Making Your Clinical Practice More Weight Inclusive

I’ve been doing a few trainings lately to help therapists, psychiatrists, and dieticians make their clinical practices more weight inclusive. This means finding new language to talk about body size diversity, navigating conversations about eating and exercise, and accommodating a variety of bodies in their physical offices.

This matters because multiple studies have shown weight bias by medical professionals, by therapists, by social workers, etc. (Kinavey & Cool 2019, Puhl & Heuer, 2009, Socha, 2025). And we have documented evidence of the very real impacts of weight bias. We have see higher rates of anxiety and depression, higher rates of cardiovascular illnesses, increased risks for eating disorders and self harm, to just name a few.  (Wu &Berry, 2017, Tomiyama et al, 2018;  Zhang, et al 2019).

I’ve seen this directly in my therapy practice. I have seen countless clients who come to me after harmful experiences with other therapists! I’ve had clients who were encouraged to lose weight or diet, whose eating disorders were missed because they were in larger bodies, who experienced lack of knowledge or compassion about the realities of living in a larger body. 

I know this was my personal experience and what led me to create my own practice. I had a thin therapist who had never been fat, and would invalidate my experiences of weight bias in the world. She didn’t get it. And so she didn’t get a large part of my life. 

So, if you care about unlearning your internalized anti-fatness, if you want to be more inclusive of all kinds of bodies in your practice, here are some of my key tips! And for a much more in depth discussion of this, contact me for consultation and trainings! 

• Be thoughtful about your language. If you are not fat, or if the word fat still has a negative connotation for you, instead, use the phrase "in a bigger body". Do not use the “o” words of obese or overweight. 

• When talking with clients about their decisions around weight loss medications or psychiatric medications, how can you discuss the medications and side effects neutrally? 

• Gently help clients notice their own anti-fatness while validating experiences of living in a in an anti- fat world (especially if they are in a larger body).

• Challenge cultural assumptions around weight, weight loss, food morality, and exercise. What we often prescribe to folks with larger bodies would be considered disordered eating in folks with thinner bodies. Use critical thinking tools to evaluate where you learned about food, eating habits, and exercise and the hierarchy of good or bad foods, etc that you learned. Are you unintentionally perpetuating food morality?

• Value the lived experiences of their clients, no matter their weight. If a client in a larger body is telling you they feel unaccepted because of their larger body, really listen to them. Validate microaggressions are real. Don’t dismiss these experiences.

• Think before encouraging physical activity. This is a common intervention we offer to clients. Exercise helps with depression and anxiety, and movement is generally health promoting most of the time. But, we can miss the triggers, such as the temptation to over-exercise, fears of judgement, and negative past experiences with movement. So ask a client about their relationship with movement before blindly prescribing it. 

• Similarly, think before encouraging seeking medical care. This is also a common intervention of having the client check in with their PCP. It’s often appropriate for nonmedical clinicians to refer back to their medical team. However, we must understand the barriers anti-fatness creates in our medical system and the high rates of weight bias and medical trauma our clients may have experiences. So, again, as the client about their experiences before recommending!

• Be cautious before celebrating perceived weight loss. Be cautious in general when commenting on a client’s body and appearance. 

• Don’t assume someone in a larger body is unhappy with that body, is trying to lose weight, binge eats, or eats “unhealthily”. 

• Consider how your physical set up accommodates a variety of bodies. Look at the weight limit of you furniture, evaluate your waiting room chairs (do they have arms? Are there different sizes and widths of chair options?), and consider stairs or steps into your office building. How are you communicating with new clients about the accessibility of your space? Are you assuming everyone can handle the three steps into the building? This is about accommodating all bodies. 

• And last but very importantly not least- don’t talk about your own weight loss experiences! This should be self evident but it surprisingly is not. 

I can keep going with how to be more weight inclusive in your practice (and I do in my trainings), but the heart of it is to examine your own anti-fat biases. What have you learned about bodies, health, and weight? What do you believe about food and exercise? What have been your own journeys with body acceptance or body neutrality and where does body autonomy fit into your clinical framework?

Again, I can keep going with the self reflection questions! 

The work we do as clinicians matters, and it has a huge impact on clients. Let’s make sure it’s a positive impact by being weight inclusive in our approach. 

Comment what you would like to add to this list!