Introduction
This document is intended to support public health professionals with addressing common scenarios that may arise in practice. It includes suggested weight- inclusive messaging and language to avoid perpetuating weight bias, stigma, and discrimination. All public health professionals need to work together to support a weight-inclusive approach that improves health outcomes for all.
Reading the position statement “Towards a Weight-Inclusive Approach in Public Health” prior to exploring the scenarios is recommended. For more tools, please see the Addressing Weight Bias Resources webpage.
Health means different things to different people. However, we recognize that health is complex and influenced by various factors, including the Social Determinants of Health (SDH).
In the following scenarios, suggesting that clients engage in health promoting behaviours may be beneficial for some individuals. However, an emphasis on health behaviours may perpetuate the belief that one’s worth is tied to their health status. This is called the moralization of health. The moralization of health can stigmatize those who view health from a different perspective and/or those who encounter systemic and structural inequities that prevent them from engaging in these health promoting behaviours. It is important to approach these situations with a health equity lens and a commitment to social justice.
Key Concepts for all Scenarios:
▶ All bodies are worthy of equitable care, regardless of size, weight, ability, health status, eating pattern, and physical activity choices. Making judgments related to the above-mentioned can:
- Cause shame and discomfort which can lead to suboptimal healthcare and healthcare avoidance,
- Reinforce dangerous preoccupations with weight/shape/size,
- Lead to negative relationships with food/self/body,
- Equate body size with health or likeability
▶ Health is independent of weight. Weight and BMI are inaccurate indicators of health.
▶ Focusing on weight/BMI perpetuates weight bias and stigma; and can negatively impact self-esteem, body image, health and wellbeing.
▶ Weight loss is not sustainable in the long term.
▶ When an individual restricts their food intake, their body makes them more hungry and slows metabolism to help maintain weight to protect from starvation and restriction.
▶ Bodies have, and continue to, come in a range of shapes and sizes that are largely influenced by factors beyond individual control.
▶ It is normal for bodies to change shape and size across the lifespan.
▶ Society is preoccupied with physical appearance. The media’s promotion of unrealistic body images, the weight loss industry, and diet culture profits from harming self-esteem.
▶ Body dissatisfaction is common at all ages, including older adulthood.
▶ Individuals can improve the way they feel about themselves without trying to lose weight. Health behaviour changes can improve how people feel physically and emotionally, independent of weight change.
Whenever necessary, encourage seeking out a dietitian or call Health 811 to speak with a dietitian if the client has food-related concerns.
Scenarios:
1 Community initiative to address weight and health
2 Workplace interested in a weight loss challenge
3 Individuals with weight and body concerns
4 Quitting smoking
5 School concern re: students with “unhealthy” lunches
6 School concerns about disordered eating
7 Concerns with infant growth
8 Taking a weight when medically indicated
9 Parent concerned with a coach’s emphasis on weight
10 Diet culture in conversations
11 Weight bias in health care settings
Individuals you work with may also be heavily influenced by diet culture. They may have strong beliefs about weight and health and they may not be open to changing these perspectives.
Quick Tips for discussing any of the following scenarios:
Center the person as the one who knows what is best for themselves. Be compassionate.
Acknowledge the person’s experience and be open to the need for a conversation around the issue. Accept the person where they are at.
Get Curious and find out what’s behind their ideas. Do not judge them.
Explain why their idea may cause unintended harm.
Reassure there is a safer and more inclusive way to address the issue.
Redirect to weight-inclusive resources or other credible sources.
Community initiative to address weight and health
When working with the community to improve the health of the population, partners may believe that the focus should be on “obesity”,1 weight, or Body Mass Index (BMI).
1 See “Language Disclaimer” in Towards a Weight-Inclusive Approach in Public Health: A Position Statement by the Ontario Dietitians in Public Health.
The partners want to highlight childhood “obesity” statistics in media releases or promotional items as a rationale for a proposed project or policy.
