Q: I’m comfortable working with clients on all types of issues, but I notice that I feel a sense of disapproval toward clients I consider fat. How can I change my attitude?

A: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 considered fat. I assumed that they were overweight simply because they were overeating, and that if they only 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 health. I’ve delved into 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 useful to consider the idea that weight is a characteristic, 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…