Working from a Weight-Inclusive Perspective with Clients Who Want to Lose Weight

Author: Alexis Conason, Psy.D., CEDS-S

“I need to lose weight,” Kira* explained as she sat across from me in my office during our initial consultation session. “I’m just not healthy at this weight. My knees hurt and my doctor said that if I don’t get my weight under control, it’s only a matter of time before I develop diabetes. Plus, I don’t feel good about myself now. I would be much happier if I could lose some weight.” 

How would you respond to Kira? 

As mindful eating professionals, most of us have had clients like Kira who come to us seeking weight loss. In my practice as a psychologist specializing in the treatment of binge eating disorder and disordered eating, I would say that most of my clients present for treatment wanting to lose weight. As a Health At Every Size ® informed professional dedicated to working from a weight-inclusive perspective, this may seem like a dilemma. How do we work from a weight-inclusive perspective with clients who want to lose weight? 

Here are 3 strategies that I rely on in my practice. 

  1. Validate. Fatphobia is real and it sucks. Fat people are less likely to be hired for jobs, less likely to be promoted, and are paid less than their thinner peers. Weight bias runs rampant in the medical system and weight-based discrimination leads to serious health complications (ironically many of the same ailments blamed on weight). It is stressful to navigate an environment that wasn’t built to accommodate your body. And the constant drone of people telling you that your body is bad is exhausting. So, it makes a lot of sense that our clients want to lose weight. As providers, it is important that we hear and recognize this. If we deny the reality of fatphobia, we are gaslighting our clients—something that none of us wants to do. 

  2. Pursuing weight loss doesn’t work. Just because fatphobia is real, it doesn’t mean that the answer is to lose weight. We don’t need to shrink our bodies to accommodate an oppressive system (but we can fight to change the system to accommodate all bodies!). Besides, we don’t have a good way for people to lose significant amounts of weight and maintain that weight loss long-term. Dieting (and other forms of intentional weight loss, like “lifestyle changes,” which are often euphemisms for dieting) is linked with an increased risk of eating disorders and disordered eating, increased body image dissatisfaction, weight cycling, and other psychological and medical risks. It is estimated the dieting fails to result in long-term weight loss for as many as 94% of people. I don’t know about you, but I don’t feel comfortable recommending something with such a high failure rate and such a high risk of complication. 

  3. Focus on what we can do. Just because we don’t offer our clients intentional weight loss, that doesn’t mean we can’t help our clients who come in seeking weight loss. Ask your clients why they want to lose weight and see if that is anything you can help with. For example, my clients often want to improve their health, improve their relationship with food, and feel better about themselves—all things that are totally in my wheelhouse and can be worked towards completely independent of weight loss. I’m upfront with my clients about what I can help them with and what I can’t (and why). Weight loss is commonly used as a stand-in for other things that we want in our lives (i.e. escape from fatphobia, health, love, acceptance, etc…); I find that when my clients and I talk about their goals underlying “weight loss,” we are very much on the same page. 

Mindfulness offers us a trove of skills to work from a weight-inclusive perspective with people who want to lose weight including (but by no means limited to) the capacity to simultaneously hold seemingly conflicting ideas, compassion, acceptance, and, of course, mindful eating.

The practice of mindfulness builds our capacity to hold our clients’ desires to lose weight, the suffering that stems from fatphobia, the ineffectiveness and harm that results from pursuing weight loss, and the possibility of acceptance. This can help us meet our clients where they are with a sense of compassion for their desires to lose weight while also holding space for an alternate path for healing.  

Diet-culture, as defined by Christy Harrison, is a system of beliefs that equates thinness with health and morality, promotes weight loss as a way of attaining higher status, and oppresses people who don’t meet this ideal. It is a pervasive aspect of many cultures and leads to people feeling deep shame about their body. In mindfulness, we foster a sense of compassion for self and others. Compassion is the antidote to shame and can be transformative for people struggling with their relationship with food and their body. 

Non-judgmental acceptance, another facet of mindfulness practice, is also important in working from a weight-inclusive perspective with people who desire weight loss. Related to the body shame discussed above, desires to lose weight are often triggered by difficulties with accepting one’s body. After all, it is hard to accept your body when society tells you that your body is unacceptable. Mindfulness practice helps build a sense of non-judgmental acceptance where people can embrace the reality of their body in the current moment without judgment and with compassion even if they don’t like their body in the moment. Acceptance and compassion can shift the way we relate to our body and care for it, approaching from a sense of nurturance instead of harshness. In my work, I find that people often mistake acceptance for liking and/or resignation that things will always be the same. It can be important to educate our clients on the difference between acceptance and liking and emphasize that acceptance doesn’t preclude change; in fact, acceptance sets the stage for change.

As discussed above, weight loss can be a stand-in for other goals and desires, including improving one’s relationship with food. Of course, mindful eating is a great practice for this! Research suggests that mindful eating is associated with improvements in binge eating and other cycles of disordered eating. Mindful eating, practiced with a strong foundation of compassion and non-judgmental acceptance, can help our clients develop a more peaceful relationship with food and their body and help guide clients towards ways of authentically caring for their body with satisfaction and pleasure. 

Working from a weight-inclusive perspective may be a new paradigm to many people. It can feel overwhelming to ponder an entirely different way to approach this work. At TCME, we believe that mindful eating is inherently weight inclusive. It is anchored in mindfulness practices that focus on acceptance and compassion and prioritizes listening to the wisdom of your body instead of trying to override your body’s internal cues with rules from diet-culture. Read more about our statement on weight inclusivity here

Do you want to work with mindful eating from a weight-inclusive perspective but aren’t sure where to start? We have great news! TCME is launching a one-year certificate program that will help you build competence and confidence in teaching mindful eating. For more information on the program, check out our webpage here. 

*a fictionalized client.

1 Sarlio-Lähteenkorva S, Rissanen A, Kaprio J. A descriptive study of weight loss maintenance: 6 and 15 year follow-up of initially overweight adults. Int J Obes Relat Metab Disord. 2000 Jan;24(1):116-25. doi: 10.1038/sj.ijo.0801094. PMID: 10702760.

About the Author

Alexis Conason, Psy.D. is a licensed psychologist in private practice in New York City where she specializes in the treatment of overeating disorders, body image concerns, sexual functioning, and psychological issues related to bariatric weight loss surgery. She is the founder of The Anti-Diet Plan, a mindfulness-based program for the treatment of overeating disorders and body image concerns. She is frequently featured in the popular press and is the author of the “Eating Mindfully” blog on Psychology Today. Dr. Conason is a fierce advocate for helping people recognize and question the societal norms that encourage feeling not good enough about ourselves so that we can live our most fulfilling and meaningful lives—at any size! 

You can find Dr. Conason on the web at as well as Twitter (@conasonpsyd), Facebook (Alexis Conason, PsyD), and Instagram (@theantidietplan).