Q & A with size inclusive Physician Dr. Mara Gordon

I was interviewed by Dr. Mara Gordon for her substack Chief Complaint!

Dr. Mara Gordon and I had a wonderful conversation about caring for our bodies through fitness from a size inclusive perspective. She published our conversation this week on her substack Chief Complaint which I highly recommend. It is so validating, even comforting, to hear someone in the medical world wrestle with the issues we all face in terms of caring for patients, but also, caring for herself. Please enjoy our Q&A and if you have recently found me via Dr. Gordon, welcome! And be sure to check out some of my favorite pieces:

Guacamole Fulfillment

Maybe You Do Eat Too Much and Move Too Little

Is it Anti-Feminist to Want to Lose Weight

From Dr. Mara Gordon:
When I first started conceptualizing my approach as a size-inclusive primary care doctor, one of the first things that radicalized me was learning that exercise was not particularly effective for long-term weight loss.

This was a cornerstone of my training in primary care! Just hop on the treadmill, I told hundreds - thousands! - of patients, and weight loss would be within your reach.

Over time, I started to notice how quickly I lost my patients’ trust with this approach. They had heard it before. It was demoralizing to get yet another lecture from a doctor about making their bodies smaller.

And it didn’t seem to work. A primary care doctor like me, suggesting my patients lose weight? It’s so common it’s a cliche, but yet it doesn’t yield long-term weight loss.

So I just stopped nagging them. My patients seemed more comfortable with me, more trusting. Moving the focus away from weight loss actually helped us make headway on more rigorous indicators of health, like blood pressure or glucose control. It was a revolution by omission. And it was the first step in my long and stumbling process towards helping my patients let go of body shame - and helping myself let go of it, too.

As I’ve gained more experience as a size-inclusive clinician, I’ve come to appreciate a nuanced approach to conversations about exercise. For the vast majority of my patients, regular movement is a cornerstone of feeling vibrant and alive. And this is despite the fact that it doesn’t make you lose weight!

Exercise is a practice that helps us sleep, helps with positive mental health, helps prevent chronic pain, helps strengthen our hearts. It continues to be an important part of my own life, and I genuinely believe that people of all body types - fat, thin, old, young, disabled, neurodivergent - can find ways to exercise that work in their lives.

Now, I tell my patients: I do not care what the number on the scale is. But moving our bodies can help us feel great.

Still, when I talk about exercise with my patients - in a way that’s much more inclusive and less stigmatizing, I hope, than a lecture to get on the treadmill - they often hear weight loss. Exercise and diet culture have gotten so entangled that it’s hard to separate the two.

That’s why I love the work of Cadence Dubus, the writer, podcaster, and fitness instructor behind Brooklyn Strength. Early on in my days of dabbling in the world of body liberation, I found her work online, and I loved the way she approached exercise with a sense of practicality and moral neutrality.

“It’s like brushing your teeth,” Cadence says. “Our culture has made us feel like we have to love it, excel at it, make massive change. It doesn’t need to have 7,000 outfits and sneakers and props and an app.”

Cadence was kind enough to talk with me about her own work helping make movement and strength training accessible to all bodies. Our conversation has been edited: I could talk to her for hours, but I won’t subject you all to that. I hope you learn as much as I did.

There is a glut of fitness content online. A lot of it is overtly fatphobic. It can be hard to know what might help us feel good in our bodies, and what might capitalize on our cultural fears about our bodies getting bigger or getting older. How does your approach differ?

I work on educating people about how their bodies work. “Let’s explore this movement. How does this feel in your body? Notice how your lower back changes when we do this. Is there a connection there?” I want to help people connect those dots so that they’re empowered to understand and take care of their own bodies.

The aim was always to be able to have an interdisciplinary, holistic approach to people's fitness and wellness. I don't teach 5-6-7-8 fitness. As in, an instructor yelling “5-6-7-8!”

We started as a storefront in Brooklyn teaching Pilates. I knew that my clients weren't going to get everything they needed from one hour of Pilates with me. And so really early on, I was like: “You should work with a strength trainer.” Or, “Have you tried meditating?” And then I would think, “What am I doing? Recommending them off to some stranger that I don't know.” So very early, I started hiring strength trainers, and then I got certified in strength and conditioning. We had a Thai massage practitioner. Now, Brooklyn Strength is fully virtual. The virtual space has actually made this interdisciplinary work more possible.