What to Say/Do:
▶ Suggest that this is not an appropriate activity and encourage the group to consider how focusing on weight leads to negative impacts for all, including the increased blame and shame on people in larger bodies.
▶ Suggest highlighting non-weight related topics for the project or policy (e.g., mental health, social connectedness, enjoyable physical activity, access to nutritious foods).
b. A school wants to measure the anthropometrics (e.g. height, weight, percent body fat), caloric intake (e.g. food intake journals, calorie counters) and activity levels (e.g. pedometers) of students for a health and fitness program.
What to Say/Do:
▶ Encourage the school to consider how:
◆ Focusing on these types of activities can perpetuate weight-based bullying and discrimination amongst peers.
◆ The experience of being weighed or measured at school can be stressful, uncomfortable and anxiety-producing.
◆ The potential harms of these activities might cause students to be more preoccupied with their body and weight or pressure them to take dangerous actions to try to control their weight (e.g., food restriction, over exercising, which can both contribute to weight cycling). 59
◆ Building positive self-esteem and body image is beneficial for students.
◆ See Scenarios 3b and 9 for information on the harms of dieting and weight loss during childhood and adolescence.
▶ Suggest alternative ways of reflection, such as journaling about the level of enjoyment or how one’s body feels after activity.
▶ Review the ODPH resource Mental Health and Weight Bias in Schools.
▶ Incorporate food literacy curriculum from BrightBites, Sustain Ontario and Food Is Science.
Workplace interested in a weight loss challenge
A workplace is interested in initiating a weight loss challenge to improve the health of their employees. They are considering measuring weight, and rewarding employees based on weight loss.
What to Say/Do: ▶ Explain that focusing on weight increases weight stigma. If employees feel stigmatized because of their weight, they are more likely to develop disordered eating habits, reduce physical activity, and have mental health challenges such as depression, anxiety, and low self-esteem. Weight loss challenges could be triggering for people with disordered eating or body image concerns. All of these consequences ultimately negatively impact work productivity, morale and workplace culture. ▶ For those who choose to not participate, these initiatives may lead to a hostile working environment. ▶ Participating in weight loss challenges can reinforce/promote food shaming, which further perpetuates weight stigma.60
▶ Prioritize wellness initiatives that lead to long-term system-level changes. As an alternative to weight loss challenges, encourage the workplace to advocate for and focus on activities that build supportive environments and protective factors: ◆ Behaviour change: walking breaks and meetings, fruit and veggie snacks for breaks, commuter challenge ◆ Social connection: games club, craft groups, book club, recipe exchange, plant swap ◆ Supportive work environment: flexible work hours, access to a variety of food options, workplace physical activity opportunities, encouraged scheduled breaks ◆ Systems change: mental health supports and other health benefits, adequate income, paid sick days
▶ For more information, see page 8-9 of NAAFA’s HR Training Guide
Individuals with weight and body concerns
The situations below may occur during conversations with clients, coworkers, community partners, and others. You can offer guidance to prevent negative consequences.
a. A client expresses concern about their weight and wants to try a restrictive/fad diet.
What to Say/Do:
▶ Acknowledge that many factors, including societal influences and direction from health care professionals, often pressure us to focus on weight.
▶ Ask them to reflect on why they feel that they want to try this diet. What do they hope to gain from this change?
▶ Ask about their experience with weight and diet changes. Discuss how they feel about their relationship with food and their body.61
▶ Explain that eliminating major food groups leads to lack of energy and certain nutritional deficiencies. This can affect our enjoyment of food and the social benefits of eating together, which can impact our mental health.
▶ Encourage the client to seek services from a health provider who practices a weight-inclusive approach.
b. A client is using “sports supplements” (e.g., protein powder, pre-workout powder) and weight training to bulk up because they feel they are smaller than the other students on their sports team.
What to Say/Do:
▶ Ask them to reflect on why they feel the need to bulk up. What are they hoping to achieve? Is bulking up the way to achieve that goal? Reinforce that bulking up isn’t needed; each person brings unique skills to the team regardless of their size. Not all players on the team need to have the same physique.
