Laura Lara, 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?

  I almost never use weight in my practice. If someone has a condition where we can gauge how much fluid they're holding onto based on weight AND they can't tell us they're holding water based on symptoms, I might suggest a weight. I might want a weight on an infant who isn't feeding. However, in the vast majority of cases weight is not useful to me and does not tell me about health. For adults, I don't use weight or BMI except in a rare circumstance in which I also have the patient's permission, and for children, I spend my time talking about being active, eating veggies, and being happy. I don't talk about weight unless there was concern about a big, sudden, unexplained change and even then I want to know why, the weight itself doesn't matter.

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

  Folks in larger bodies experience significant stigma and discrimination from society and healthcare professionals because of their weight, which can affect health, and folks in larger bodies also frequently have necessary care delayed or denied while they "work on losing weight." For those reasons, sometimes people in larger bodies do have health complications related to weight, but they are because of how the patients are TREATED based on their weight, not because of the weight itself.

• Finish this sentence: “Fat people are…” 

  Normal.

• 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?

  We certainly deal with specialists who use BMI cutoffs, and we have to try to find ways for people to get adequate care despite that. In the clinic, each provider functions independently, so I am free to follow weight neutral principles when I have a patient seeking that care. I try to erase any reference to BMI on the patient chart, whether they can see that info or not.

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

  We just say okay and move on. In fact, our rooming staff always asks "would you LIKE a weight?" and if someone is known to be a patient who comes here for weight neutral care, we don't ask at all.

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

  I follow the principles of bodily autonomy. I'm like the electrician you call when you have a wiring problem, you don't HAVE to do what they say, you just hire them for their specialized training. We won't talk about anything the patient doesn't want to talk about unless I'm VERY worried about something.

• 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? 

  We have sufficient seating that is wider, including the toilets in our hospital, and larger wheelchairs available. I would like ALL of the seating and toilets to be appropriate for larger body sizes, and that may be something we can arrange in the future.

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

  I make sure my staff all know what weight neutral care is and when I want the principles applied (which is always unless a patient specifically wants to address weight, and we do that with a THOROUGH discussion of my knowledge on the subject). I also have positive messaging in my exam rooms, such as "all bodies are good bodies" to give folks an idea of how their provider is when they walk into the room. I make sure there is wider seating available WITHOUT the patient having to ask for it, and I work to educate other providers about this type of medicine and why it helps our patients.

• 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. 

  I'm a middle-aged cisgender heterosexual white woman in a slightly larger body (I was in a larger body but had an illness and unintentionally lost weight, may gain it back, which is fine). My husband and kids are Native American (Tarahumara) from Mexico and my oldest child is trans. Having multiple identities in my family increases my compassion and concern for folks of different genders, orientations, immigration statuses, races, etc. We are also not religious.