In your Busy Body podcast, you explore exactly this issue: that wellness is so multifactorial. It’s not just about exercising for a certain amount of time or to attempt to burn a certain number of calories.

There's a great book which I talk about all the time; I interviewed her early on in my podcast. It's called Let's Get Physical by Danielle Friedman.

My book club read that book!

I didn't realize until I read that book that I'm so clearly part of a lineage of women fitness entrepreneurs. All the women described in that book were creating space for women to get in touch with their bodies. Women historically were never allowed freedom in physical spaces: sports, classic gyms, even just outdoor recreation areas. Public space was and still is male space, I would argue.

The world of sports and fitness, typically dominated by men, which women have been really closed out of. This meant that women created these other spaces, like dance-aerobics and barre. But they’re very different from a strength training program, or playing soccer. A strength training program is really addressing the physical needs of the human body for strength, mobility, joint protection. Jazzercise or dance aerobics – it’s a safe place where women are allowed to move their bodies, which I’m a fan of. But it’s also a place for them to continue to chase thinness, appear really feminine, and not be sweating or grunting.

I'm 43, so I was a teenager in the 90s. I was the first generation of women that just had open access to gyms, like Equinox, Gold's Gym, whatever gym. I used to go in with my high school bestie, and we used to lift weights. It was women in the 80s that really broke that ground by pushing themselves into these typically male spaces, which revolutionized what gyms looked like. Suddenly gyms had yoga rooms, and amenities essentially for women and physical activities that are more associated with women. All these gyms used to just be weight rooms and saunas, and that's it. But once women were allowed in those spaces, not only were we there to do ‘stretch classes’, we got access to things previously associated with men and male bodies; strength training, athletic achievement that doesn’t use words like ‘tone’ and ‘tummy’.

Exercise, kind of by definition, isn’t demure or sexy.

Look at Venus and Serena Williams. They broke ground by grunting while they’re playing tennis. There were headlines complaining that they “make so much noise.” They’re the best players in the world. Women are still fighting to be in a gym in a T-shirt and shorts, taking care of their bodies without it being about, “Don’t worry, I look cute. I’m not sweating too much.”

So much of women’s fitness is about trying to make our bodies smaller, and trying to look hot while doing it.

And people are using those feminine-coded activities to punish their bodies, which is usually what the marketing encourages. That’s really upsetting for me.

What I’m doing is trying to give people as many entry points as possible to a real fitness program that could change your body in a number of ways: increasing mobility, preventing injury, making you feel stronger. Because taking care of your body is really important. How can I help you find a way to take care of your body that’s really neutral?

It’s like brushing your teeth. It can be as simple as that. It is a form of discipline, but our culture has made us feel like we have to love it, excel at it, and make massive change. Your routine could just be walking and strength training and, “Yep, I do this thing for 40 minutes, and it’s just what I do. And then I do it again on Thursday. I don’t love it. I don’t hate it. But I feel better after and I can see the benefits in my life.” It doesn’t need to have 7,000 outfits and sneakers and props and an app, and you don’t have to tell all your friends.

I don’t tell all my friends when I brush my teeth. I don’t have an app that tells me to brush my teeth. I don’t take a picture with my toothbrush to post on social media.

Why is exercise culture so vulnerable to scams and misinformation?

We live in a patriarchal world. Women’s bodies are constantly controlled and oppressed. There is also so little research on women’s health. [Editor’s note: The Trump administration is actively defunding research on women’s health.] There’s this sense that women’s bodies are a mystery; women don’t understand their own bodies. It leaves us really vulnerable. Anyone can say, “I’m going to help you. If you’re feeling tired, come join my program. I’ll save you. All you need to do is workout for 80 billion hours a week, drink this juice, don’t eat this thing.” People are signing up in droves because they don’t have any real, accurate information.

When I say the word “exercise” to my patients, they often hear “weight loss.” Which is not my intention: I practice size-inclusive medicine and don’t direct my patients to lose weight. But culturally, we think of exercise as a tool to lose weight, not as a practice to improve mobility and prevent pain.

