Most clients who are living in larger bodies have tried to diet at some point in their lives. The first thing I explain, is that diets do not work. Secondly, that being in a larger body is not the result of poor willpower, laziness or any personality defect. However, this client group often believe just that, and may experience low self-esteem and assume they are at fault. Dismissing this is crucial, and restoring self-worth is my first goal.

Body size is not definitive, and I will be curious to get to know the individual's true personality, what brings joy or worry into their life, and what their weaknesses and strengths are. Together we may revisit their past and consider what may have triggered weight gain, loss, or concern.

The client must feel safe, and experience true unconditional positive regard as we begin to build a trusting relationship. I offer kindness, honesty and useful psychoeducation as well as nutritional wisdoms. Together we can explore lifestyle choices, changes, barriers to change and what they need from the people around them.

Our therapy goal needs to be established. Is it weight loss, or acceptance? Is the goal simply better overall health? What is the reason for needing support and what changes are they hoping for? Has there been childhood trauma or challenges that might be relevant to how they see themselves now, and how they experience others? All of this is in many ways more important than considering how that client is nourishing themselves.

Research shows that diets may result in short term weight loss followed by a return to the body’s set weight, plus a little extra. A year after a ‘successful’ diet the client finds themselves heavier than before. This is disappointing and leads to feelings of low self-worth and failure. However, the real story, the science behind the situation, is more complicated.

With the right education about how the body processes food, a client can learn how to keep their blood glucose stable. For some clients, this may be achieved by considering the timing of meals and snacks, or the order certain foods are consumed as well as food choices. This results in reduced inflammation, feeling less tired, less cravings and ultimately reaching a healthy weight. It should happen gradually; this is rarely a linear journey. When blood glucose is stable and nutritional needs are met, clients often find they do not feel the urge to eat with a sense of being out of control (a binge). Often binge eating creates guilt, low self-worth, and can result in compensatory behaviours such as purging. Our goal is to prevent or stop this upsetting and unhealthy behaviour so that the client thrives, and can enjoy a lifetime of understanding how to nourish their unique self.

Many clients in larger bodies are fed up with being told they need to 'eat less and move more'. For many clients they are doing their absolute best, but eating less is not usually a solution. Being hungry can only ever be temporary and can lead to feeling depressed and frustrated, as well as making bingeing more likely. Although I encourage all my clients to limit ultra-processed foods, no foods are completely off limits. Instead, we consider how to structure and plan meals so that a client develops skills to nourish themselves properly. Equally, some clients find moving more a challenge. There are barriers to joining gyms, swimming and sometimes even walking, such as cost, confidence, shame, and suffering from aches and pains. We will consider all of this compassionately and work out what the barriers are, and how we might work together to find a way to create a lifestyle change that involves movement that is enjoyable and sustainable.

We need to consider food scripts. What does ice cream mean to this client? Could it mean a hot summer’s day, a reward, or a way to soothe their sore throat? Our scripts influence our food choices and the associated emotions. Furthermore, how is eating used to soothe or block emotions? This is often revealing and insightful work, and finding authentic answers to these questions is at the heart of beginning a healthy relationship with food and feeling happier in the body they live within.

This is highly rewarding work for the client and for me. Empowering my clients with knowledge, self-compassion, and self-awareness, confidence, and ultimately the ability to make lifestyle changes to promote better health, becomes a shared motivation for this therapeutic intervention.