation.

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

  I have conversations upon establishing care around weight monitoring and that it never needs to be black and white, should they opt into being weighed - it can be a blind weight, it can be a processing opportunity, or they can simply decline and all of those are appropriate.

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

  I'm not entirely sure this is relevant in my practice given weight loss is not a lens I counsel from. It would be difficult to not discuss nutrition given I am a dietitian, if a client did not want to discuss nutrition, I would consider referring out to a provider that may better fit their needs/goals.

  Exercise is a small part of discussions but is never a focus unless a client feels it is to them.

• 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? 

  Accommodations include nearby parking that is always available, accessible entryways, working elevators, size-inclusive lobby seating and also furniture in my office.

  I hope to get a scale with a larger base platform in the future, the current one was provided by my previous practice. The current scale weighs up to 550lbs.

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

  Walk clients back personally to my office to allow for a comfortable pace and casual conversation. Allow folks to decide where they want to sit based on comfort between the chair and couch, and provide fidgets to manage anxiety.

• 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.