I have a lot of clients in their 70s and 80s, and many of them say, “Well, I never had to exercise because I was always thin.” There’s a generation of ads that said: “Join the gym, slim down in 30 days!” Every time you say “exercise,” they’re imagining that.

So I’ll say things like, “What’s the regular movement that you do for yourself? For your body?” And that often trips people up. So then I say, “Do you do anything when you wake up in the morning? Some stretches before you walk the dog? Do you play pickleball?” It’s stored in people’s brains as “fun, casual time,” not as fitness, not as exercise. We’re not talking about jumping on the Stairmaster for 45 minutes. Are you doing anything to just take care of your body, just like you would take a shower, throw your clothes in the laundry?

We have a lot of contradictory conceptions of what kind of bodies are allowed to exercise. I have a lot of patients who live in bigger bodies who say that they think of fitness spaces as only being welcoming to people who are thin. But then there’s also a narrative, like your clients shared, that exercise is only necessary if you’re trying to lose weight.

I’ve read some personal essays where someone in a larger body is exercising, and imagining the worst thoughts coming from the thin person on the next treadmill or bike across them at the gym. And I’m thinking, “That poor woman is suffering, too.” We live in a fatphobic society. To paraphrase the philosopher Kate Manne in her book Unshrinking, “We all live under the yoke of fatphobia.” Thin people are desperately trying to hang on to their thinness, and fat people are trying to get thin. Everyone is suffering in that way.

Mainstream fitness spaces essentially cater to a population that is already, fit, coordinated, young or un-broken. That is actually not most people. Most people sit for most of the day and have tight low backs and tight hamstrings. They have asymmetries from living life; old injuries and strains. Most people walking into the corner bootcamp class are only going to be able to be there until they re-injure themselves or get burned out trying to keep up.

I'm trying to teach people that exercise can be accessible if you are actually taught how to engage with your unique body. When was the last time someone really taught you how to do a plank? Not told you to do one, but slowed down and taught you how to do it so it feels actually achievable? That’s what I do. I teach. I don’t tell.

How can we make movement a more realistic and welcoming habit for people?

I read an article recently by a woman who grew up in Canada and now lives in Paris. And she was writing about going back to visit her parents in the suburbs in Canada, and noticing how there was no way to do anything without getting in the car. In cities that have prioritized pedestrian movement, she says, “I’m active without even thinking about it.” Everywhere is walkable. There are bike shares that cost hardly anything, we just get on the bikes and pick them up and drop them off.

So many of my clients in the U.S., they don’t even know the last time they’ve been on a bike. They think of it as a big fitness thing. Or, “I’m too big. I’m not coordinated.”

In so many cities around the world, they make it so much easier to just walk. It’s more pleasant. The city planners pay attention to keeping cars slightly further away from the sidewalk, so you walk three miles and don’t even notice.

I live in Coney Island, which has a big Ukrainian and Russian population. There’s such a long culture of physical fitness. There’s one older woman I see out all the time, wearing a bright red bikini, pushing her walker and striding down the boardwalk. There are people of all ages and body types, all genders, working out – rain, sun, night, day, winter, summer. They’re doing really interesting movements, too. They’re not just trying to burn calories. They’re doing mobility exercises. There’s so much cultural knowledge there: This is what you do to take care of your body. There’s just a daily necessity to move. In the US we’re taught that everything has to have an outward goal. Maybe the goal can be internal. Maybe it can be comfort in our own bodies. Maybe it can be ease. Maybe it can be a sense of peace in our routine. We can teach ourselves to be connected to our physical selves without focusing on an external gaze. We can learn to appreciate the contentment that comes with caring for our bodies through movement.

You can find Cadence’s Virtual Fitness and Wellness Studio, Brooklyn Strength at brooklynstrength.com find useful reels on pain relief and more on her instagram @brooklynstrength and listen to her podcast Busy Body as well as receive essays from her substack HERE.

I also teach beginner strength and stability via Kettlebells and Pilates as well as several restorative classes and workshops including Anti-Anxiety Cardio and Fascia Release™ all of which are designed to gently shift our bodies into balance without the ableist fat shaming ‘sweat is fat crying’ mentality that infects so much of mainstream fitness. I also do virtual one-to-one sessions, just me and you working out, relieving your pain, or talking about your needs and goals.

I hope you can find something here that supports you.