▶ In terms of protein supplements, protein intake above personal needs does not result in more muscle gain.
▶ Performance in sports can be improved through practice, training, and nutrition. Explain that a well-balanced, varied eating pattern will provide the nutrients needed for optimal health and growth, as well as peak performance.
▶ There are some instances where increased dietary intake is warranted, and the best approach is to speak with a Registered Dietitian for more information.
c. A new parent asks how long it may take them to return to their pre-pregnancy weight.
What to Say/Do:
▶ Our bodies change significantly to support pregnancy, delivery and postpartum. Discuss why the parent feels the need to return to pre-pregnancy weight.
▶ While there is often focus on body weight and shape in the immediate postpartum period (such as the “get your body back” messages), it is a critical time to dedicate to mental wellness, parental bonding and wellbeing, and community connection.
▶ If the parent is breastfeeding or chestfeeding (See resources: Transgender and Non-binary Parents and Queer Doula Toolkit), remind them that energy needs are higher, and that calorie restriction is not appropriate. While breastfeeding or chestfeeding, one may feel more hungry. Remind them to honour their hunger cues and fuel their body, so they have the energy to care for and feed their child.
▶ Encourage the parent to speak with their health care provider about when it is safe to return to previous physical activity levels. Discuss the non-weight related benefits of physical activity.
▶ Encourage the client to seek services from a mental health provider who uses a weight-inclusive or weight neutral approach.
d. An older adult is concerned about gaining weight.
What to Say/Do:
▶ Ask them to reflect on why they are concerned about gaining weight.
▶ Contrary to popular belief, weight can have protective factors in older adults:
◆ Higher weights and increased body fat may be protective, particularly in older adults and are associated with greater muscle mass, lower osteoporosis risk, lower falls and fracture risk.[224]
▶ Older adults are at higher risk for malnutrition, and this risk increases if they are purposefully restricting calories. Intentional weight loss also results in muscle loss. Muscle loss has been shown to decrease functional capacity for independent living.[225]
▶ Explain that gradual weight gain as we age is normal and not concerning from a health perspective.
▶ The goal should be to stay well nourished for overall well-being and falls prevention. This includes eating regularly, avoiding getting too hungry, choosing a variety of foods that you enjoy while getting adequate nutrients (i.e., calcium, protein, and vitamin D), and staying hydrated.
Quitting smoking
You are working with a group or an individual who is thinking about quitting smoking but worried about gaining weight. You are afraid their fear of weight gain may be a deterrent to them successfully quitting.
What to Say/Do:
▶ Provide the ODPH “Quitting Smoking and Your Weight” Fact sheet as appropriate.
▶ Acknowledge that concern about weight gain can be worrisome for people who are quitting smoking. Explore what might be driving that fear (e.g., health concern, body image, cost of clothing replacement).
▶ Emphasize that quitting smoking is a key contributor to improved health. The benefits of quitting smoking include easier breathing, lower blood pressure, more money, better tasting food, more enjoyable movement, etc.
▶ Acknowledge that there is no way of telling if someone will gain, lose, or stay the same weight after quitting smoking. Our age, genetics, how much and how long we’ve been smoking, stress, mental health, behaviours, and environment can all affect how quitting smoking might impact our weight.
▶ Recommend trying to improve overall nutrition and enjoyment of food and physical activity rather than starting a diet, restricting food, or exercising with the intention of preventing weight gain.
▶ Encourage taking a mindful and curious approach to cravings. Suggest asking themselves: Am I hungry? What am I feeling? Why do I feel this way? How can I choose foods that make me feel good, and meet my needs? Food cravings from quitting smoking will go away; however, how long it takes is different for everyone. Taste preferences might change after quitting smoking.
▶ For background information, see “Addressing Concerns about Weight Gain While Quitting Smoking”. For ideas on how to address client concerns, see “Having a Conversation: Weight Gain While Quitting Smoking Guidance for Addressing Client Concerns”.
