A new care paradigm: Accessible weight-inclusive care environments

In an era where diversity and inclusion are at the forefront of societal progress, the healthcare system of Aotearoa stands at a crucial crossroads. The time has come to critically examine how healthcare environments can better serve patients of all body sizes.

The challenges faced by patients living with obesity in our healthcare system are multi-faceted and deeply entrenched. From ill-equipped facilities to damaging weight bias among healthcare professionals, these barriers compromise the quality of care and patient dignity. The structural discrimination manifests in myriad ways: inadequate examination rooms, inappropriate imaging facilities and subtle yet damaging microaggressions in patient-provider interactions. These issues are not isolated incidents but symptomatic of a broader failure to adapt our healthcare system to the diverse needs of our population.

A fundamental shift in perspective is required – moving away from viewing patients living with obesity as “the problem” to critically examining and rectifying the environmental and systemic barriers that hinder accessible care. This paradigm shift demands re-evaluating how healthcare delivery is conceptualised and implemented.

The transformation of healthcare environments requires a comprehensive approach. Drawing from successful models, such as those implemented by Alberta Health, Canada, standards of practice should encompass patient-centred care, specific clinical knowledge, appropriate equipment and resources and effective communication protocols. These elements collectively foster an environment prioritising dignity, safety and high-quality care for patients of all body sizes.

This approach acknowledges the complex interplay between physical environment, medical knowledge and interpersonal interactions in healthcare settings. Rather than focusing solely on technical solutions, it emphasises the need for cultural transformation within healthcare institutions.

Implementing these changes faces obstacles within our current healthcare climate, such as budget constraints, existing biases and organisational inertia. A multi-faceted approach is recommended, including ongoing education programmes addressing weight bias, policy reforms that encourage the adoption of inclusive practices and active involvement of patients living with obesity in the design and implementation of changes. Furthermore, fostering interdisciplinary collaboration between healthcare providers, architects, equipment designers and policy makers can lead to more comprehensive and effective solutions. Continuous monitoring and evaluation processes are crucial to ensure ongoing improvement.

The cost of maintaining the status quo is measured in patient harm, compromised care quality and perpetuated stigma. Aotearoa can lead by example, demonstrating a commitment to providing excellent care for all its people, regardless of their body size.

This is more than a call for incremental change – it is an invitation to transform how healthcare environments serve patients of all sizes fundamentally. The medical and healthcare community must move beyond acknowledgment to meaningful action. While the path ahead presents challenges, the potential benefits of improved patient outcomes, increased satisfaction, and a more equitable healthcare system are immeasurable.

Given the prevalence of extreme obesity within our most vulnerable population, the time for change is never more pressing. Through collective action and commitment to these principles, New Zealand can create a healthcare system that truly serves all its people with dignity, respect and excellence. This transformation begins with accepting the challenge to examine current practices critically and embrace the opportunity for meaningful change.

The evidence supporting accessible, weight-inclusive care environments presents a clear pathway forward. By embracing these changes, New Zealand’s healthcare system can transform from one that inadvertently creates barriers to one that truly embodies the principles of equitable care for all.

Caz Hales, RN, PhD, is a senior lecturer at the School of Nursing, Midwifery and Health Practice at Victoria University of Wellington