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.