Discussing weight in therapy can be appropriate when it directly relates to the client's mental health or treatment goals. For instance, significant weight changes may indicate underlying conditions like depression or anxiety, warranting exploration in therapy sessions1. Additionally, if a client initiates conversations about body image issues or eating disorders, weight naturally becomes a relevant topic for therapeutic discussion2. However, therapists should exercise caution and only address weight when it is clinically pertinent, avoiding unsolicited comments that could potentially harm the therapeutic relationship or exacerbate existing body image concerns23.

When addressing weight in therapy, therapists should adopt a size-affirmative approach that recognizes weight as just one aspect of a person's identity1. This approach focuses on overall well-being rather than solely on weight loss, challenging societal assumptions about the relationship between size and health. Therapists should be aware of their own biases and the potential impact of weight stigma on clients' mental health1. It's crucial to avoid unsolicited suggestions about weight loss, as participants in recent studies reported these to be unhelpful1. Instead, therapists can explore alternative approaches to well-being, such as Health at Every Size (HAES) or Well Now, which advocate for a holistic view of health that considers factors beyond just food and movement1.

Respecting client autonomy is paramount when addressing weight-related issues in therapy. Therapists should honor a client's preferences and comfort level, refraining from discussing weight if the client expresses discomfort with the topic1. It's essential to recognize that each client's journey is unique, and some may not be ready or willing to focus on weight-related concerns. In cases where clients express a desire to lose weight, therapists can explore alternative approaches to wellbeing, such as Health at Every Size (HAES) or Well Now, while acknowledging that only 2-5 percent of dieters maintain long-term weight loss2. By prioritizing client autonomy, therapists can foster a safe and supportive environment that empowers clients to make informed decisions about their health and well-being.

Ultimately, the appropriateness of discussing weight in therapy hinges on maintaining a delicate balance between clinical relevance and client comfort. Therapists should approach the topic with sensitivity, adopting size-affirmative practices that challenge societal assumptions about weight and health1. When clients initiate weight-related discussions or express a desire for change, therapists can explore holistic approaches like Health at Every Size (HAES) or Well Now, which focus on overall well-being rather than just weight loss12. By prioritizing client autonomy and addressing weight only when clinically necessary, therapists can create a supportive environment that promotes mental health while respecting individual experiences and goals.