CASE EXAMPLES FOR: Decolonizing Body Size: Exploring the Roots and Misconceptions of Weight as a Measure of Health

CASE 1: 

  • 63yo cis-gender woman who is a Nigerian immigrant and who has with diabetes, hyperlipidemia, and generalized anxiety disorder comes in for diabetes-focused visit. She is on Metformin 1000mg twice a day and Invokana 100mg for diabetes. She is on Rosuvastatin 5mg and Lexapro 10mg daily. 
  • BMI 28
  • Labs: A1c 8.4, Previous A1c in 6.3-7.2 range
  • She is distraught about A1c increase. She does not have any symptoms. She states: “I’ve been eating a lot of sweets. I can’t help it recently. I know it’s bad. I’ve been doing really bad with my eating and I’ve gained 7 pounds since I last saw you.” 

Reflection Questions: 

  • What are your initial thoughts about this patient when reading this case?
  • Size-inclusive and compassion-based approach: What questions would you ask this person to find out more information about their life, eating behaviors, and feelings about food and their body?  

 

CASE 2: 

  • In your “Cooking and Nutrition for Kids and Families” group medical visit, there is a 9-year-old girl who you notice is hyper-focused on food and is food hoarding during communal eating time. 
  • This patient has a robust knowledge of nutrition information. During education portion discussing food groups, patient asked “do you mean triglycerides?” When asked where she learned about triglycerides, she said at “Lurie’s Nutrition program” (She was referred to Lurie Children’s Hospital Pediatric Wellness and Weight Management Center because her weight was well over the 100th percentile) 
  • During kids only group portion, patient often mentions “my mom says those foods are bad” and “my mom won’t let me have those”

Reflection Questions: 

  • How should we discuss children’s growth with their families?
  • Eating? 
  • Body Size? 
  • How can families support healthy relationships with food and bodies as their children are growing? 

 

CASE 3: 

  • Last week, a 42yo cis-gendered man who is an immigrant from Mexico came for a physical and labs. 
  • He is a non-smoker, and his blood pressure is 124/76. His BMI is 32. He’s here to see you today to discuss his abnormal blood test results, below:
  • A1c 6.0
  • TC: 212, LDL: 106, HDL: 30, TG: 235

Reflection Questions: 

  • What are your initial thoughts about this patient when reading this case?
  • Size-inclusive and compassion-based approach: What questions would you ask this person to find out more information about their life, eating behaviors, and feelings about food and their body?  

 

Explore your Relationship with Food and Your Body

Think back to your childhood: 

  • What was your food experience like?
  • Did you have access to food? Did you eat dinner at home with your family, or alone? Did you eat out often or eat homemade meals? Who prepared the food? 
  • Was eating a stressful experience or a happy one?
  • What messages did you get about food? (e.g. you need to finish your plate, you need to watch how much you eat) 
  • Were there any exciting experiences around food? Was food used for any other purposes, such as punishments or rewards? 
  • Did your eating change as you grew up? Why do you think this happened? 
  • What messages were communicated about your body? 
  • Did your family make comments about your body size or the size of other people around them? Were you told to change your body in any way? Or did you receive compliments? 
  • What were you being told from society about what a “good” or “healthy” body should look? (e.g. from magazines, TV, your friends) 

Think to the present: ​

  • How do you feel about your body now? Do you have any negative thoughts, or wish things were different? Are there parts of your body you love? Do you feel connected to your body? 
  • How do you feel about eating now? Do you find eating to be a positive or calm experience? Do you ever feel shame or joy when you eat? Do you have time to eat? What does your food environment look like now?
  • Are there any connections between what you feel now, and what you experienced in your childhood?

 

Reflect on your Experience with Fatphobia

How does fatphobia show up for you internally? 

  • Explore your own internalized fatphobia. What biases do you have towards your family, friends, colleagues or students who have larger bodies? 
  • What types of conversations do you have with your family, friends and colleagues about body size, dieting, or what being healthy looks or acts like? Do they prioritize thinness?
  • When you speak about your experience with the BMI or your body, are you looking for reassurance that you’re not fat? 
  • If you live in a thin body, consider the privileges this brings. Keep in mind intersectionality, and how other identities such as race and ability may play a role in the oppression of bodies. How can you be a better advocate for people in oppressed bodies

How does fatphobia show up in your workplace? 

  • Do you weigh patients and recommend weight loss to patients before exploring more about their life? 
  • Do you prioritize patient goals over weight loss? 
  • Are you creating an environment that is safe for fat folks? Do you have equipment like blood pressure cuffs or chairs that are comfortable for people in larger bodies? Are you requiring people to be weighed or report their weight? Is there imagery that promotes people in larger bodies living healthy, happy lives? Consider how these aspects may be harmful or stigmatizing to people in larger bodies. Are you creating situations where fat folks are able and encouraged to participate in a study?

How does fatphobia show up in your research? 

  • Do you use BMI in research or contribute to/fund research that is fatphobic?
  • Do you consider a broad range of research about the impact of weight on health? 
  • How can we use research to explore interventions that are uplifting for all people and inclusive of all body sizes, rather than interventions rooted in shame? 
  • Ensure that you are creating an environment that is safe for fat folks. Do you have equipment like blood pressure cuffs or chairs that are comfortable for people in larger bodies? Are you requiring people to be weighed or report their weight? Consider how these aspects may be harmful or stigmatizing to people in larger bodies. Are you creating situations where fat folks are able and encouraged to participate in a study?