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  • Writer's pictureMeg

On Being a Fat Therapist

Therapists have power in the therapy room. Sometimes we think we do not, sometime we confuse a client’s ability to leave and find a new therapist with the structural power that comes from being the expert in the room. We can specifically work to deconstruct those dynamics, and even then we have power. But that power is not absolute. Larger social dynamics still exist.

Being fat in today’s society means a constant awareness that for a large number of people around you, your body is their worst nightmare. I stand in groups with thin people talking about their diets at parties and my stomach knots as they describe how their extra five pounds makes them disgusting. I stand there knowing that I would have to lose half my body weight to get to the place they are now. What does that make me?

This dynamic exists in therapy. Many many clients want to lose weight, and though their comfort discussing the details with their fat therapist varies, in session clients often comment about their weights, and their goal weights, and their body hatred.

Therapy is an appropriate place to discuss these things. Therapy is perhaps the most appropriate place to discuss these things. AND it’s damn hard listening to a client discuss their body nightmares knowing that my body is pounds heavier than their nightmare weight.

I have been on the diets, I have weight cycled, I have had the eating disorders, I have done the diets rebranded as lifestyle changes and believed for every noomilicious moment that I could stop being fat. I am done with that. I have done the research, I know the food science, I know that weight cycling (gaining and losing weight over and over often from trying diet after diet) is more dangerous health wise than fatness and I know that my fat body is precious, just as precious as the thin bodies we idolize in this culture.

When a client tells me about their new diet, their intermittent fasting, paleo, keto, old school Atkins, WW (has the rebrand worked? Have we forgotten WW was once weight watchers?) etc. my heart sinks. I know that they will probably lose weight and then, in all likelihood, like 95% of dieters, they will gain it back over the next few years. Probably they will end up heavier than when they started. Worst case they will have a shiny new eating disorder.

I am not a registered dietician (RD) and I am not an MD. I am a therapist - an LICSW. It would be outside my scope of practice to counsel these clients how to change their eating, and it feels uncomfortable as a fat person to try to convince these clients about body love over body reduction. So many people believe body reduction is body love and I believe firmly in meeting clients where they are and not imposing my beliefs on them.

Often I take a harm reduction approach. I provide access to scientific information, I brainstorm with them how to mitigate negative consequences, I refer them to RDs without dieting mindsets and encourage them to research and to ask their MDs tough questions about things like weight loss drugs. I try to encourage critical thinking. I do not tell them to stop. I want to tell them to stop.

Occasionally I get a client who wants to support a loved one on their weight loss journey. I recommend books to them (usually You Just Need to Lose Weight and 19 Other Myths About Fat People by Aubrey Gordon) and I tell them to try to keep the focus on health and not on weight. Inside I wonder if my family or friends have ever had conversations like this with their therapists.

I am very open with clients that I am coming at this from a fat liberation perspective. This has not always been true. I have clients who started with me years ago before I was radicalized and they are, more often than not, the ones who want weight loss help.

My website has this disclaimer on the page about my work, “If you are looking for help on your weight loss journey I am not the therapist for you.” That’s a self-protective statement. I can no longer be the person with whom you strategize about weight loss. I can’t get excited for you that intermittent fasting is working or that you are on a new med that promises to “jumpstart” your weight loss. It is difficult scientifically and it is difficult interpersonally and I won’t do it anymore, or at least I won’t do it with anyone new.

I struggle with how to enact this change with current clients who bring up weight loss. I keep my harm reduction stance, and I remind them I am not their dieting accountability buddy, and I tell them that I will support them through anything that truly addresses health. There are no easy answers. I care deeply for these clients and want good things for them. I care deeply about myself and want good things for me.

Fat therapists: How do you handle it when your clients want to lose weight? Do you feel self-conscious when thin clients talk about their bodies? Drop a comment or shoot me an email at

Want to work with me? Click the work with me link above or just email me at

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