Title: “Social justice in the clinic: Caring for larger patients”
Supervisory Committee: Prof. Laura Hurd (Research Supervisor), Associate Prof. Moss Norman (Co-Supervisor), Prof. Robert Woollard (Department of Family Practice)
University Examiners: Associate Prof. Jennifer Black (Department of Food, Nutrition and Health), Associate Prof. Laura Nimmon (Department of Occupational Science and Occupational Therapy)
External Examiner: Prof. Alex Dumas (Faculty of Health Sciences), University of Ottawa
Chair: Prof. Catherine Backman (Department of Occupational Science and Occupational Therapy)
Abstract: Many larger patients experience weight-based discrimination in healthcare settings, and are judged by practitioners as irresponsible and non-compliant (Phelan et al., 2014). Though there has been increased attention on how weight-based discrimination jeopardizes patient health outcomes (Sutin et al., 2015), empirical research is lacking on 1) practitioners who adopt a social justice approach to caring for larger patients or 2) larger patients’ experiences of receiving social justice-informed care. Social justice in practice refers to addressing intersecting macro-level inequities such as racism, sexism, and sizeism through micro-level practitioner-patient interactions (Mishler, 2005). The present study fills a research gap by examining how social justice is understood, enacted, and experienced in weight-related clinical interventions. Drawing on one-on-one interviews with 22 diverse healthcare practitioners who identify as social justice advocates and 20 larger patients served by such practitioners, four main questions were addressed: 1) How do participants understand social justice? 2) How do practitioners translate social justice principles into practice? 3) What challenges do practitioners encounter when practicing social justice? 4) How does social justice-informed care shape larger patients’ experience? The findings reveal that participants rejected the notion of obesity as an individual problem, and demonstrated a deep awareness of the broader social factors shaping weight and overall wellbeing. Nonetheless, participants’ approaches to care differed depending on whether they regarded obesity as either primarily a social construct or a biomedical fact. Furthermore, despite the prevailing paradigm of obesity as a disease, participants conveyed that non weight-related factors such as financial strain and racism more profoundly impacted patients’ health, which casts doubt on whether medicalizing obesity truly benefits larger patients. A social justice informed-approach to care was found to enhance patients’ experience, with patients expressing appreciation for having their trauma histories and social challenges handled with compassion and curiosity. The study highlights the need to integrate micro-level strategies for individual healing with a macro-level framework of systemic change, as well as cultivate in patients, clinicians, and the public at large a more nuanced understanding of weight and health. The findings provide practice-oriented insights for care informed by frameworks of weight-inclusivity, structural competency, and person-centredness.