School concern re: students with “unhealthy” lunches
A school staff member approaches you with concerns regarding “unhealthy” food and beverages in a student’s lunch.
What to Say/Do:
▶ Reinforce mealtime roles.
◆ It is the educator’s role to decide when and where students eat.
◆ It is the caregiver’s role to decide what foods to pack for lunches (or what is available to pack).
◆ It is the student’s role to decide whether they eat, what order they eat their food, and how much.
◆ Maintaining these roles is important in helping children learn to respond to their hunger and fullness cues and to develop a positive relationship with food.
▶ Emphasize that students don’t have control over the foods that are included in their lunch.
◆ Families select foods based on what’s available, their income, values, cultural food norms, time, food skills, accessible and familiar to them and their child, and what their child will eat at school, etc.
◆ Judging packed lunches undermines the trust and connection between the child and the caregiver.
◆ It is inappropriate to make judgements about a child’s overall nutrition based on one snack or meal in a child’s day.
▶ Discuss that rules or restrictions on what foods a student can eat from what they brought from home and in what order, is inappropriate and potentially harmful.
◆ Rigid rules can take away their ability to listen to body cues of hunger and fullness and can lead to disordered eating.
◆ Drawing attention to a particular food item may create a stressful eating experience for a child, isolate them from their peers, and damage their self-esteem.
◆ Outside of safety concerns, such as food allergens that are not allowed in the classroom, schools should not be providing direction about what children can eat from their packed lunches.
▶ Recognize that all foods can fit.
◆ Labelling a food or beverage as ‘good’ or bad’, ‘healthy’ or ‘unhealthy’ is confusing for children.
◆ It can also negatively impact their relationship with food, their bodies, and themselves (e.g., I am ‘bad’ because I ate a ‘bad’ food).
▶ Share the “Nurturing Healthy Eaters in the Classroom” resource (elementary, secondary) and “School Lunch Your Kids will Munch”, both available from ODPH website.
▶ Highlight that school community members can play a key role in creating a supportive school nutrition environment. Some examples include:
◆ Being a positive role model. This involves enjoying a variety of food in the presence of students, and practicing positive self-talk (e.g., my body feels great after a walk, I enjoy how I feel after morning yoga).
◆ Intervening if weight-related teasing occurs at school.
◆ Providing universally accessible breakfast, snack, or lunch programs at school.
◆ Offering a variety of food and beverages during classroom celebrations.
◆ Using non-food classroom rewards such as colourful pencils, stickers or a “student of the day” program.
◆ Providing students the opportunity to practice food skills at school.
School concerns about disordered eating
An educator is concerned about a student that they believe has an eating disorder. They’d like you to come in to present on eating disorders to the classroom to address this.
What to Say/Do:
▶ Explain that there are various reasons why a presentation to the classroom is a harmful approach and is not recommended. See Eating Disorder Ontario Prevention “Overview of Disordered Eating Prevention: How Can Schools Help” (FR) for more information.
◆ Discuss that eating disorders are complex mental illnesses with physical symptoms, and biological, psychological, and social factors influencing their development. There are many types of eating disorders, and each person will have different signs, symptoms, and behaviours.
◆ Avoid exposing the student to content and discussions that involve weight or body image, as this can trigger eating disordered thoughts. Discuss that the approach used to support students who might be at risk for or experiencing an eating disorder is very different from the approach used to prevent eating disorders in the general school population. Food and weight preoccupations occur on a continuum that ranges from worrying about body shape and what we eat, to medically diagnosed eating disorders, like anorexia or bulimia nervosa. Each one requires qualified, individually focused help to identify the specific issue and recommended treatment.[226]
▶ Share the NEDIC helpline, which supports educators, families, students, etc. They can call the NEDIC helpline (1-866-633-4220; Toronto: 416-340-4156) or live chat.
