The Anti-Fat Bias Wrapped In “Health”: The Silence, the Subtext, and the Weight of Our Words
- Damara Loewen
- Dec 8
- 4 min read
In the therapy room, “health” can sound neutral, compassionate, even grounding — yet it often carries the weight of cultural bias we’ve inherited without realizing it.
Before we talk with clients about health, we need to understand what we’re actually saying, and what our words might be reinforcing.
In this post, we’ll explore three common ways anti-fat bias shows up in our language — through the words we choose, the assumptions underneath them, and the moments when we stay silent.
Each section offers reflection questions to guide you into noticing the subtle ways these beliefs and assumptions might take shape in your work.
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1. Are we using the word ‘health’ when what we really mean is ‘weight’?
Mental Health Professionals are trained to be supportive and nonjudgmental. So instead of telling a client directly to lose weight (which we may know may be harmful), we often default to:
“Let’s talk about healthy habits.”
“What would it look like to take better care of yourself?”
“Maybe focusing on your health will make you feel better.”
These sound supportive, but they can still carry an unspoken expectation: “Health means thinness.”
Please hear me, this isn’t about shaming you — the well-meaning, compassionate Therapist. It’s about recognizing how thoroughly we’ve been conditioned.
So we can begin to challenge those harmful narratives that we’ve internalized and which end up harming our clients.
Reflection Prompts:
When I talk about “health,” am I imagining thinness, weight loss, or “fixing” the body — even subtly?
What if what was most healthy for my client meant them gaining weight or not even trying to pursue weight loss?
2. Are we assuming what “health” should look like?
Many of us were trained within systems that treat higher weight as a clinical problem in and of itself. We are living in the age of the “Ob*sity Epidemic” after all — where a certain body size is commonly thought to be a “life-long, remitting chronic illness”. (1)
Our standard training and everyday lived experience instills in us - in every way - the idea that fat is bad and thin is good.
So naturally, we’re accustomed to:
Elevating “clean eating” or “healthy eating”
Measuring our exercise success by how much it changes our bodies
The constant pressure of optimizing our health
Tricks and hacks to help us avoid emotional eating
Striving for a goal weight
These assumptions can slip in without us even recognizing the bias and moral judgments inherent in them. But if we peel back the layers, we often find thin-centric beliefs hiding beneath the surface.
Reflection Prompts:
Do I assume that my clients want to lose weight or that they would benefit from successfully shrinking their bodies?
Where did I learn that? Who benefits from that belief? Who gets harmed?
Does talking about these things with clients in smaller bodies feel different for me than talking about them with my clients in larger bodies? How so?
3. What aren’t we saying? (The silence that speaks)
Sometimes the harm isn’t in what we say — but in what we don’t say.
A client shares:
a body-shaming experience
a humiliating doctor’s appointment
a lifetime of being teased
And we reflect the hurt back to them and meet it with compassion, but we don’t challenge the bias underneath their story.
When we leave that bit out we’re unintentionally treating that one experience as a story of personal trauma, and stop there. Something isolated. Not a poignant and painful example of the systemic anti-fat bias baked into our Diet Culture.
Even when it’s not our intention, when we fail to name the oppressive system, we end up agreeing with it. Not that we agree with the way our client was treated, but with the underlying premise.
In that silence, or in the comforting words that never mention the cultural anti-fat bias, we’re affirming the belief that Diet Culture is built on - “well, you could do something about it.”
Because we’re trained to secretly believe that underneath it all, the problem is our client and their body. Or at least that they could have done something to avoid that painful experience.
They could, even now, still do something about it. They can change their body so as to not give their abuser a reason to abuse them.
And that’s a message that none of us would intend to communicate to our clients.
Reflection Prompts:
When a client expresses weight fear or body shame, do I gently name weight stigma — or do I quietly move on?What stops me from naming it?
Am I really seeing the systems that oppress larger bodies?
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The process of becoming a weight-inclusive provider isn’t about getting it perfect. It’s about learning to notice — the words we choose, the assumptions we carry, and the moments when we stay quiet.
Diet Culture and anti-fat bias are so woven into our training, our society, and our reflexes that we often speak from them without realizing it.
That doesn’t make you a bad therapist. It makes you a human one.
But when we begin to see it — when we pause to ask, “What am I really saying when I talk about health?”, something shifts.
We create more safety. We reduce shame instead of reinforcing it. And we begin to offer our clients the dignity, autonomy, and respect they’ve always deserved.
Weight-inclusive care starts here - with curiosity, honesty, and the courage to examine the Diet Culture narratives we ourselves have internalized.
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Want to Go Deeper?
Download the free “Becoming a Weight-Inclusive Provider” workbook for Mental Health Professionals.
Deepen your professional competency by signing up for an online training for Therapists. Learn more and see upcoming dates.
(1) See, Ragen Chastain’s Weight and Healthcare Newsletter on Substack, “Should we rename Obesity?” posted on August 30, 2023.
