Have you ever gone to a healthcare professional for help and left the office feeling worse than when you went in due to the practitioner blaming your discomfort solely on your weight? People of larger body size frequently report similar experiences.
Visiting a healthcare provider doesn’t have to be an anxiety-ridden experience. There is a more inclusive, accepting way to treat patients of all shapes and sizes. Health At Every Size (HAES) is a health initiative/model that is body-inclusive. It takes the focus of health from being weight/size-centered and shifts the focus to making healthy choices based on internal body cues. Interestingly, research over the past 20 years has consistently shown that health measures (blood pressure, cholesterol levels) can be improved with healthy behaviors regardless of whether there is a change in weight. It reframes lifestyle from dieting and/or excessively exercising, to listening to internal hunger/fullness cues, and reframing exercise to be joyful movement instead of something that you must do even if you dislike it. By doing this, people tend to become much more consistent with food intake as well as participation in exercise which in turn contributes to improved health.1
Media and societal beliefs have created and perpetuated stereotypes about people of size that are simply untrue which contribute to feelings of shame associated with larger body size. These stereotypes carry over into the medical community. Frequently, people of higher weights go to the doctor, and are told that everything from high blood pressure to a hangnail is because of the extra weight they carry. They are then given a prescription for weight-loss and are sent on their way. This “medical advice” is internalized by patients as, for example, “I’m lazy; I don’t care about my health; it’s my own fault that I have *insert medical condition*”. People leave the doctor’s office feeling despondent and deeply ashamed of themselves with no new or helpful information, so they avoid seeking healthcare. What is worse is that when they do seek out care, because healthcare professionals tend to blame so many ailments on weight, they’re often misdiagnosed or dismissed which can lead to worsening health conditions or even death.
I have a personal connection to HAES. I am a larger-bodied physical therapist who has been following its principles and practicing intuitive eating for 2-3 years. I have since been able to stop the vicious restrict/binge cycle of disordered eating, and have become consistent with movement multiple times a week. I now enjoy exercise because I view it as a way to give my body the movement it craves instead of viewing it as a punishment for its size/shape. I have also experienced doctors giving me a blanket prescription of weight-loss for seemingly any ailment. It can be very frustrating and demoralizing, and I have often avoided seeking treatment in fear of ridicule or shame.
This is why I value incorporating what I have learned through practicing HAES and intuitive eating in my personal life into my treatment of patients. I am someone who people of all shapes and sizes can come to without fear of judgement or prescription of weight-loss to solve whatever pain they may be having. As PTs we have the knowledge to modify exercises appropriately so that everyone can participate and benefit. I hope to be a source of support for people who have avoided seeking care in the past so that regardless of size, they can work feeling better in the body they have right now.
2024 Update: How Weight-Neutral Care Has Evolved in Healthcare
Growing Acceptance of Weight-Neutral Approaches: Since this article was first published in 2021, weight-neutral and HAES-informed approaches have gained broader recognition in healthcare. Multiple professional organizations — including the Association for Size Diversity and Health (ASDAH), the Academy of Nutrition and Dietetics, and growing numbers of physical therapy training programs — have formally incorporated HAES principles. A 2023 systematic review in the journal Obesity Reviews found that weight-inclusive interventions (focusing on health behaviors rather than weight loss) produced significant, sustained improvements in psychological wellbeing, disordered eating behaviors, and health-related quality of life — with no adverse outcomes compared to conventional weight-focused approaches.
Weight Bias in Healthcare: What the Research Shows: Weight bias — negative attitudes toward individuals based on body size — remains a pervasive problem in healthcare settings. A 2022 study in the International Journal of Obesity found that weight bias from healthcare providers was independently associated with healthcare avoidance among larger-bodied individuals, even after controlling for access and cost barriers. This avoidance leads to delayed diagnoses, undertreated conditions, and worse health outcomes. Physical therapists, like all healthcare providers, can perpetuate or counteract this bias depending on their training, language, and approach. Trauma-informed, weight-neutral PT care creates conditions where patients feel safe to engage in rehabilitation without fear of judgment.
Weight-Neutral PT in Practice: In a weight-neutral PT practice, evaluations and treatment plans focus on functional goals — strength, mobility, pain reduction, activity tolerance — without defaulting to weight loss as the primary outcome. Equipment is sized appropriately and available without comment. Functional fitness is framed around what a patient’s body can do, not what it weighs. Exercise prescription is based on the patient’s current capacity and what movements feel good and empowering, not on achieving a particular body size. This approach aligns with the American Physical Therapy Association’s ethical commitment to providing care that respects human dignity and patients’ self-determination.
-Jack Doucette-Long, PT, DPT, ATC
References
1.Bacon L. In: Health at Every Size: the Surprising Truth about Your Weight. Dallas, TX: BenBella Books; 2010:167-169.
