I’m about to share what could be considered a controversial or even unpopular opinion. I don’t say this to “put down” other clinicians, rather I feel that it is my duty as a therapist to express why I believe that promising weight-loss to our patients is not only negligent, it’s a downright unethical practice.
As a therapist in private practice in Rockville, MD, specializing in helping teens and adults who struggle with eating disorders and body image issues, I’ve witnessed firsthand how damaging a focus on weight-loss can be. It boggles my mind that I see other therapists who claim to specialize in both “eating disorders” and “weight-loss.” A focus on weight-loss is contraindicated for treating eating disorders across the spectrum.
Additionally, I would argue that a weight-loss focus is unhelpful (and often harmful) for all individuals, regardless of their presenting concern. This view is not to say that weight-loss is inherently bad. For instance, there are a wide variety of reasons that could cause someone to gain or lose weight. Rather, I am proposing that a goal, expectation, or focus on weight-loss is damaging.
First off, as clinicians we pride ourselves on using treatments that are based on strong research. Most therapists try to use evidence-based treatments in their work with patients. With a 95% to 97% “failure” rate of diets (statistic holds true, even if you mask them as “lifestyle changes”) to maintain weight-loss over the long-term, there is simply no substantial evidence to support our ability as clinicians to help someone to lose weight and keep it off in the long-term.
In promising our clients weight-loss, we leave them feeling like “a failure” when they inevitably lose the weight and then proceed to gain it back. Of the 5% who do maintain the weight loss long-term, many of them either have disordered eating, eating disorders, or spend the majority of their days fixated on food and exercise. This focus is simply not an ideal way to live.
Further, dieting (which I define here as any restriction or rules with the aim of weight-loss) has been shown to contribute to the development of eating disorders (for those who are genetically predisposed), poor health outcomes, and weight-cycling.
Additionally, we often do not know our clients’ set point weight-range. Set point weight is a range that our bodies will biologically fight to maintain and it is different for everyone. Body-diversity is real and not all bodies are meant to be thin. Some individuals might naturally have larger bodies and trying to force them into a smaller one, is like trying to squish a size eight foot into a size six shoe.
A focus on weight-loss comes from the belief that “we are not enough.” Literally any goal that an individual hopes to attain through weight loss, can be achieved without having a weight-loss focus. For instance, if someone wants to improve their health, they can work on adding in some fruits and vegetables to their meals, work on intuitive eating, and find forms of exercise that they enjoy. If someone wants to feel more confident, they can work on this goal through therapy-at any size.
Our bodies are smart and will take care of regulating our weight, if we can treat them with kindness and care, through things like learning to (generally) honor our hunger and fullness signals, eat a wide variety of foods, get adequate sleep, manage our stress, and find forms of joyful movement.
So Why Do Clinicians Promise Weight Loss?
In light of the research, why do clinicians continue to promise weight-loss to patients? One reason is that weight loss sells. We’ve been culturally conditioned to believe that our value lies in our body size. People want to lose weight, so clinicians who are looking to generate more clients may decide to take this approach.
However, I don’t believe that all clinicians promise this simply because of a marketing perspective. Many are steeped in their own disordered eating and weight-bias and may genuinely believe that they are helping their clients by promising them weight-loss. If this is you, I’d highly recommend that you learn more about intuitive eating and health at every size.
As therapists, we can do better and our patients deserve it. Let’s give up any weight-loss goals or focus, and instead teach people of all sizes to learn how to take compassionate care of themselves.