Weight-inclusive care means that you receive the same professional level of healthcare regardless of your weight. Weight-inclusive care means that the size and shape of your body do not determine whether you are acknowledged, respected, and listened to by your provider.
I’m Michelle F. Moseley, a Licensed Clinical Mental Health Counselor in NC and a Certified Body Trust Provider who provides weight-inclusive mental health services. I am also a fat* woman who has a history of disordered eating. I regularly work with individuals who are navigating body image concerns or feelings of being disconnected from their body, always utilizing a weight-inclusive approach.
What is anti-fat bias?
A weight-inclusive approach to care (both physical and mental healthcare) is not the norm in the United States. In fact, many individuals in larger bodies avoid seeking medical or mental healthcare due to multiple experiences of anti-fat bias with providers.
Anti-fat bias describes the stigma and discrimination that larger-bodied people face based solely on body size. In healthcare, anti-fat bias can include experiences such as:
- Not being provided a size-appropriate drape when being seen for a mammogram; therefore, having to walk through the corridor with your breasts barely covered.
- Being seen for a sinus infection and receiving a 15-minute lecture about your body size and the need to be smaller.
- Not having a single medical or mental health provider inquire about potentially harmful disordered eating behaviors because your body is still large despite drastic changes in a short period of time.
- Having a colleague (who is not your medical provider) comment about your weight in relation to a health concern that they know nothing about.
These types of things happen regularly to folks in larger bodies. All of the above are examples of my own experiences. These kinds of interactions are a top reason that many fat people avoid medical appointments, sometimes leading to complications that could have been prevented with respectful, weight-inclusive care.
What Are Other Approaches to Care?
The typical model of care described above is known as a weight-normative / weight-centric approach. In this model of care, an emphasis on weight and weight loss is the focus when defining a person’s health and well-being. This model of care overlooks many other factors that can play a role in someone’s overall health and well-being. Factors that are often not considered include: finances, access to supportive relationships, life stressors and skills to cope with them, adequate housing, and time to engage in enjoyable activities. When the emphasis is on weight and body size, many contributors to overall well-being are missed.
The weight-normative approach to healthcare leads to body size being viewed as a moral issue – smaller bodies seen as good, larger bodies seen as bad. Body size is viewed as one-dimensional, with the responsibility for body size lying on the individual’s willpower. This misses the huge impact that genetics and financial access have on a person’s body size and overall health.
Another approach to healthcare is a weight-neutral approach. This approach expands the emphasis of healthcare to include overall wellbeing, factoring in aspects beyond only weight and body size. A weight-neutral approach is more supportive and helpful to individuals of all sizes, creating space for providers to discuss multiple aspects of health rather than only focus on weight. However, even a weight-neutral approach can leave many folks in larger bodies feeling judged, blamed for their body size, and excluded from care.
What Makes Weight-Inclusive Care Different?
Weight-inclusive care is actively inclusive of all bodies. This means being proactive in making decisions that include and welcome folks of various sizes, shapes, and abilities. While a weight-neutral approach doesn’t make body size the main emphasis of care, it may still exclude certain bodies based on availability of seating options or ability to discuss caring for bodies of various sizes or abilities. A weight-inclusive approach is built on intentional decisions to make a space and the services provided inclusive and respectful of folks, with various body sizes and abilities being actively considered.
Weight-inclusive care includes:
A space that welcomes a variety of bodies. This starts with the entrance to a physical space and continues to the seating available and the equipment or interventions that are utilized. Things like a ramp, an automatic door, a variety of seating options (high, with arms, without arms, wide, etc.), and a hallway that can accommodate various body sizes and/or assistive equipment are all part of weight-inclusive care.
In a medical setting, there should be gowns of varying sizes (because people come in varying sizes), as well as equipment that fits a variety of bodies (think blood pressure cuffs). If appropriately-sized equipment is not available, the provider/facility should take responsibility for that oversight and not place blame upon the person seeking services.
In a mental health or therapy setting, there is rarely a need for weighing folks. Some medications may require a weight for proper dosing or tracking side effects, but a weight-inclusive prescriber will explain this need and allow options for a patient to not view or be told their weight if they prefer not to know.
The discussions in therapy with a weight-inclusive provider do not center body size. In fact, weight or body size may only be part of the discussion if / when a client expresses a desire to talk about this. For example, I may ask about eating habits or body changes during an initial appointment with someone in order to better understand if they have concerns around nourishing themselves or have experienced any recent shifts in their body. This is part of gathering information about the person in front of me and does not impact how I view their worth. As a weight-inclusive provider who also works with lots of neurodivergent folks, I encourage folks in finding ways to nourish and care for their bodies that feel good and are accessible to them.
A focus on well-being, as defined by the person seeking services. When I sought medical care for a sinus infection, well-being would be the ability to breathe freely. A weight-inclusive provider would focus on that concern, not provide a lecture about the size of my body.
A commitment to acknowledging and making efforts to reduce weight stigma. Weight stigma refers to the stereotypes, negative attitudes, and discriminatory behaviors that are directed toward people based on their body size. Larger-bodied individuals are aware of this and experience it on a regular basis. The store that doesn’t carry clothing in your size. The person who gives the side eye to your plate during a meal. The assumption that you are unable to participate in an activity based on size. The pervasive belief that everyone would be thin if they had enough willpower. The medical provider who does not listen to your concerns because all they see is the size of your body. This is weight stigma.
A weight-inclusive provider, regardless of their body size, is aware that weight stigma exists and believes their client when the client shares their experiences with these stereotypes and negative attitudes. We also work to reduce weight stigma through efforts such as educating colleagues and engaging in advocacy for more weight-inclusive spaces.
Weight-inclusive care is built on respect for each individual person, which is an integral part of adequate healthcare for individuals of all sizes. The outcomes of care – both medical and mental health – are vastly improved when the person seeking care feels heard, understood, and valued. This creates an environment where patient / client and provider can work together to determine the best path toward wellness, as defined by the person seeking care.
Next Steps
If you’re looking for a therapist in NC who provides weight-inclusive care, please check out my services. I work with folks who are dealing with body image concerns or feelings of being disconnected from their body. Even when the concerns discussed in therapy are not focused on body image, my commitment to weight-inclusive care means that I continue to value supporting clients in a way that offers respect and that honors autonomy. Take some time to look around my website and complete a contact form to schedule a free, virtual consultation to see if we might be a good fit for working together.
Not in North Carolina? You may want to check out the Directory of Certified Body Trust Providers to find someone near you who offers support from a weight-inclusive lens.
*A note about the word “fat”: I use this term as a neutral descriptor, and personally prefer it over the medicalized terms often used to describe individuals in larger bodies.
Michelle F. Moseley (she/her) is a Licensed Clinical Mental Health Counselor in NC (#12491). She believes ALL people deserve respect, compassion, and access to mental and physical healthcare. Michelle specializes in working with survivors of religious trauma, and with those who have body image concerns, finding there is frequent overlap in these areas. She also frequently supports late-identified neurodivergent individuals as they navigate the grief and relief of a new understanding of self. You can learn more about Michelle by visiting her website at MichelleFMoseley.com or following her on Instagram – @therapy_with_michelle
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