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?

• Weight is not an indicator of health, so I usually don't need to know about it at all. The only way my care is different is that the stigma and mistreatment affecting people in larger bodies does come up and we talk about it. Similarly to how I would speak with a Black patient a little differently because I want to address that they may have a history of subpar care and trauma because of racism. It's the same with children. Children of all body sizes get similar discussions about how weight and health are not equivalent. I do weigh newborns, or babies who aren't eating well.

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

  Weight is related to health because people in larger bodies are denied treatments as providers just tell them to lose weight, meaning they end up having conditions with cumulative effects untreated for longer. They may be less comfortable going to a doctor knowing the stigma. It may cause depression when people try to lose weight and are unsuccessful (even though the things they did to lose weight were the ACTUAL healthy things, like decreasing stress and adding some whole grains). So weight is related to health because it is a social determinant of health. And that's all.

• Finish this sentence: “Fat people are…” 

  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?

  I don't use it at all. BMI is not useful information for me. The clinic tracks it, and many places we refer patients have BMI cutoffs, but I delete BMI from all of my notes, remove obesity from all problem lists, and do everything I can to help patients find specialists that will actually treat them.

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

  I don't weigh my patients anyway. If I wanted a weight for some reason (e.g. a patient with heart failure who holds all the fluid evenly distributed and thus can't really track fluid changes based on symptoms) I would explain why and ask the patient if they'd like to get a weight for that reason. I make it okay to say no (and this hasn't happened often, I rarely get a weight). For kids, the clinic does get weights, but I only look at trajectories, not the BMI, I don't care if you're 3rd percentile or >99th percentile, I care if you suddenly dropped off. The only time I might actually try to push someone for a weight would be a baby who isn't eating well.

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

  That's fine. I'm a consultant that people hire for health advice, not a deity. When I call the plumber to fix my sink, they obviously don't want me to make bad choices for my sink, but it's my sink and they'll respect that. When a patient consults me for my education on medicine, just like the plumber's education on plumbing, I'm going to respect their autonomy.

• 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 least half of our providers are weight neutral providers (at my current location), and none of the others are against it in any way, just haven't totally hopped on yet. But we could certainly use more size options for wheelchairs, beds, and chairs.

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

  Well, I'm fat, so that helps a little I think. I also don't weight my patients, delete BMI out of their chart, and I'm very clear that weight does not indicate health status and it's not information I need. I also just treat people with kindness and respect and try to be humble and take feedback.

• 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 did above in my bio! I've had abortions and kids so I care even more about abortion and fertility justice. My husband and kids are not white, which makes me care even more about racism. My oldest kid is both a boy and a girl, which makes me care even more about gender justice. My husband is native and was an undocumented immigrant which makes me care more about native rights and immigrant rights. I'm fat and have a history of an eating disorder, I also have a history of an alcohol use disorder and depression. I just care about all of these things anyway, and I don't need to have an immediate family member with a certain identity to care, it just really amplifies your concern when you see directly how bias affects people you love.