Yuvie Styles. Photo Yuvie Styles.
Shortly after moving to Chicago, Brooke Boyarky was looking for a new primary care physician. She was running late to an appointment, but she had to have her Harvard T-shirt.
“Something I’d accidentally discovered years before was if I wore it to the first session and the doctor saw me in the Harvard T-shirt, their tone [would change],” Pratt says. “Now, they’d see me as educated. When I realized I’m literally willing to run late to find a Harvard T-shirt in my closet because I will not go to the doctor without it and I was like, ‘What the hell is going on?’”
Pratt says weight-inclusive healthcare is a rarity and the process has always been long.
Following her appointment, she researched how common the experience was, feeling impassioned but ultimately stuck to her corporate real estate job. After giving birth to a child in Chicago, however, she felt like she was “put on this planet” to try and make the experience easier for others.
She co-founded knownwell with physician and Chief Medical Officer Angela Fitch and, aiming for accessibility, ensured that the clinic accepts all commercial insurance, Medicare and Medicaid.
The clinic offers primary care for adults and optional weight management for adults and teens that have a goal to lose weight.
The clinic’s first location opened in the Boston area in early 2023.
“Our very first patient when we opened our doors in Boston was a 58-year-old woman who had not been to the doctor for 18 years because of how stigmatizing the experience she had last time was,” says co-founder Brooke Boyarsky Pratt. “She hadn’t had bloodwork in 18 years and in her first visit with us, we found a lump that, thank God, ended up being benign … but that’s the cost of people feeling [stigmatized].”
What makes the clinic different?
We practice what’s called weight-inclusive primary care. I did not know this before this idea came up, but there are two ways of practicing medicine. The typical way in the United States is called weight-normative. I have experienced, maybe 15 to 20 times in primary care, “You’re 5 foot 4 inches, did you know you should be 140 pounds?” “You’re much heavier than that.” “You’re overweight.” The research actually shows that a stigmatizing experience where the doctor yells at you about your weight, which is what the vast majority of Americans have experienced, leads patients to gain more weight. Our standard of care is exacerbating and making the disease worse. Imagine if we had a treatment for leukemia that we knew made leukemia worse and that was how every doctor practiced in the U.S.
So what came out over the last decade was this idea of inclusive medicine. So that might mean I walk into the doctor and they say, “How can we incorporate walks to improve your cardio?” “Can we improve our consumption of plants and protein?” So the underlying idea here was to create clinics that were a place I would go as a patient.
How does weight-normative care look in practice?
Once I moved to Chicago, I went to the doctor with a sinus infection. As I was leaving, the doctor said, “You know, if you lose weight, you might get less sinus infections.” I immediately called my doctor friends, and they couldn’t imagine a situation in which those two things were related. Like many people, I’ve had a pain that’s dismissed — like when my right knee ended up being a meniscus tear and they were like, “It’s probably related to your weight.” But it was because I was playing tennis and being active.
Why open a clinic in Plano?
It’s really the growth in where families are coming, right? The DFW region is obviously huge and ultimately we narrowed it down to Plano because there’s so much need, as you move a little bit outside of the city. When you start looking at Plano, McKinney, Allen and even Richardson and further out, we saw a much lower clinician to patient ratio. We serve adolescents and adults for weight management and only adults for primary care. We really pride ourselves on being able to see the whole family, and in Plano in particular, it is such a family-oriented community that we thought it would be a really cool place to start.
This interview has been edited for clarity and brevity.
