Creating a size-friendly environment means considering each client's total experience within your setting. All staff should greet clients in an approving, helpful, and courteous manner. Comments / humor promoting size discrimination should be strictly prohibited.

Waiting Room:

Décor (pictures, statues, etc) should present a wide variety of body shapes & sizes.

Avoid choosing a preponderance of materials that promote the thin ideal.

Include materials that offer an alternative view of desirable body images such as Radiance or BBW.

Provide chairs that are sturdy, armless, and big enough to support large clients.

The Examination Room:

Chairs within exam rooms should also be big, armless, and sturdy.

The exam table should be secured to prevent tipping and big enough to position large clients comfortably throughout their exam.

Gowns and drapes should be large enough to provide both comfort and privacy.

Accurately-sized medical equipment including blood pressure cuffs, needles, and tourniquets must be available in order to obtain accurate readings and specimens.

The Encounter: A person's body weight in and of itself implies little, if anything, about health status. Providers must remember that body weight is only one piece of information within the vast data base that exists for each client.

Assessment

• Make no size-related assumptions about client needs (small clients may have eating and weight-related concerns, while large clients may not).
• Avoid using height/weight tables, scales, skinfold calipers, bioelectrical impedance and all others measures of body weight and fatness. If the BMI must be used be able to explain why it is a poor indicator of health.
• Address the subjects of body image, eating, and physical activity in the context of health promotion screening. Avoid linking this assessment to body weight.
• Use open-ended questions/statements such as:
1. "How do you feel about your physical appearance?"
2. "How physically active are you?"
3. "Tell me about your eating patterns."
4. "Describe what the terms hunger, appetite, and satiety mean to you."
5. "Do you have any concerns about your eating patterns, physical activity, and/or appearance?"
6. "Would you like assistance with any of these concerns?"

Diagnosis

Avoid the use of the terms "obesity," "overweight," and "overfat." Click on the link for more information.

When larger individuals present with medical problems offer the same approaches that would be offered for a thin person with similar presenting problems (Burgard & Lyons, 1994). As an example:

For a thin person with essential hypertension conventional medicine suggests dietary changes, aerobic physical activity and stress management followed by medication, if necessary. Yet a larger individual presenting with the same diagnosis is told to lose weight, despite all that is known about the most likely consequences of this prescription (weight cycling, weight regain, etc.)

Remember that this approach may be most important for larger individuals who are at HIGHER medical risk due to hypertension, diabetes, coronary artery disease, etc., because of the potential health risks of weight loss and weight fluctuation.

Treatment Plan: Client decides on the plan's direction: This might include working on size acceptance/body image (Unit IV Lesson A), eating patterns (Unit IV Lesson B), physical activity (Unit IV Lesson C), or any combination thereof. It is important to keep in mind that:

• Clients suffering from a diagnosed eating disorder or entrenched "disordered eating" need assistance from mental health professionals and nutritionists currently utilizing new paradigm principles.
• Health care providers should be aware of new paradigm resources within their community and utilize them whenever possible.
• Providers should empower clients by instructing them to access customer service representatives for third party payors and ask direct questions about covered services.
• Clients can be encouraged to appeal through appropriate channels when discrimination occurs or when size-friendly services are denied.

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© Fall 2001