Recognising weight stigma in therapy

Despite growing awareness of diversity and inclusion, weight stigma remains largely absent from most counselling training and supervision spaces. Fat clients often enter therapy already carrying a history of trauma, not just from interpersonal experiences, but from the way our culture and institutions treat their bodies as problems to be solved.

This article draws from emerging research, including my own MA research investigation, to explore how weight stigma manifests in therapy, and how we can move toward more affirming, anti-oppressive practice.

What the research says

Mainstream health and therapy services tend to follow a weight-normative approach, where fatness is pathologised and thinness idealised. As Tylka et al. (2014) and Calogero et al. (2019) argue, this model equates body size with health, morality, and personal responsibility while ignoring the complex biological, social, and psychological factors that influence body weight.

Stigma, not weight, is often the real health risk

Research shows that experiences of weight stigma are associated with:

• Disordered eating and chronic dieting (Bacon & Aphramor, 2011)
• Higher rates of depression, suicidality, and shame (Puhl & Suh, 2015)
• Delayed engagement with healthcare due to experiences of dismissal and discrimination (Puhl & Heuer, 2009)

My own research is underway, exploring the extent to which recently qualified therapists explore their own anti-fat bias during their training and their confidence and ability to offer fat clients a truly weight-inclusive, anti-oppressive space.

Why this matters in therapy

Fat clients regularly face microaggressions in and outside of therapy, such as being told to consider weight loss, comments about food choices, assumptions about movement habits, having body image or medical concerns dismissed, or encountering silence when they speak about fatness as an identity. As Cooper (2016) notes, even therapeutic silence can echo societal disapproval when it comes to fat bodies.

Therapists who aren’t aware of their own conditioning may unintentionally reinforce the very systems their clients are trying to heal from. This includes:

• Overemphasising food or exercise in therapy.
• Assuming fatness is linked to trauma or lack of self-control.
• Avoiding body-related conversations out of discomfort.

Working in a weight-inclusive way: Practical guidance for therapists

The weight-inclusive approach, as outlined by Bacon & Aphramor (2011), applied to therapeutic context in Calogero et al. (2019) and expanded in critical fat studies, shifts the focus from weight to overall well-being, autonomy, and dignity. Here’s how therapists can begin to integrate it into practice:

1. Explore your own bias

• Take the Harvard Implicit Association Test (IAT) on weight.
• Reflect on how your own body image and social conditioning may shape your clinical lens.

2. Use neutral, affirming language

• Avoid clinical terms like “obese” or “overweight” as they are pathologising and stigmatising by nature.
• Ask clients what language feels safe and empowering for them. Some may prefer to reclaim “fat” as a neutral descriptor.

3. De-pathologise fat bodies

• Don’t assume weight loss is a goal or a solution.
• Shift from “fixing” bodies to supporting clients in developing agency, connection, and trust with themselves. Be aware of an additional layer of disconnection and shame a fat person might be carrying in terms of the body. 

4. Validate lived experience

• Ask open questions like: “What has it been like to move through the world in your body?”
• Name and normalise the impact of anti-fat bias without turning it into a personal failing.

5. Broaden the definition of embodiment

• Recognise how fatness intersects with race, disability, gender, and trauma.
• Create space for clients to define health, movement, and care on their own terms.

6. Commit to ongoing learning

• Read from fat activists and scholars (e.g., Charlotte Cooper, Virgie Tovar, Ragen Chastain).
• Incorporate weight stigma into CPD, supervision, and peer reflection groups.

Fat clients deserve more than neutrality; they deserve active, compassionate, affirming therapeutic care. This means naming the systems that harm them and holding space for the stories they were never allowed to tell.

References 

(Selected from a wider literature review for article clarity and brevity.)

• Bacon, L., & Aphramor, L. (2011). Weight Science: Evaluating the Evidence for a Paradigm Shift. Nutrition Journal
• Calogero, R.M., Tylka, T.L., & Mensinger, J.L. (2019). Scientific Weightism: A View of Mainstream Weight-Stigma Research Through a Feminist Lens. Frontiers in Psychology
• Cooper, C. (2016). Fat Activism: A Radical Social Movement
• Puhl, R.M., & Suh, Y. (2015). Health Consequences of Weight Stigma: Implications for Obesity Prevention and Treatment. Current Obesity Reports
• Tylka, T.L., Annunziato, R.A., Burgard, D., Daníelsdóttir, S., Shuman, E. and Davis, C., 2014. The weight-inclusive versus weight-normative approach to health: Evaluating the evidence for prioritising well-being over weight loss. Journal of Obesity, 2014, pp.1–18. https://doi.org/10.1155/2014/983495
• Puhl, R.M. and Heuer, C.A., 2009. The stigma of obesity: A review and update. Obesity, 17(5), pp.941–964. https://doi.org/10.1038/oby.2008.636