▶ Individual student approach: Refer to your school’s policies and procedures. If speaking to the student privately to express concerns for the student’s overall health and well-being, avoid discussing the physical and appearance-based changes. Consider seeking advice from guidance counselors or the leadership on how to navigate the situation and when to involve the student’s guardians/ caregivers. See NEDIC for more conversation tips.
◆ Acknowledge that this is a difficult and delicate conversation; advise the educator to show empathy and support for the student and their family. Consider any cultural or social issues that may make it hard for the families to discuss issues. The closest health unit may be able to provide information about resources in the community that parents can access.
◆ It is important that the individual student receives help and support. People can, and do, recover from eating disorders, but professional help is almost always required. Eating disorders impact both mental and physical health, and the longer symptoms are denied or ignored, the more difficult recovery will be.
▶ General school population approach: If the educator is interested in school wide prevention of eating disorders, recommend that prevention efforts take place on many levels. For example:
◆ For Staff:
■ Provide staff training regarding creating supportive environments for positive body image and self-esteem (e.g., examining their own beliefs, role modeling, teaching, and curriculum supports).
■ Provide school staff with information on recognizing the signs of a student at risk.
■ Share ODPH’s Mental Health and Weight Bias in Schools, Nurturing Healthy Eaters in Elementary Schools and Nurturing Healthy Eaters in Secondary Schools with colleagues.
◆ In the classroom:
■ Create a classroom environment where students can practice being respectful of each other’s point of view; provide and receive positive feedback; listen and respect differences; challenge stereotypes; and where their food choices won’t be monitored or judged.
■ Avoid using food or physical activity as a reward or punishment. Promote physical activity and movement as being fun and as part of a joyful lifestyle, not as a way to lose weight. And modify physical activities to be non-competitive and inclusive of all skill levels.
◆ For parents:
■ Equip parents with ideas on how to promote positive self-esteem and body image, balanced eating, and enjoyable physical activity in the home.
◆ Further resources: See NEDIC’s Beyond Images for curriculum supports.
Concerns with infant growth
The situations below may occur while working with families. You can offer guidance to prevent negative consequences.
What to say/do: (Applicable to both scenarios)
▶ Just like adults, babies come in a variety of sizes. If they are growing consistently and meeting their developmental milestones, their size is likely not a concern.
▶ Growth is somewhat genetically predetermined. Efforts to change an infant’s growth are unlikely to be helpful and may negatively impact feeding, eating, and growth in the future.
▶ When a child’s growth falters or accelerates off of their normal growth trajectory, further assessment should include feeding methods and practices, understanding cues, developmental milestones, life changes (e.g., starting to crawl or walk), etc. Changes in growth pattern indicate a need for further assessment, but there is no need for alarm. Some change in growth patterns can be normal.[227] The goal is to help increase caregiver confidence in how to know their baby or child is doing well, and the need for emotional attachment and physical closeness, and understanding of growth and developmental milestones.
a. A parent is concerned that their baby is smaller than other babies of the same age. The parent asks what a 7-month-old is supposed to weigh and has purchased a scale to weigh the baby at home twice a week.
What to say/do:
▶ Recognize the parent/caregiver’s intention to do the right thing for their baby.
▶ The recommended schedule for a primary care provider to weigh a baby is within 1–2 weeks after birth; at 2, 4, 6, 9, 12, 18 and 24 months; once per year after age 2.[228]
▶ Weight alone is not an appropriate measure of growth and development. It should be combined with assessments of length/ height and/or head circumference over time to assess growth and development. One-time measurements do not provide adequate information to assess a child’s growth.[228] Research shows that weighing babies more often than recommended is not helpful, and may be harmful, because of the overemphasis on weight.
b. A baby’s grandparent has suggested that the parents stop feeding so often at night because the baby is gaining weight too fast.
What to say/do:
▶ Encourage parents to trust their baby to know when they are hungry or full. Review that parents/caregivers should not pressure their baby to eat more than they want or restrict the amount of food given or eliminate a feed when the baby seems hungry.
