Handling Client Anxiety About Weight Gain

When someone breaks up with diet culture to focus on healing their relationship with food, body, and self, it is not uncommon for weight gain to occur. Chances are the weight of a person, after years of chronic dieting and disordered eating behavior, is not their natural set point. As they let go of their tight grasp for control and the reins on their eating behavior are loosened, it is extremely common for there to be some backlash as they work on neutralizing food and eating while becoming more attuned to internal cues of hunger and fullness. This is often uncomfortable for many reasons: 1) the person is used to having a ton of food rules to follow so they often feel like they are flailing when they let go of the culture’s ideas of “right/wrong, good/bad, healthy/unhealthy”, and 2) weight gain tends to occur as eating is normalized and the focus turns toward healing their relationship with food/body (which is only possible when thoughts about controlling the size, shape and weight of the body are put on the back burner).

Making promises about what their weight will eventually be is not the answer to their discomfort. Telling people they are”restoring weight, not gaining weight” is not the answer. Making statements like “we aren’t going to make you fat” is also not an answer. We must avoid reinforcing the BMI as a meaningful measure of health (or recovery from an eating disorder)—we all know it is not. The truth is we don’t know where weight will settle, but their body does know, and our job is to support them in cultivating body trust. We do this by not reinforcing weight stigma.  

So, when we have people sitting with us expressing concern about what will happen (or is happening) with their weight, our job is to honor and make room for that discomfort. We can: 

• Let people know weight gain is to be expected (and is a common experience early in the healing process) after years of chronic dieting and disordered eating.

• Explain how it is unethical for us to make any promises about what their natural set point weight is. (If we do, we are just colluding with the dieting mind and are no different than the diet industry). Acknowledge how uncomfortable this time can be.

• Reassure the client by letting them know that their body isn’t just going to keep gaining and gaining and gaining weight, just like bodies don’t often keep losing and losing and losing. The body will draw a line somewhere and we trust their body to sort it out.

• Challenge the mechanistic thinking dieting culture promotes. Help people understand how weight regulation is far more complicated than the “calories in vs. out” equation we are sold. Read the book Body Respect by Drs. Linda Bacon and Lucy Aphramor to learn more about the science of weight dynamics. Recommend the book to clients. Keep a copy in your waiting room.

• Encourage people not to step on a scale to see what their weight is because it disrupts months of progress. Also work to reduce other body checking behaviors (feeling for bones/fat, mirror gazing, clothing checks, etc).

• Provide reassurance by reminding people that normalizing food and eating behaviors after years of chronic dieting and disordered eating takes time. Discuss findings from Ancel Keys’ semi-starvation study. We find it is especially helpful to highlight how it took many men in this study up to one year to normalize their eating after only one six month period of restricted intake. If they’ve been engaged in disordered eating for years, it is going to take time to heal.

• Recommend they, at a minimum, buy a bra (if applicable) and a pair of pants/jeans that fit so they are comfortable. People can also purchase button extenders to let the waist out an inch or so, which in some cases creates enough room to be comfortable in their current clothes.

• Avoid mentioning thyroid dysfunction unless there is a known history of thyroid disorder or you have good reason to believe this might be the case. Blaming weight on thyroid dysfunction just reinforces the idea that there is something wrong with their body and if we just find the right fix, they will have a “normal” BMI. This is essentially fat shaming and normalizes the thin ideal.

• Talk about the grief that comes when we sit in a body that is difficult to accept (because of the culture we live in), while also knowing that dieting and disordered eating are no longer an option. Reinforce awareness that weight loss attempts are doing more harm than good. Letting go of the thin ideal (and the illusion of control) is the death of a dream. Make room for this grief, over and over again. This is not just work for the therapist; we can all learn to hold space for people when they most need it.

• Express empathy. It is one of the most healing gifts we can offer. Empathy, at its essence, means feeling with someone. What is the predominant feeling in the room? Sadness, anger, fear, joy? Ask about that, acknowledge that, support that. Feelings don’t resolve when ignored or placated. They seek acknowledgement.

• Help others see and name beauty where it has not been named before. Ragen Chastain says “The ability to perceive beauty is a skill, so if I can’t see the beauty in someone, it’s not because they aren’t beautiful, it’s because my skill set is lacking.”

• Be aware of and check your own size bias. Providers also live in this toxic culture that pathologizes certain bodies while worshipping others. Your internalization of the thin ideal will impede your ability to help clients heal body shame. You cannot help your clients go further than you’ve gone. We believe strongly in the need for embodied practitioners. We understand why you hold these feelings. You don’t have to hide them. We do, however, believe you must address them.

Our mission, as helping professionals, is to help people develop the resiliency needed to live in a world filled with weight bias. These conversations can be uncomfortable, and yet it is the only way we can truly help people heal without reinforcing weight stigma and colluding with the dieting mind.