As therapists, we work hard to create safe, welcoming spaces – but there’s one form of bias that often goes unnoticed, even by those of us with the best of intentions: fat phobia in therapy.
In a recent episode of the Good Enough Counsellors podcast, I had the privilege of speaking with Jo Reader and Cat Chappell, also known as The Fat Counsellors, about how diet culture and body shame can show up in our work – and how we can be more inclusive to people of all sizes.
If you prefer to listen, I also have a podcast that explores this topic. You can listen below.
If you would like to subscribe to the podcast, click here.
Why Fat Phobia Is a Therapist’s Issue
Fat phobia isn’t just about personal attitudes – it’s woven into our medical systems, language, and cultural beliefs. It tells us that thin is always better, healthier, and more worthy. Jo and Cat reminded me how deeply embedded this thinking is, even for those of us who believe we’ve “done the work.”
But the truth is, you can’t ignore the reality of diet culture. As Jo said, “We all have a body, and there is a hierarchy of bodies in our society. That doesn’t disappear in the therapy room.”
Internalised Bias Is Still Bias
Even when we don’t say it out loud, clients pick up on our assumptions. Cat shared how therapists can unconsciously collude in diet talk, or miss signs of disordered eating because the client doesn’t fit the stereotype of someone with an eating disorder.
It’s not always about the things we say directly – it’s also about the attitudes we carry silently. We may nod along when clients talk about dieting without curiosity. Or we might avoid exploring body shame because it feels uncomfortable.
As Jo pointed out, these unconscious biases can still shape the therapeutic relationship. And clients often know, even if we haven’t said anything directly. That’s why doing this work matters.
Understanding Fatness Without Shame
One of the most powerful parts of our conversation was exploring how fatness isn’t a problem to be solved – it’s a body size, not a moral failing. Jo and Cat both use the word fat as a neutral descriptor, and they teach therapists to understand how medical tools like BMI were never designed to measure health.
They also highlighted how fat phobia is historically rooted in racism and colonialism – a fact many of us were never taught.
This isn’t about saying all bodies are the same. It’s about acknowledging the very real disadvantages that people in larger bodies face, from inaccessible chairs and blood pressure cuffs to being denied fertility treatment or surgeries.
Creating an Inclusive Therapy Space
Top tips from Jo and Cat:
- Get curious about your own body story: How have you internalised ideas about weight and worth? If you’d like to examine this in more depth, please see the further learning section below.
- Avoid making assumptions: Don’t assume health status or eating habits based on size.
- Name the body difference when it matters: As Jo and Cat suggest, if a client brings up body shame, gently invite reflection: “How is it to talk about this with me, in the body that I’m in?”
Final Thoughts
Jo and Cat’s training has challenged me to reflect on my internalised fat bias and on how I talk to myself. And I’m very grateful for that.
If you haven’t already, I’d really encourage you to listen to the podcast and consider joining The Fat Counsellors’ training. It’s eye-opening, sometimes uncomfortable, and absolutely essential.
Because all bodies deserve respect – including yours.
Ready to create a more inclusive private practice?
Inside Therapy Growth Group, we support you to grow your practice ethically, thoughtfully, and with care—including reflecting on bias, building confidence, and making your marketing more accessible.
Further Learning
If this topic has sparked your curiosity (or discomfort), here are some powerful resources to explore:
Training & CPD
The Fat Counsellors – Part 1 Training: Fat Phobia and the Therapy Room
A 6-week course exploring internalised fat phobia and body bias in therapeutic work. Available live (online or in person) and on-demand.
Books & Articles
Fearing the Black Body: The Racial Origins of Fat Phobia by Sabrina Strings – on the racial origins of fat phobia
Shrill by Lindy West – part memoir, part manifesto on fat acceptance and feminism
What We Don’t Talk About When We Talk About Fat by Aubrey Gordon – a clear, challenging look at weight stigma and public health myths
Health at Every Size (HAES) by Linda Bacon – a research-based approach to health without weight stigma
HAES Health Sheets – practical, non-stigmatizing health information: haeshealthsheets.com
Podcast Episode
Fat Phobia and Creating Inclusive Therapy with The Fat Counsellors – Listen here
My conversation with Jo Reader & Cat Chappell (aka The Fat Counsellors) on fat bias, body image, and the therapy room.