Facing Our Client Prejudices

How to Transform Assumptions about Overweight Clients

Judith Matz

Question-smQuestion: I’m comfortable working with clients on all types of issues, but I notice that when I meet with clients whom I consider fat, I feel a sense of disapproval toward them. How can I change my attitude?

Answer: When I started specializing in eating and weight issues, I made many of the negative assumptions that are common in our culture about people who are fat—that they’re overweight simply because they overeat, and that if they normalized their relationship with food, they’d lose weight and be healthy and happy. Despite my best efforts to accept them for who they were, some part of me still made judgments about their body size.

Over the past couple of decades, I’ve spent a lot of time examining my own attitudes about body size, weight and, and health. I’ve immersed myself in research that shows overwhelmingly that diets and weight-management programs produce only short-term weight loss. To date, not a single program has data to show long-term success, considered to be two to five years. Although you may know someone who has sustained a substantial weight loss, the chances for that outcome are about 5 in 100.

In shifting how you think about—and ultimately help—your clients, it’s helpful to consider the idea that weight is a characteristic, and not a behavior. It’s not simply a matter of calories in and calories out, and our weight-regulation system is largely outside of conscious control. All sorts of variables influence weight, including genetics, frequency of yo-yo dieting, medications, and the environment. By focusing on sustainable behaviors, such as exercise, eating a wide variety of food, getting a good night’s sleep, and practicing mindfulness or meditation, your clients are in the strongest position to reach their goals for health and well-being, regardless of whether they lose weight in the process. Likewise, for higher-weight clients who also struggle with binge or emotional overeating, resolving these issues can, but won’t necessarily, result in some weight loss as a side effect. This paradigm, known as the Health at Every Size (HAES) approach, is gaining greater recognition as an evidence-based framework that supports the well-being of people of all shapes and sizes.

I’ve come to believe that the way we as therapists feel about our clients’ body size is not only a clinical concern, but a social-justice issue. It’s not easy to challenge internal attitudes that are reinforced every day in the general culture, but if you’re willing to go against the cultural current, there are some things you can do to help you assess—and transform—your internalized views about weight and dieting.

Read Judith's complete article, "Beyond Lip Service: Confronting Our Prejudices Against Higher-Weight Clients," in the March/April 2014 issue of Psychotherapy Networker magazine.

Topic: Professional Development

Tags: client prejudice | diet | Judith Matz | overweight clients | prejudice

Comments - (existing users please login first)
Your email address will not be published. Required fields are marked *


Friday, May 2, 2014 4:01:11 PM | posted by karena
Ms. Matz seems to make the assumption that the hypothetical overweight client in question has come for help with their weight. Let us not overlook the obvious: obese people have challenges and issues just like people of other shapes. It may be that overcoming our prejudices in treating obese patients has to do with seeing them as more that just a body and relating to the person as an individual. Overcoming our prejudices about a client's body shape may demand more of us than an understanding of what makes people obese. We must look into ourselves to find the solution to this puzzle.

Thursday, May 1, 2014 1:37:47 AM | posted by Beth Cohen
I think the article just touched upon issues surrounding weight in America. Just prior to reading this I was listening to podcasts from some of the country's leading experts such as Dr Jonny Bowden, Dr Peter Attia, John Romaniello and Mark Sisson on diet, exercise and weight loss in " the total fat loss solution summit." The food industry is invested in making sure Americans adhere to the standard American diet of mostly processed foods. The American dietitian association has for the last 30 yrs espoused the high carbohydrate, low fat diet that actually put people on the path to obesity and diabetes. Therapists need to become very educated about the facts and myths surrounding obesity and weight loss. Diet, Exercise, Toxins( food sensitivities
that influence hormones), Stress and Sleep all play a part in obesity. I would hope the more knowledgeable the therapist the less judgmental they would be.

Wednesday, April 30, 2014 4:22:23 PM | posted by Colleague Last Name
I'm very disturbed by this article. It seems as though it normalizes a therapist's prejudice toward a client for being overweight. I realize we are humans, too, and have our own beliefs and values, but to have to teach yourself how not to be prejudiced against a "fat" person who comes to you for help is ridiculous. We hold ourselves to a higher standard than the general public when working with mental illness and other emotional issues, so why is the issue of weight any different? As the author points out, there are a tremendous number of factors that influence a client's weight. Our therapy rooms are supposed to be safe places for any of our clients to come to us for help in, not another place where they have to worry about being judged.

Wednesday, April 30, 2014 3:26:15 PM | posted by theresas2
Well said. It is a complicated public health problem, rather than an individual failure of willpower. Being healthy is important - exercising, eating whole foods, having skills to cope with stress. But, the fact that large numbers of people are now overweight suggests something larger is at play in terms of advertising, food additives especially HFCS, mass production of food, and an increasingly sedentary lifestyle.