▶ Discuss signs of infant hunger (e.g., reaching for spoon or food, pointing at food, getting excited when food is presented) and fullness (e.g., eating slows down, mouth clenching shut, pushing food away, turning head away).
▶ Make a referral for further assessment and support if you suspect that growth is a concern. Contact support from a Public Health Nurse, Lactation Consultant, Dietitian, Nurse Practitioner and/or Family Physician if warranted.
Taking a weight when medically indicated
While weight may sometimes be needed to provide effective care, the experience of being weighed can be an anxious and stressful experience for many individuals. The two scenarios below describe circumstances where one may need to ask for/take a client’s weight:
a. You are meeting with a client interested in birth control. Because the efficacy of these medications can be impacted by weight, it is important to obtain a weight from the client.
b. You are phoning a client who was bitten by an unidentified dog and needs post-exposure Rabies Immune Globulin prophylaxis. The dosage for the vaccine is based on body weight, and the client asks how many needles they will need. In order to answer their question, you will need to find out their weight.
What to Say/Do (Applicable to both scenarios):
▶ Talk to the client about why their weight is needed. The type and effectiveness of the medications can be impacted by body weight.
▶ Obtain consent to weigh the client and ask if the client is comfortable with weight being taken prior to doing so.
◆ Be aware that the act of weighing the client may cause them distress. Be kind and compassionate, and offer support as needed.
◆ Ensure the measurement area is private and keep measurements confidential by having them face away from the scale or by turning the screen away.
◆ Avoid mentioning and sharing with client, if possible. It is best not to comment on the weight or measurement. Stay neutral and use wording like “thank you” or “you can step off the scale now”. Avoid making any comments about a person’s shape or size.
▶ Recognize that weight is a sensitive subject for many. If the client says something negative about their weight and/or size:
◆ Tell the client, “Your weight doesn’t tell us anything about your health status and won’t impact the quality of the care you receive from us.”
◆ Review messages in Key Concepts for all Scenarios section.
Parent concerned with a coach’s emphasis on weight
A parent expresses concern about their child’s coach, who is promoting specific dieting practices, talking about weight control with some athletes, and using weight-based bullying as a means to motivate athletes. The parent is concerned that this will lead to disordered eating and negatively affect their children’s self-esteem.
What to Say/Do:
▶ Provide support in speaking with the coach to address this important issue. Encourage them to reiterate the below key points to the coach:
◆ Reinforce parent/coach roles. It is the parent’s role to decide what, when and where their child eats. It is the coach’s role to support the child in their training. It is not the coach’s role to comment on or use the children’s weight or body size as a way to motivate them.
◆ Promoting weight loss may negatively impact a child’s self-esteem and can stigmatize those in larger bodies. Children are heavily influenced by role models and adults in their lives.
◆ Emphasizing weight control can take away from the enjoyment of physical activity and eating food. Focus on the importance of physical activity for skill-building, and building self-esteem and teamwork.
◆ Children and youth are growing, and weight gain is a normal part of healthy growth and development. Weight loss (e.g. through restrictive diets), dieting, and extreme exercising behaviours are not recommended. They can lead to the development of disordered eating and eating disorders, which can cause serious harm at an already vulnerable life stage. It is important to ensure optimal nutrition intake and adequate sleep for peak performance in physical activities.
▶ Parents could make an informed decision to take their concerns to the governing body of the sport or league.
Diet culture in conversations
The topics of weight and dieting can come up in everyday discussions. If these topics come up, steer the conversation away from diet culture.
a. While hosting a food literacy training session for community partners, some participants are commenting on how the recipes do not align with their latest diet or weight loss efforts.
What to Say/Do:
▶ Remind the group that the focus of this training is to promote food literacy. Ensure the group is aware that it is not the role of the facilitator to comment or recommend any weight loss diets or supplements/products.
▶ Clarify with the group that talking about food, restriction, dieting, and weight can hinder others’ enjoyment of the workshop. Explain that weight loss or weight status isn’t an indicator of health and that it is not the focus of the workshop.
