Lily Ward, 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 working with people in larger bodies, I do not assume things about a person's health status, nutrition, or activity level based on their weight. I ask permission before discussing these things with all persons as these conversations can often be triggering. I do not recommend weight loss or calorie counting. I order tests and perform physical exams to investigate symptoms regardless of body size. Given that people in larger bodies experience more discrimination and even abuse by the health care system, I am mindful in my words and actions in order to avoid re-traumatizing and perpetuating health inequities. This approach is the same in children. I welcome feedback on how I can improve.

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

  I do not believe that weight is a risk factor for diabetes, high blood pressure, heart attacks, strokes, or early death. Nutrition and activity are important for treatment of diabetes, high cholesterol, and high blood pressure. However, a person's body size is not related to nutrition or activity. Therefore, a persons' weight is health neutral.

• Finish this sentence: “Fat people are…” 

  good, worthy, and deserving of respect.

• 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?

  As of writing this, the MHealth Fairview system automatically includes BMI on patient printout after visit summary. There is no way for a provider to remove this that I am aware of. When a diagnosis of "high BMI" or "Ob*sity" is added automatically to a patient's chart, I remove it. The system sometimes adds it back after I remove it, but it usually stays off.

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

  Being weighed at Smiley's Clinic is optional. I would ask more, but not require a weight, if they are pregnant or <18 years old.

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

  I would thank them for letting me know and move on.

• 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? 

  There is an exam table which is accessible to persons in larger bodies. I wish there were more of them. There are a variety of chair sizes in the waiting room. The patient's seat in the exam room is a long bench that accommodates all body sizes. The exam room has a small size chair for guests (I wish the guest's chair was larger).

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

  Weight is optional, ask permission before discussing nutrition and exercise

• 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 am nonbinary and use they/them pronouns. I identify as queer.