What Therapists Can Do to Combat Body Shaming

Written by Erica Mashall-Lee, Ph.D., ABPP, Sheethal D. Reddy, Ph.D., and Desiree Frain, Psy.D., on behalf of the Atlanta Behavioral Health Advocates.

Source: Yan Krukau / Pexels

“She has such a pretty face—pity she’s so heavy.” “He is so athletic to be so skinny.” “I’d kill to be that skinny!” “You must be having a hard time—I see you've put on a little weight.” “Do you think you should eat that?”

These types of comments are not only unwelcome but harmful mentally and physically. As someone whose weight has ranged from 89 to 219 pounds, I have heard it all. The comments have impacted me in ways that to this day, I do not fully share with anyone.

As a psychologist, this has helped me to relate, build rapport, and empathize with my clients—especially the ones who say, “You don’t know what it’s like to be so heavy/to try to gain weight” especially. Ah, but I do!

At the ripe old age of 25, I found myself in tears when my father told me that I should drink Diet Coke, and again at 53 when my mother said I looked weak and frail and should eat more. My parents mean well and have good intentions; however, the comments had very deep effects.

This “fat talk” or “body shaming” can be the root of a multitude of mental health concerns that may lead to or stem from physical conditions. I once heard someone say, “The only time you should comment on someone’s body is if they are on fire” and I tend to agree (though I might add also if they are bleeding).

Body shaming encompasses statements, comments, and nonverbal behaviors that produce a feeling of shame in an individual about their appearance. Body shaming can happen to anyone—large or small, old or young, able-bodied or disabled, and conventionally attractive or unattractive individuals. However, some individuals may be more susceptible to negative statements about one’s appearance than others.

If you are familiar with the literature on body image and gender, it will come as no surprise that women are significantly more likely to experience body shaming than men (Schluter et al., 2021). It is also likely no surprise that body shaming has been linked to poor mental and physical health and increased rates of eating disorders or disordered eating behaviors.

Body shaming may also occur in the context of bullying or cyberbullying, which is linked to a host of negative mental health outcomes (Moore et al., 2017). Even mere teasing based on appearance has been linked to several negative outcomes, including poor body image, body dissatisfaction, and disordered eating habits such as restrictive eating or purging behaviors (Menzel et al., 2009).

Body shaming can be especially damaging for children and adolescents, whose bodies are changing during puberty. One notable study by Puhl et al. (2017) examined the longitudinal impacts of body shaming—namely, weight-related teasing in children and adolescents 15 years after the start of the study. Girls who experience weight-related teasing in adolescence demonstrated a high number of negative outcomes as adults, including binge eating, unhealthy weight control, emotional eating, and poor body image (Puhl et al., 2017).

To further exasperate the issue of body shaming, social media has introduced a whole new platform for these statements to reside in. One needs only to open Instagram and look at comments on a celebrity’s newest selfie to see body shaming happen in real time. And the conversation around body shaming on social media is ballooning—there are currently over 287,000 posts on Instagram with the hashtag #bodyshaming.

Psychologists can be role models in healthy messaging around body image. The first step is to become aware of our own biases.

To do that, there are validated and reliable tests of implicit attitudes like the ones available for free and online through the Project Implicit Attitudes Test site (Project Implicit, n.d.). Other ways to increase bias awareness are surveys that assess fear of fatness (Robinson, Bacon & O’Reilly, 1993), identification with a thin body ideal (e.g., Heinberg, Thompson, & Stormer, 1995), or body figure rating scales (Stunkard, Sorenson, & Schlesinger, 1983).

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The outcomes of these types of screeners can be eye-opening. Once aware of such biases, we can then become curious about when these biases developed and how they inform our own body image. 

In the treatment setting, a collaborative, patient-led interaction style may help to strengthen the therapeutic relationship and decrease patient attrition (Miller & Rollnick, 2013). In the context of body shaming, for example, "coming alongside" the client to build empathy and a greater understanding of their situation would be preferable to assuming that the client is ashamed of their weight and size.

Use neutral or compassionate language when talking about the body. Instead of, “I have bad skin,” what about, “My skin needs more care”? In conversations around obesity and dieting, avoid glorifying extreme weight loss or body transformations (e.g., celebrity stories of weight loss).

Body shaming is not limited to verbal communication. Non-verbal gestures and actions contribute to feelings of insecurity and shame among people who are self-conscious about their appearance. Air travel and restaurant seating (restrictive booths vs. more accessible tables) are commonly reported negative experiences for people with larger bodies.

For these reasons, in your practice, ensuring that patients have appropriate seating in waiting rooms and that materials or audio-visual materials (e.g., TV, magazines, posters) are inclusive and welcoming are small but critical actions that can provide unspoken support for these individuals.

In summary, individuals of all sizes are vulnerable to body shaming, but particularly those who are at either end of the size and shape spectrum. Shaming may be public, private, verbal, or nonverbal.

No matter the context or mode of shaming, psychological interventions that increase patient awareness of society’s influences on body image are a first step in increasing resilience to such experiences. Providing care in a non-judgmental and patient-led manner can increase comfort and trust in the working alliance. Creating a welcoming space for all body types can be simple and incredibly effective in communicating respect and care for clients.

Finally, role modeling healthy body image and self-care are key in challenging implicit biases and unhealthy societal pressures.