Is anti-fat bias affecting the quality of care you provide your larger-body patients? Probably. Anti-fat refers to behaviors, systems and attitudes that marginalize and exclude fat bodies.1 In health care settings, anti-fat bias harms patients and denies them access to care.2
Although no studies have looked specifically at acupuncture clinics, we can assume that anti-fat bias is a problem for us, too.
Acupuncture and Chinese medicine are not anti-fat, but when these modalities are practiced within an anti-fat culture, we will carry biases that negatively impact the work we do. As CM practitioners, we have an opportunity to take a body-inclusive approach and help larger-body folks get the highest quality of care; but to do so, we need to understand the way that prejudice plays out in our clinics.
When larger-body patients interact with health care providers, their weight is often identified as a problem to treat. Weight may also be blamed for other symptoms like pain. As Chinese medicine practitioners, we do not need to take this approach.
We see pain in bodies of all sizes and can let our patients know this. We should treat their pain or any other condition without an expectation that they should lose weight or that the weight is causing their symptoms. Our treatments are already based on qi, not BMI, so this should be an easy transition to make.
Anti-fat bias impairs our ability to properly diagnose. If you were trained that “excess” weight is always damp accumulation, then you’re going to see dampness even if it isn’t there. I work in the Pacific Northwest; dampness here is an issue for most people, not only larger-body folks.
In fact, my experience is that my larger-body patients have more qi and yin deficiency, likely from the stress of frequent dieting and the emotional pain of living in a culture that constantly demeans and dehumanizes them.
Chinese dietary therapy should be used cautiously with larger-body patients. Diet is a fraught subject for many people, and unless you have training in disordered eating and dismantling anti-fat bias, it might be best for you to avoid this topic.3 If you are discussing diet only with your bigger-body patients, then you are probably doing so from an anti-fat lens.
A better approach is to emphasize supporting the spleen qi by emphasizing relaxation and self-care. It is also helpful to let patients know that there are no bad or good foods in Chinese medicine. This will help create a more neutral landscape for the patient.
The clinic environment is also important to consider. Do you have adequate seating for larger bodies? Do you advertise using diverse body types? Do you have table extenders or extra-wide tables? For larger-bodied folks, accessing health care is difficult and traumatizing. We need to create spaces that don’t replicate this.
As acupuncturists, we want to provide high-quality care to all patients regardless of size. By informing yourself about anti-fat bias and improving your practices to better serve larger-body folks, you will help this population access the care they need.
References
Chronic pain afflicts over 20% of the adult population. Sadly, most MDs have essentially no education in treating pain, beyond offering a few toxic medications. Then they tend to steer people with pain away from those health practitioners who are trained. This puts the acupuncture community on the front lines for addressing this epidemic.
When the body is going through a stressful event, the sympathetic system is activated. This activation will help the body with a life-threatening situation. If this state is activated for prolonged periods of time, it starts to consume energy. These traumatic events that generate stressors in the autonomic nervous system (ANS) will eventually become internalized.
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One of the things that makes acupuncture so difficult to measure is that the medicine actually does contain some esoteric aspects. There have been numerous studies that demonstrate the neurochemical reasoning behind why acupuncture points stimulate the autonomic nervous system to enact change However, not all the benefits of TCM can easily be measured by randomized, controlled trials. But does that make them fundamentally and definitively untrue?
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