Reframing the Narrative Around Clients in Fat Bodies
Therapists play a crucial role in challenging weight-centric narratives and supporting clients in fat bodies with compassion and respect. The recent proposal in The Lancet Diabetes and Endocrinology to redefine obesity into clinical and pre-clinical categories offers a more nuanced understanding of weight and health. However, this shift also requires therapists to critically reflect on how they approach weight in therapy, moving beyond harmful stereotypes, assumptions, and an overemphasis on intentional weight loss.
Learning from Yalom: A Missed Opportunity
In Love’s Executioner, Irvin Yalom recounts the story of “Fat Betty,” a client who successfully lost weight during therapy. Yalom, while proud of her weight loss, appeared to frame it as a significant marker of her progress. However, this focus on her size risks diverting attention from the deeper relational, emotional, and psychological work that might have been central to her healing.
Many people in fat bodies suffer due to a lifetime of fat phobia and fat stigma. Many people in fat bodies suffer with disordered eating and body image concerns that often fly under the radar due to the focus on ‘lose weight for health reasons’, by well meaning health professionals. We don’t know how Betty’s struggles with her body started, but what Yalom’s framing highlights is the potential red herring that weight loss becomes when it is the primary focus and is celebrated as success. What do we miss over here—the relational concerns underneath binge eating for example, the role of fat as a protector, or the emotional needs of the client—when we focus over there on weight loss? Intentional weight loss, and dieting, often distracts from the broader picture, leaving deeper, unresolved issues unaddressed.
Moreover, with the high rates of weight regain following dieting or intentional weight loss, celebrating weight loss as a therapeutic success can feel short-sighted. For clients like Betty, what might the long-term impact of focusing on weight have been? This story reminds us to shift our focus away from fat as the problem and toward the holistic needs of the client. It also highlights how we might ‘miss’ the client’s needs within the therapeutic relationship.
Shifting the Focus: From Weight to Health
The societal obsession with weight has caused harm, particularly to clients in fat bodies. Therapy should instead centre on health-seeking behaviours and overall well-being, encouraging clients to reconnect with their bodies and prioritise sustainable practices that honour their unique needs.
Reject Diet Culture and Intentional Weight Loss
Both dieting and intentional weight loss are often framed as health-promoting, but they frequently lead to disordered eating and further body disconnection. By replacing internal cues of hunger and fullness with external rules, these approaches foster cycles of shame, guilt, and weight regain.
Encourage Conscious Eating
Support clients in trusting their bodies by honouring hunger, fullness, and satisfaction. Conscious eating moves clients away from restrictive, punitive mindsets, allowing them to build a positive relationship with food and themselves.
Promote Joyful Movement
Movement should be about connection, joy, and well-being—not punishment or a tool for weight loss. Help clients explore activities they genuinely enjoy, from dancing to gardening, that enhance their physical, emotional, relational and spiritual health and wellbeing.
Address Specific Health Needs Without Focusing on Weight
For clients managing conditions like blood sugar regulation, sleep apnoea, or joint pain, therapy should focus on sustainable strategies for improving health and quality of life. Weight loss need not be central to addressing these concerns. Suggest that the client asks their GP, ‘If I was in a thin body, what would your recommendation be for me?’
Challenging Therapist Biases
Therapists are not immune to societal biases around weight. Statements such as:
- “Losing weight is about taking responsibility for your health.”
- “Encouraging healthy eating and exercise is essential for well-being.”
- “If you’ve lost weight, it’s a success story that can inspire clients.”
may seem supportive but often reflect implicit biases. These comments assume thinness equates to health, that weight loss is universally positive, or that therapists know what’s best for their clients’ bodies. Such beliefs risk reinforcing shame and perpetuating harm for clients in fat bodies.
Therapists must confront these biases and focus on the relational and emotional dynamics underlying eating and weight concerns. For some clients, fat may serve as a protector, a shield from intimacy, vulnerability, or past trauma. Therapy should explore these meanings, creating space for clients to find connection and purpose beyond weight.
What the New Guidelines Mean for Therapists
The proposed redefinition of obesity provides an opportunity to reshape therapy practices around health and inclusion:
- Clinical Obesity: Support clients by addressing health concerns such as joint pain or sleep apnoea with sustainable, size-inclusive approaches.
- Pre-Clinical Obesity: Focus on monitoring and encouraging health-seeking behaviours without framing weight as the problem.
By moving beyond outdated measures like BMI and focusing on holistic well-being, therapists can help reduce weight stigma and foster a more inclusive therapeutic environment.
A Weight-Inclusive Future in Therapy
Yalom’s story of Fat Betty reminds us that focusing on weight is a distraction from the real work of therapy. By prioritising health, meaning, and connection over weight loss, therapists can better support clients in fat bodies. This shift requires rejecting diet culture, addressing biases, and honouring the complexity of each client’s relationship with their body.
When we centre the client’s unique needs—not their size—we create space for healing that goes beyond societal expectations, allowing clients to reclaim their worth and well-being on their terms. It also allows the therapist and client the space to focus on the interpersonal needs of the client via the therapeutic relationship, so the therapist is truly attuned to the client and their early childhood needs that may have been neglected.
It is also crucial to note that many people in fat bodies, only have issues with weight because they have grown up in a fat phobic society so as therapists, we must always explore how growing up in a fat phobic society has impacted their sense of self. People come in all shapes and sizes.
Resources for Therapists to Reframe the Narrative Around Clients in Fat Bodies
- What is Health at Every Size? podcast episode
- Health at Every Size Manifesto by Lindo Bacon
- How Therapists Reinforce Unworthiness When They Support Intentional Weight Loss by Alison Puryear
- A Movie Review of the Whale with This Jungian Life
- Conscious Eating Guidelines by Carolyn Costin
- How to Befriend the Eating Disorder Self
- 15 binge-worthy shows that will help you embrace body diversity, body positivity and body love
- Top 6 Binge & Emotional Eating Podcasts with Lourdes Viado
- A Jungian Understanding of the Fat Complex with Sheryl Fuller PhD
- Stop the Fat Shaming: No-one is More Aware of Their Body Than a Fat Person
- 5 Dance Classes to Help Your Befriend Your Body
