Many conversations around healthcare for people with obesity have focused on one thing lately: GLP-1s.
But weight loss drugs are just one part of weight-inclusive healthcare, according to Brooke Boyarsky Pratt, the co-founder and CEO of knownwell.
Knownwell, which started serving patients in 2023, is a primary care clinic for people with obesity. Designing the Massachusetts-based facility to have exam tables with built-in scales, wider doors, and larger blood pressure cuffs, Boyarsky Pratt set out to make the healthcare experience more accessible for a group that’s been historically marginalized in healthcare.
Boyarsky Pratt spoke with Healthcare Brew about what successful weight-inclusive care looks like, especially during the current GLP-1 craze.
This interview has been lightly edited for length and clarity.
What does it mean to grow weight-inclusive primary care during the current GLP-1 craze?
Super interesting time, right? The positive is, patient awareness that there is medical intervention for weight management is at an all-time high because of GLP-1s. Where that actually helps long term, with the stigma, is understanding obesity as a disease state. The [American Medical Association] said that obesity is a disease in 2013. But before the GLP-1craze, I think people still defaulted—and unfortunately, some physicians, too—to seeing it as a lifestyle failure. And I think these amazing pharmaceutical interventions coming out are helping people see it as a disease.
Step one in reducing stigma is understanding that this is a disease state, not a personal failing or moral failing of a patient, and that has meant that a lot more patients are seeking treatment or seeing once again that healthcare is a place that can help them. From “a rising tide lifts all boats” kind of thing, for knownwell, it’s really helpful that patients are starting to feel more confident in the idea of “There may be something there for me,” instead of getting shamed by a clinician.
Overall, [it’s an] exciting time where patients view healthcare as a place that maybe they can go back to, but also a time that we need to be really careful in doing the right thing because you have a lot of people taking advantage of the moment.
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Why is it important to have specialized primary care for people who have historically been marginalized in healthcare?
It’s sort of shocking that it wasn’t already done. We couldn’t get over it because 70% of the US is overweight and has obesity. And you could find these specialized primary care offers for much smaller groups of patients before we thought about it for overweight and obesity, which is great; every patient deserves that experience.
But in our view, we saw a couple of things. One was: Holy moly, 70% of the US. Number two, those rates are increasing, so what we’re doing today is not working. And number three, we know from the research that these patients are actually avoiding primary care, which is exactly where they should be going.
What has always been obvious to me as a patient has been, if left to its own devices, while each doctor is going to do the best they can, this system is not fostering a good experience for people with overweight and obesity, from the physical spaces to how doctors are trained in medical school on obesity. So, I felt like if part of the solve has to be getting patients back into healthcare, we need to make healthcare accessible and better for those patients.
What does successful weight-inclusive care look like, understanding that there’s still so much stigma and discrimination built into the healthcare industry at large?
My message is this: With what’s happening with GLP-1s today, so much of the airtime is about either getting patients to a drug or getting them not on a drug.
We should be focused on getting patients back into a healthcare home. The appropriate treatment will follow.
But what’s most important is that a patient has somewhere to go—not an app where they can fill out a survey or anything else. So, I hope that we can move the conversation from “How do we get patients GLP-1s or prevent patients from getting GLP-1s?” to “How do we get patients back into our healthcare system?”