Weight-Inclusive Care by Hilary Kinavey, LPC

Body shame and dissatisfaction are a common concern in psychotherapy offices. Therapists are in a unique position to name and dispel myths regarding weight and body size with their clients. Unfortunately, many therapists do not feel adequately trained nor do they fully understand the impact of sizism on the lives of their clients.

Those of us who have worked in the disordered eating and body dissatisfaction corner of the mental health world know something that we wish everyone knew: there is no weight loss prescription, weight change suggestion or diet that is psychologically benign. Clinically and culturally, we fail to name and acknowledge the impact of weight stigma on us all. People large and small are often hustling for weight and body change and have their worthiness bound up in the pursuit. All too often, weight change is mistakenly seen as a possible and helpful intervention for clients who live in larger bodies or who feel dissatisfied with the bodies they are in.

It is very true that diets do not work. This is true for fad- diets, plans sold as “lifestyle changes”, and medically prescribed plans. In fact, 95% of diets fail, though often not initially. Typically, dieters regain weight at 2-5 years post diet. This is such a predictable occurrence that we must ask why it is we more commonly blame the individual than the diets or plans themselves? To avoid further harm, it is necessary to consider what could be possible in the lives and wellbeing of our clients if we located weight concern outside of the individual and named it as a cultural concern or mandate? When we critically evaluate the data, what we find is that the evidence that weight is even a risk factor is, at best, incomplete and contradictory. Here are the links to a few research articles critically evaluating weight science and offering data to support a weight-inclusive model of care:

Weight Science: Evaluating the Evidence for a Paradigm

The amount of weight bias in the literature (and therefore the medical community) is astounding. Health and mental health care providers must become critical reviewers of the research to provide safe and ethical services. Many studies finding a correlation between weight and health have not controlled for things like SES, weight cycling, fitness, stigma, oppression, trauma, and more. Correlation is different than causation.

Conversations about inclusion and social justice do not commonly include sizism and fatphobia. It is commonplace to believe that a little shame and public humiliation can provide catalyst for change – something we all know to be false about the change process. The truth? Fat people have always existed and will continue to. This is not an abomination or culture gone wrong. But it is an intersection. Fat people are less likely to be believed, trusted, treated (medically) and hired. Add intersections of race, ability, gender expression, and the injustice multiplies.

Consider who told you that people can and should lose weight.

Consider who taught you that people can and should lose weight. Check out the $60 billion+ industry that thrives on this and then research alternative approaches such at Health at Every Size® and Body Trust®. Look deeply into this. You will unearth more freedom for yourself perhaps. But do this for equity, truth and justice. Do this for your clients who expect you to collude with the problem of their body. Do this in the name of wellbeing and liberation.

Hilary Kinavey, LPC is the cofounder of Be Nourished, a revolutionary business that helps people heal body dissatisfaction and reclaim body trust. The Be Nourished Training Institute offers training for helping professionals who want to move towards weight-safe and inclusive care. You may also find them on Facebook.