Rachel Petersen-Nguyen, 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?

  I share with all patients that their weight does not tell me very much about their health. I do need to monitor it at times to make sure that their body is getting enough nourishment. I do everything I can to support patients in their healing without regard to their weight.

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

  Weight does not tell me very much about health. I do become concerned if weight is dropping or if children are not gaining weight adequately.

• Finish this sentence: “Fat people are…” 

  Fat people are oppressed, and it is not fair.

• 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?

  When patients come to a visit, they do have measurements taken. At certain ages (3 and older), height and weight are used by the computer to calculate the BMI. I do not look at the BMI and I do not talk to patients about their BMI. I do not provide written information about their measurements unless it is requested. I ask permission before talking about measurements or growth. If patients/parents ask me about their BMI, I let them know that it is not an important or helpful measurement and focusing on it can be harmful.

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

  Depending on their age and concerns regarding their nourishment, we may need to check it. I see a number of patients with disabilities (physical, neurological, cognitive) that make it difficult for them to get adequate nutrition. We do need to check weights to make sure they are getting adequate nourishment. If we have recent evidence of their health showing that they are adequately nourished (normal pulse, blood pressure that is not too low, normal physical exam showing adequate hydration...) we may be able to skip the weight. Pediatric medication dosing is sometimes based on weight. If I need to prescribe an antibiotic or another weight-based medication, we may need to check the weight. We will offer a blind weight and avoid offering printed information with the weight if they do not want to know it, or if it would negatively impact their health to see the number.

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

  I do not recommend weight loss, so they do not need to decline this from me. I discuss joyful movement and I like to discuss ways they like to move their bodies. If I think it is appropriate for them, I may discuss gentle nutrition through an intuitive eating lens, with permission to include all foods (other that anaphylactic food allergens). I share that all foods are allowed. Some foods give our body energy, some give us energy and give our body other benefits as well. I also encourage kids, when they are old enough, to notice how their body feels when they eat foods they enjoy.

• 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? 

  We do have sturdy chairs without arms. We have blood pressure cuffs for patients of all sizes. We have 1 exam room with an exam table that is sturdier than others, and works well for patients of all abilities, and patients in bigger bodies.

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

  I do everything that I can when I am seeing the patient and their families. This includes language I use in providing care. I continue to raise awareness for other staff (reception, rooming staff, triage nurses, colleagues) to increase their skills and knowledge in this area.

• 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 identify as a queer, cis-gender female.