Devon Prevost, 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 strive to treat all clients with kindness and respect. I listen to them, hear their story and build a treatment plan based on their true needs, not their body size. I would say the only difference in treating folks in larger bodies is the greater emphasis on compassion and advocacy. So many folks in larger body have a negative history with their body, created by our fatphobic society and obsession with dieting. I like to hold space to unpack that hurt and start to nurture a softer and kinder relationship with one's body.
  Additionally, other providers are often encouraging weight loss or dismissive of client needs because of their weight. This is where I can make an impact with advocacy and fat friendly resources to my clients so they feel empowered and are cared for from a HAES lens.

  When working with children in larger bodies, how we talk about weight and health is extraordinarily important. When it comes to talking about weight with children, I think less is more. I work with parents to adjust their language around food and body and try to quell their anxieties they may experience around their child's weight. I reinforce that weight loss is never a healthy goal for any child, and instead work on nurturing adequate development growth and a positive and confident relationship with food and body.

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

  I proudly work with a HAES and non diet approach. I disagree with the way our healthcare system puts so much stock into the correlation between weight and health, especially when we know weight and health goes far beyond diet and exercise. I believe clients mental and physical health outcomes improve when weight is not the focus of care. That being said, I create space to discuss the complexities of living in a larger body and how that may impact their lived experience.

• Finish this sentence: “Fat people are…” 

  People who deserve to be respected, listened to and supported, just like every human.

• 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 never display BMI on information my clients have access to. I only discuss BMI it if the client brings it up, to which I like to create a teaching moment about the harms and history of BMI. I do not use it for diagnoses unless insurance requires it for coverage.

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

  I only ever encourage weigh ins if there is medical necessity (weight restoration tracking, edema etc.). I always have extensive conversations with clients on how they feel about being weighed and offer blind weight resources.

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

  Clients have full autonomy to discuss or not discuss any topic. However, if there are areas relevant to our work together, I will approach it with compassionate curiosity to better understand the desire to not discuss certain things. Depending on what is discussed, I do my best to move forward, which could mean providing resources, referring to another provider, collaborating with care team members etc.

• 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 has generous parking spaces, comfortable and size inclusive furniture and elevators. The office is ADA friendly. My office has a scale that weighs up to 550 lbs.
  The walk from the lobby to my office is down a long hallway. I think having a wheel chair accessible could be a valuable inclusion.

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

  I greet my clients and walk with them to my office at the beginning and ending of appointments. I have fidgets, pleasant scents, comfortable seating and relaxed lighting. I treat all my clients with respect and care and allow everyone to set the pace of their care and goals.

• 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 want to point out my privilege of being a straight size, cis white woman. I know I have a different lived experience than many of my clients hold.