How can we make therapy safer for fat people with eating disorders?

The term "fat" here is used as per Aubrey Gordon's plea in the Your Fat Friend documentary. I know this word can be difficult for some, but there is an effort to reclaim this as a neutral descriptor. Please watch the film if you need more info on this!

I recently saw “Your Fat Friend”, a documentary about Aubrey Gordon made by Jeanie Finlay. I’m a big fan of Aubrey’s work, her books, blogs and podcast - Maintenance Phase. She’s been a huge influence on me both personally and professionally. I'm a counsellor and I work with people struggling with eating, body image and the impact of weight stigma. I’m passionate about highlighting the importance of helping those in larger bodies with eating disorders, and training other counsellors in understanding disordered eating and weight stigma. This film just lit even more of a fire in me.

Image: https://www.yrfatfriendfilm.com/

From February 2025, Your Fat Friend is available on iPlayer. I highly recommend this film  as a form of CPD (continuing professional development) for counsellors and therapists as it's so important in our roles to reflect on anti-fat bias. In this blog, I explore how we can help make therapy safer for people in larger bodies, particularly in the context of disordered eating.

In one part of Your Fat Friend, Aubrey opens up about having an eating disorder and the barriers for fat people trying to access help. She says eating disorder treatment/support for fat people literally doesn’t exist. This simultaneously broke my heart but also I wanted to shout "BUT THAT'S WHAT I DO!" at the screen. It felt like my work was validated, but at the same time I was, and have been for a long time, saddened by how many people struggling with disordered eating don't get the help they deserve.

I’ve worked for eating disorder charities in various roles for over 8 years now and it’s always disheartening to hear stories of being turned away from NHS services for not being “thin enough”. And, if a fat person has an eating disorder it is assumed that must be binge eating. This is absolutely not the case; people in smaller bodies can struggle with binge eating and fat people can struggle with restrictive eating. Binge eating can often include restriction (eating less than your body requires) and it’s part of what keeps the cycle going – restrict, binge, feel guilty/ashamed, and double-down on restriction again. It’s called a binge cycle and can also be applied to dieting – diet, “fail” at the diet, shame, back to dieting. This is how diet companies make money (sometimes now not using the word diet, but “wellness” or some other fluff), because it’s never the diet’s fault, right? It’s ours for lacking willpower, being lazy/not good enough etc. This is why dieting does not “work”, it’s just creating more shame, more anxiety, more self-blame, and ultimately creating more disordered eating.
 
Aubrey also mentions Atypical Anorexia, basically just the same as anorexia but not fitting the low BMI threshold to tick the box of being “sick enough”. This is extremely harmful as it’s stopping so many people from accessing services (though in the UK this is likely largely due to significant underfunding of ED services). This also means we have limited hope of “early interventions” which the NICE Guidelines state are so important for eating disorders. Being turned away for help, or anticipating not being able to get help, can often just exacerbate the disordered eating, with people feeling there is nowhere to turn. This was very much the sense I got from Aubrey talking about having nowhere to go as a fat person with an eating disorder. It’s so hard to have trust in professionals when they have all grown up in the same fatphobic, diet culture, and have little to no training in this. 

​When I was training to become a counsellor I realised this was very much the case for our industry too. Nobody talks about eating, body image, weight stigma or fatphobia, yet it is extremely likely counsellors will encounter people affected by these issues at some point. This is why I'm so passionate about this work and filling this gap – we must make it safer for fat people to access therapy.  Counsellors need to know about eating and body issues through an intersectional lens, looking at power, privilege, class and biases. Sadly, in my experience, this is not happening anywhere near enough as the industry is prominently white and middle class, and this is even more so in the eating disorder world. Both research into eating disorders and treatment services are run by thin, white, middle-class women, focussing on helping thin, white, female clients. There are so many people left out of eating disorder treatment, not only fat people but black people, disabled people, trans and non-binary people, and many more minoritized people. Getting help isn’t safe enough for so many people. This has to change.
 
In all honesty, the difficulty I find in writing about these issues is that I don’t want to scare people or put them off trying to find help and support. I want to raise awareness of what’s going wrong so we can work on changing it, but for individuals seeking help, I don’t want this to be another thing that reinforces the idea that there is no help for them. There is help (I'm just one practitioner doing this work!) and there are others who will advocate for the safety of fat people. 

Aubrey says in the film, “you can’t self-love your way out of oppression” which I totally get, but whilst it's still hard to change societal views, we can help fat people feel safe enough to start healing. It may always be hard navigating the world as fat person but there are ways to help process that trauma, and build resilience and self-compassion. Fat people deserve to heal and we as practitioners need to make sure that can happen safely.

So what can we do? Here are some suggestions to help make therapy safer for fat people:

• Read/listen to everything that Aubrey Gordon has ever done and watch Your Fat Friend if you haven't already!
• Do extra CPD training on weight stigma/fatphobia (I offer this, check out my workshops page)
• Reflect on your own relationship with food, your body, and about fat bodies. We have all grown up in an anti-fat culture so nobody is exempt!
• Reflect on how body size intersects with other aspects of identity eg gender, class etc (this is something I cover in more detail in my training)
• Use diverse images, including fat people, on websites/social media
• If working in-person, make sure the room is accessible with larger chairs/no arms on chairs
• Avoiding using weights, numbers, BMI etc where possible and avoid food diaries and encouraging tracking as this can be shaming (if working for eating disorders services this may not be possible)
• Throw weight loss out the window – healing should not revolve around weight (again, in ED services this will not be possible). Weight is not a measure of health, and health is not a prerequisite for respect.
• Services and charities can help by elaborating on the popular slogan “eating disorders don’t discriminate” (erm, yeah but people do!) We keep being told that ED’s can come in all genders, bodies, ages etc, so why aren’t we seeing and why aren’t people experiencing that? How can you show that you don’t have discriminatory practices against fat people and minoritized groups?
• Just let fat people be fat, alright?

 
I am proud to work with people in larger bodies who are struggling with a range of eating problems and body distress. Sometimes I feel like I’m the only person in their life who doesn’t tell them they need to lose weight. We need more counsellors, therapists and people working in the eating disorder field to help fat people feel that they are safe, welcome, and cared for. 
 
Thanks for reading. If you’re interested in having counselling please head to my counselling page for more info. If you’re interested in my workshops and trainings, I’ll be offering more soon so check out my workshops page and sign up to my mailing list and I’ll let you know when more dates come up. Thanks!

​Your Fat Friend trailer: