Christy Atkinson, 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?

  My approach is the same for folks of all bodies. I do not bring up weight unless there is a significant change in weight one way or another that warrants exploration related to a person's wellbeing and my care of them (ie.. new significant weight loss could be due to depression; new significant weight gain may be due to new psychiatric medication, etc). If you bring up weight, my approach will continue to be compassionate, centering your autonomy and agency in your care. I will explore with you any feelings you may be having around health changes/struggles. I will never recommend weight loss medications as none that are FDA approved are evidence-based for longterm health; if you ask me about starting them, expect a full informed consent conversation. Again, your agency is most important.

  The approach is the same for children: I do not bring up weight but rather use our time together to counsel on and support health-promoting behaviors, no matter a child's size.

  I am learning and continue to challenge myself in the realm of weight-neutral care; I am very open to feedback from patients and appreciate it when it is offered.

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

  Weight in and of itself is not a marker of health. Weight is related to health insomuch as anti-fat bias affects health. I subscribe to the Health at Every Size (R) Principle that 'Health is a sociopolitical construct that reflects the values of society'

• Finish this sentence: “Fat people are…” 

  important and valuable PEOPLE.

• 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?

  Unfortunately, because the health insurance industry has complete buy-in to the false connection of BMI to health, health systems are constantly trying to demonstrate/document a person's ratio so that they might get paid more by insurance. This results in BMI automatically getting pulled in to the electronic record and visit note if weight/height are recorded in the chart somewhere. I myself consistently delete this information from my note, or add a note of how this is not relevant to my patient's care. Because it can sometimes flag in patients' face if we are looking at the chart together, I will then address the issue directly and have a discussion during the visit of how I am addressing the pop-ups.

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

  I fully support this practice and am working to shift institutional culture of automatic weighing in my health system (see quality improvement work above). I will work with my future care team at River Falls clinic to address weight bias around weighing practices.

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

  I would respect this, 100%. In the future, once trust has been established, I would be curious to hear more about a person's experience with body movement practices, to understand pain/access/other barriers, from the framework that body movement can have non-weight related benefits.

• 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? 

  At Smileys: Our waiting room is a large space with many wood chairs, most of which have armrests. Our exam room seating includes a long but shallow padded bench and usually a chair with out arm rests. Our exam tables are "standard"; only one of them goes up and down. Regarding staff attitudes - most subscribe to "traditional"/weight-based approaches of our western medical system, though the majority are very kind, flexible people.

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

  I am working to change a very rigid system of automatic weighing. I am evaluating my future workplace including clinic rooms for accessibility for all bodies. I am working with care teams to name and change anti-fat bias tendencies. I am working to change pamphlets, printed documents, and other written material that reaches patients and contains anti-fat bias/opposes weight-neutral 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. 

  I acknowledge my identities as a cis, able-bodied white woman from a privileged background who has not experienced life in a larger body, and how this informs the care I provide and relationships I hold.