Why Weight-Inclusive Counselling Is Essential for Eating Disorder Recovery

One of the most persistent myths about eating disorders is that they have a “look” – often thin, white, young women. This belief causes harm to individuals and contributes to stigma in wider society. Weight stigma shapes how people are treated in healthcare settings, how seriously they are taken, and whether they receive support at all.

In my work as an eating disorder therapist, I’ve heard too many stories of people being overlooked and dismissed, especially those in larger bodies. Sadly, many are also recommended weight loss, which only worsens disordered eating. Clients often come into therapy carrying not just their struggle with eating, but also years of invalidation, confusion, and shame from being told they are “not sick enough” or “too big” to have an eating disorder.

As someone working from a weight-inclusive counselling perspective, and having experienced weight stigma myself, I understand how important it is to be heard, seen and believed.

Image: AllGo

​Atypical Anorexia Is Still Anorexia

One way weight stigma severely impacts access to eating disorder support is demonstrated by the label “atypical anorexia” given to those who don’t meet the “underweight” criteria for anorexia.

Atypical anorexia carries many of the same risks as anorexia (e.g. malnutrition) and is not “atypical” because there are so many people in larger bodies (and those deemed a “healthy” weight) engaging in restrictive eating. Due to weight stigma and anti-fat biases, our society often has difficulty understanding that many people at higher weights do restrict their food intake. People in larger bodies often are dieting and restricting, contrary to wider socio-cultural assumptions about greed and gluttony.

Many people in larger bodies who have restrictive eating patterns are praised for the pursuit of weight loss, encouraged to diet and restrict further, or sent to weight management services by healthcare professionals. These messages can exacerbate disordered eating and push the person further away from helpful support and recovery.

​Advice often recommended for people at higher weights (i.e. restriction) is deemed an eating disorder in thin people (Gotovac, 2020). The over-focus on BMI (Body Mass Index) and weight in the NHS and in eating disorder services prevents many people from getting the help they need.
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​The Impact Of Weight Stigma

Weight stigma and anti-fat bias are prevalent in healthcare settings, and weight stigma can impact people’s careers, education and relationships (Tomiyama et al., 2018). Clients of multiple marginalised identities, e.g. somebody who is not white, who is non-binary and at a higher weight, will face stigma, biases and discrimination in multiple ways that intersect. Stereotypes, assumptions and biases impact access to medical treatment, which creates barriers for those struggling with body image problems and disordered eating.

Weight stigma negatively impacts mental and physical health through increased stress, chronic (yo-yo) dieting and disordered eating. Emphasis can be placed on higher-weight people to just exert more willpower, on the incorrect assumption that everyone has the capacity to lose weight and to be thin if they just try hard enough. This creates more self-blame and shame for those struggling, and can keep people in cycles of disordered eating. Shame and punishment are never good motivators to look after your body.

Health advice on how we “should” eat is heavily influenced by white Western, neurotypical, able-bodied ways of eating, which favour restriction and deprivation of food as part of diet culture. Neurodivergent clients, in particular, can feel embarrassment and shame due to pressure from others to eat “normally”. Working from a neuro-affirmative and weight-neutral approach means building acceptance that everyone has their own way of eating that feels right for them, without the influence of outside norms or expectations.

Weight loss attempts are more associated with negative predictors of health and the development of eating disorders (Campos, 2004). A weight-inclusive approach can help clients move away from harmful weight loss behaviours, understand their relationship with food, and rebuild trust in themselves.
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​Why Weight-Inclusive Counselling Matters

Weight-inclusive counselling shifts the focus away from weight as a measure of health or success. It centres mental health and wellbeing without framing the body as something to be fixed. A weight-inclusive framework allows space to explore body image distress, disordered eating, and experiences of stigma without colluding with diet culture or the thin ideal. It means understanding and honouring harmful experiences the client may have faced due to their body shape or weight.

Offering a place to be heard is so crucial for those who have been dismissed, ignored and invalidated in the past. This allows for trust and compassion to be received and developed. This approach can be especially important for people with atypical anorexia, those who binge eat/emotionally eat who may have been recommended weight loss interventions, or anyone struggling with eating who feels they don’t fit a label. Weight-inclusive counselling can also be helpful for those who want to have counselling for other concerns, but want assurance that they won’t be judged or pathologised in any way for their body size.
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In my practice, clients in larger bodies often tell me they feel relieved to talk to someone who “gets it”. They don’t have to explain what it’s like to live under assumptions and stigma. They know I won’t assume just because they’re bigger they must want to lose weight. They know I won’t collude with diet culture. So they know they can come and talk about the stuff that matters to them the most, without judgement.
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Weight-Inclusive Practice For Therapists And Health Professionals

For those working in mental health or healthcare, this is an invitation to reflect on your own thoughts and feelings about weight. Many weight-based assumptions are deeply ingrained and can be unintentional, but well-meaning actions and comments can be harmful. This is not to blame or make anyone feel bad, as many of us have grown up swimming in diet culture. It’s an opportunity to reflect on your own experiences, including your own relationship with your weight and your body.
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We need a cultural shift to help reduce stigma and to create more size acceptance. But, as individuals, we can help by reflecting on our own biases and learning about these topics. For therapists, working ethically includes offering non-discriminatory practices, and this needs to include weight and size inclusivity to avoid harm.
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​Looking For Weight-Inclusive Counselling?

You’re in the right place! I offer counselling sessions online, usually weekly at £60 per session. Find out more about my counselling practice here.
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I offer a free 15-minute introductory chat on Zoom, to start the process. Get in touch and let me know your availability, and I’ll get back to you as soon as I can.
 

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About Mel

​Mel Ciavucco is an integrative counsellor, writer and trainer, specialising in eating disorders and body image, and also trauma and sexual abuse.

She has worked in mental health charities for over a decade, including domestic abuse services and eating disorder charities.

​Mel writes informative content on her blog about disordered eating and more.
Read more blogs here.

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