Reflecting on Weight Stigma in Dietetic Practice
As a Registered Dietitian, I’ve long believed in providing respectful, evidence-informed, client-centered care. But reading through the recently updated Dietetic Weight Stigma Q&A (October 2024), I was reminded just how deeply weight stigma is embedded not only in our health care systems, but in our training, language, and even our good intentions.
This resource, developed with input from Florence Sheppard, MHSc, RD and Nooshin Alizadeh-Pasdar, PhD, RD, offered an important lens through which to re-examine my assumptions and the systems in which I work. It has pushed me to reflect more honestly on my own biases, on the subtle (and not-so-subtle) ways stigma can appear in my practice, and on the work we still need to do as a profession.
Weight Bias, Stigma, and Discrimination: More Than Just Semantics
One of the most helpful aspects of the Q&A is the clear distinction it makes between weight bias, weight stigma, and weight-based discrimination. These terms are often used interchangeably, but they describe different aspects of the same harmful system.
I was particularly struck by the discussion of how easily we can unconsciously praise weight loss or make assumptions about health based on body size. Even something as subtle as interpreting unintentional weight loss differently depending on a person’s starting weight is an example of bias.
Language Matters...But So Does Listening
The Q&A emphasizes that no single term is universally acceptable when talking about weight. While research shows that most clients prefer neutral language like “weight” or “BMI,” ultimately, the best approach is to ask clients how they want to be described. That’s a simple but powerful shift.
Terms like “obese” or “morbidly obese” can be alienating even harmful. They can reinforce shame and internalized stigma, especially when clients are seeking help, not judgment.
The growing Fat Acceptance movement is working to reclaim the word “fat” as a neutral descriptor. I’ve learned that while some clients may identify with this language, others may not. That’s where trauma-informed, person-centered care comes in: we don’t assume, we ask.
Why Reducing Weight Stigma Is Essential to Health
Perhaps the most important takeaway from the Q&A is that weight stigma itself is a serious health risk. It affects mental health, physical health, and access to health care. It can lead to delayed diagnoses, disordered eating patterns, and chronic stress.
As RDs, we often talk about social determinants of health (income, housing, food access, etc) but often forget weight stigma is a determinant of health too. It shapes how people are treated in clinics, whether they feel safe seeking care, and whether they’re taken seriously.
The evidence is clear: shaming people for their size doesn’t improve health. In fact, it may worsen outcomes through mechanisms like weight cycling, elevated cortisol, and avoidance of medical care.
A Call to Colleagues
Reading through the Dietetic Weight Stigma Q&A felt both affirming and challenging. It affirmed that we, as a profession, are beginning to confront harmful norms. But it also challenged me to go further to examine not just how I speak, but how I think, how I document, how I teach, and how I advocate.
I encourage fellow dietitians to read the Q&A thoroughly and sit with its implications. Reflect on how weight stigma might be showing up in your own practice even in ways you don’t yet recognize.
Because ultimately, if we are to provide truly equitable, trauma-informed, and person-centered care, then reducing weight stigma must be part of our ethical responsibility.
Resource:
Dietetic Weight Stigma Q&A – Updated October 2024, with special thanks to Florence Sheppard, MHSc, RD and Nooshin Alizadeh-Pasdar, PhD, RD. Full resource available via: Dietitians – Resources | CHCPBC
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