▶ Acknowledge that our society is very weight focused, and often the conversation shifts back to weight and diet. This can be exhausting and alienating; share that the group will create a safe and positive space free of diet talk.
▶ Review messages in the Key Concepts for all Scenarios section.
b. You overhear a colleague, community partner, client, or even catch yourself making an inappropriate comment about someone’s body, physical activity, or food choices.
Some examples include:
“You look great, have you lost weight?”
“You are so thin; you don’t need to work out!”
“Wow, you’re going to eat all that food?”
“Look at what they’re wearing. They should not be wearing that with that body type!”
“You’re eating bread? I don’t eat bread because it makes me gain weight.”
“I need to work out after eating that cake; I feel so fat.”
▶ It is best to avoid comments related to a person’s body or eating habits, as this could unintentionally cause low self-esteem and negative body image.
▶ If you find yourself in this situation, you may:
◆ Excuse yourself from the conversation;
◆ Not engage in or contribute to the conversation; or
◆ Change the conversation to something else
◆ Address the comment in a kind but firm way
▶ If you catch yourself making a comment, consider taking accountability and addressing what was said. Apologize for making the comment and/or for passing judgment about someone’s body, physical activity, or food choices. Although we make mistakes, it is important to take ownership and learn from them.
▶ In certain situations, it could be a great opportunity to start a positive conversation by reframing the comment as a question. Some examples include:[229]
◆ “Have you ever thought about why we focus so much on body fat?”
◆ “Why do we spend so much time and effort being critical of our bodies, rather than focusing on loving who we are?”
◆ “Why is it so normal to find faults in the way people eat, exercise and look?”
▶ Focus on the person’s character, talents, personality, and actions when giving a compliment.
▶ For more ideas on how to respond to these types of comments, see the Clever Replies to Damaging Remarks resource.
Weight bias in health care settings
A client comes into the Health Unit to access services. The clinical equipment (e.g. gown, blood pressure cuff, vaccine needle) and furniture is not appropriate for them to use.
What to say/do:
▶ Apologize for not having the correct sized equipment in the office and assure the client that this is not their fault, but the issue lies within the organization. Acknowledge that it is inappropriate that the Health Unit does not have equipment and seating that can be used by all people-with all body shapes, sizes, and abilities.
▶ Do not suggest that a client wear two gowns to “make it work” or try to take their blood pressure with a cuff that is too small. If there is a way to provide services that are not stigmatizing, due to inappropriately sized equipment, work with the client to discuss alternatives based on their comfort level. For example, if it is a sexual health visit with a pelvic exam, perhaps they can keep their top on and use a sheet/blanket to cover their bottom half if they are comfortable to do so.
▶ Advocate to ensure that the Health Unit has accessible equipment available and so that all spaces have appropriate clinical equipment or, if that is not possible, that everyone knows where to access it without having to draw undue attention to the process.
◆ Bring this issue forward to the internal accessibility committee and formally document the complaint, if possible. A formal complaint process is important for accountability purposes.
◆ Review these assessment tools and advocate to make changes to the physical environment in which you work:
■ Ragen Chastain “Creating a Size Inclusive Health Care Office”
■ National Association to Advance Fat Acceptance (NAAFA): Size Diversity in Employment HR Training Guide
■ Ontario Dietitians in Public Health Weight Inclusivity Checklist
◆ Additional considerations include having:
■ Sturdy chairs with a minimum capacity of 500 lbs
■ Wide base weight scales with a minimum capacity of 500 lbs
■ Chair/seating without arms and wide seating with arms to assist with moving from sitting to standing
■ Uncluttered spaces for moving around in the waiting room and washrooms
■ Accessible exam tables (appropriate width, with steps, height adjustable, minimum 500lb capacity, bolted to floor/ wall)
■ Floor mounted toilets (instead of wall mounted) in washrooms
■ Non stigmatizing reading materials and artwork (e.g., no magazines that promote weight loss, normative bodies)
■ See Recommendation for Public Health Practice section for further considerations
