Laurel Neufeld, 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?

  The way I care for patients with larger bodies is mostly similar to how I care for patients with smaller bodies. I never assume something about any person’s health behaviors by looking at them, and always ask consent before talking about nutrition and exercise. I make sure to offer patients with larger bodies all the options I would offer to a patient with a smaller body. When people of any size tell me they want to work on being healthier, we explore what that means to them, then talk about behaviors that might be accessible to them (and of course weight is not a behavior).

  The one difference in my approach when working with fat patients is that I try to be extra attuned to how anti-fat bias is shaping our visit. I scan for my biases when entering the room, when asking questions, and when making recommendations; and I am curious and sensitive about how bias and oppression have impacted my patients’ experiences.

  When working with children, as with adults, I feel responsible for creating a clinical environment free from anti-fat messaging, and for fostering trust and joy in their bodies.

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

  My knee-jerk response to this question is, “it kinda is, it kinda isn’t, and who cares.” To break that down:

  It kinda is: so so many people’s experiences, and so much research, tells us that anti-fatness operates like other forms of oppression that affect people’s health. Fat people receive subpar medical care—including advice to lose weight, which more often than not worsens people’s health—and I see how this compounds with other axes of discrimination to harm health.

  It kinda isn’t: I don’t think that fatness causes disease or is “unhealthy” in any other way. There are some correlations between weight and disease, but the research I’ve read shows many confounding factors that better explain this relationship, like history of disordered eating, weight cycling, experiences of discrimination, and more.

  And who cares: as your (potential) doctor, of course I care about your health. But usually when people ask this question, they’re using it as a way to disparage fatness. Even if I believed that being fat caused disease (which, as above, I don’t), I believe in your right to receive care without prerequisite weight loss, your right to be offered the same options as patients in smaller bodies, your right to not be pressured into shrinking your body, your right to be at peace in your body the way it is right now, and your right to exist in a world without oppression. I see recommending weight loss as antithetical to these principles.

• Finish this sentence: “Fat people are…” 

  my loved ones and friends and community members! An honor to take care of!

• 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?

  Patients can opt out of weight and BMI being included on their after visit summaries, through an option on MyChart online. There is one spot where weight is automatically in our note template; I always delete this, but if you see a different doctor in our clinic, you might need to ask them to delete it manually.

  I’m new to this health system, so still learning about navigating our referral networks. I’m eager to learn with you, and we can talk about your needs as they come up. If we encounter a BMI cutoff for accessing specialty care, imaging, etc., I will advocate for your access to these services and work with colleagues to find you options.

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

  I work with a variety of support staff (staff who help with rooming, intake, vaccines, etc) and always check in to request they don’t weigh my adult patients. It’s possible someone might be used to another doctor’s style and forget, but it’s pretty common at our clinic to not routinely weigh people so I would be surprised if you faced any pushback, and would want to hear about it so I can address it.

  If I am interested in knowing your weight because of a medical condition where it could be relevant (e.g., people with heart failure sometimes retain fluid, and tracking weight can help us understand how well we’re managing their condition), we can talk about whether checking your weight feels safe for you. Like any other medical intervention, it deserves an informed consent conversation. We can be creative enough and smart enough to come up with other ideas if getting weighted is not right for you.

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

  I thank them for sharing that boundary and we discuss other options that don’t have to do with these topics.

• Do you offer weight loss as a service, and if so, how much of your practice is this? What do you do if a patient requests your assistance with losing weight?

  As a doctor new to practice, I am still navigating this question. Many thoughtful providers who I respect have very different approaches to this.

  I am leaning towards not prescribing medications like GLP-1s for weight loss (although I will prescribe them for diabetes), because I think that recommending weight loss is not safe, evidence-based, or ethical. I am not interested in creating a world with fewer fat people. I feel lucky to have learned from the scholarship of fat studies researchers who see any effort to eliminate fatness as an instrument of fat oppression.

  This is complex, because I also very deeply value patient autonomy, and believe that my patients are the experts of their own lives. I’ve been coming back to the idea that when our anti-fat society and medical culture demands you change your body, that’s not autonomy, that’s coercion. It does feel complicated to draw this line as someone who does not experience anti-fat discrimination. That said, medication—and trying to use medication to remove someone from an oppressed group—is not a solution to oppression.

  I’m always open to learning and changing. If you feel differently, let’s talk about it. I can also always help patients access types of care that I don’t provide, by finding trusted colleagues who do.

• 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? 

  I did an audit of the physical accessibility of our office, and am happy to talk about this in more detail if patients have questions or individual needs. In brief, the waiting room only has 3 wider chairs (29 inches wide), the rest are 19 inches wide. The exam rooms each have one chair and one bench. The chair has arms and is 20 inches wide. The bench is 16 inches deep (shallow enough that patients often feel they are sliding off) and 57 inches wide. Exam tables are 28 inches wide.

  We do have larger gowns (8X) and larger blood pressure cuffs (thigh and XL) but no troncoconical blood pressure cuffs. Bathrooms are single-stall, gender-neutral, and spacious. Most of the toilets are wall-mounted with supports under the bowl.

  The clinic is set up in a large square. The closest exam room to the reception door is approximately 5 meters, while the farthest exam room from the front door is approximately 50 meters.

  I wish the benches in the exam rooms were deeper, and I wish we had more wide chairs in the waiting room. I have shared this with clinic leadership, and they reference this information when they have the ability to replace equipment. I wish we had a budget for these changes to happen faster.

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

  As above, I always check in with my teammates to request they don’t weigh my patients, and have given feedback to clinic leadership about physical accessibility. As a resident I don’t have much control over our office decorations, but someday would love to practice in a space with art featuring fat people on the walls.

  I always try to chat about something non-medical before starting a visit, to help patients feel welcome and cared for. And I am honored to help patients process experiences of anti-fat medical discrimination, and hope that having space to share and receiving a different approach from me helps patients feel comfortable.

  I also am eager to hear feedback about my style. I hope that my patients feel welcome to suggest other ideas!

• 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 benefit from white, cisgender, able-bodied, and thin privilege. I am a queer woman, and have experienced healthcare that was not affirming of this identity. I hope that this experience, plus my values of curiosity, connection, and liberation, help me be receptive to and aware of my patients’ needs.

Profile last updated June 2026