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The Clinical and Practical Limits of "Body Acceptance"

Meredith Cariski Writes about Struggles Finding a Therapist Who Acknowledges Medical Problems Associated with Weight

Don't Let a Therapist Tell You That You Don't Have a Problem When You Do!

Body positivity is a popular fad with curvy Victoria Secret and Sports Illustrated models strutting down the runway and music artists like Lizzo posing almost nude at every chance she gets. Acceptance is the key to being body positive. But what if you have actual health conditions resulting from obesity and being body positive is detrimental to your wellbeing?

If you have high blood pressure, diabetes, sleep apena, fatty liver disease or heart problems from being obese, you might go to a therapist to cope with the emotions that come with the obese baggage that you very uncomfortably carry on you at all times. You may also go to try to lose weight to mitigate those health concerns.

But what happens when you muster the courage to go to therapy and you are told exactly what you DON’T want to hear?

“You don’t have a health problem. You just have to accept yourself and your body for where you are at the moment.”

But, it is a problem. You can’t have your doctor telling you that you have a serious medical problem and your therapist telling you the opposite. That is just plain stupid. Maddening even.

A therapist that offers you a solution to repress your feelings about the reality of being obese and the health conditions that come with it is irrational and dare I say it, absolutely absurd. It is the furthest thing from making you feel better and even worse, it stalls any future progress.

You don’t need an escape route that is paved with the path of radical body positivity for your health problems. You need an action plan and a therapist who knows what the hell they are talking about.

If you encounter a therapist whose definition of accepting the problem is doing nothing about the problem, then you won’t make any changes to your lifestyle at all. These therapists may be leading their clients to their ultimate demise.

Being over 75 pounds overweight and having to deal with burdening health issues is a BIG problem and it is the problem that needs to be accepted. It should not be minimized and you know this to be true. Why would you pay someone to tell you that you don’t have a problem when you are fully conscious that you do? It doesn’t make any sense.

You would think that a therapist knows enough about defense mechanisms to not teach you to give into them.

Minimizing your health problems by shoveling in your mouth body positive slogans just makes the problem seem smaller or nonexistent when you have to live with it every day.

Rationalizing the problem with body positivity and do-nothing-acceptance makes it more complicated. Your lack of acceptance of the problem does not go away with rainbow sprinkles of positive body image lies. You are uncomfortable with the choices you have made in your life that have led to obesity and health dangers and there is no positive reason to cover that up.

This is reaction formation at its finest. This is when you fully understand how you feel and then act completely opposite of you instincts. Your instincts are to see a therapist to guide you towards solutions and instead, many therapists say: “You don’t have a health problem, and you should accept your body as is.”

Instead, a therapist should acknowledge the problem and give you ways to cope with them in a healthy way.

Accept your reality and do what you can to change it so that you can be your best, healthiest self long term.

If you have health problems that result from obesity, don’t fall in love with them; deal with them so that the doctor can give you a smiley face sticker instead of sending you for pointless bariatric surgery.

That’s why having a therapist who has been there and understands the intricacies of body positivity, its effects on the human psyche and physical body. Who will reflect their client’s relation to their size and how it affects them.

And let me be clear. I am not shaming body positivity. It does good, life-changing things for some people. But, your social and behavioral patterns affect your weight, and becoming a body positive activist of sorts will lead you going in the wrong direction.

You will say with your words that you love yourself, but when you go to sleep at night, are you really thinking that this is true as you dream of scary results from your doctor.

If you are in the position where you are obese and its causing you health concerns and mental distress, you need a therapist who will tell you what you need to hear which is not positive body image BS.

You need to hear the cold, hard facts and apply them before its too late. Get a therapist like mine and choose body reality over false body positivity.

Brian Baumal Responds...

Meredith, what you have written is exceptionally powerful. It is also very complicated and nuanced. Body acceptance is a cornerstone of most any eating issue or self-esteem issue related to the body. I wholeheartedly preach body acceptance, and state that it is a goal of treatment with me. However, there are many caveats to that:

Eating Disorders Can Be Deadly. I Take Them Very Seriously and Incorporate Weight Acceptance Accordingly.

For every person I treat, whether they have any medical conditions caused by obesity or not, I spend an inordinate amount of time assessing people for a history of disordered eating, and their likelihood of possibly engaging in disordered eating or full-blown eating disorder behaviour when I treat them. The last thing I want is for someone working with me to develop an eating disorder that can cause them significant harm in the future.

If I suspect that someone may be prone to such deadly eating behaviours, I work on body acceptance before I work on any weight adjustment strategies, even if someone has severe medical conditions. However, the point is, I do assessments for these behaviours, and I discuss my treatment plans with my clients. I also ask them directly if their physician is concerned about any of their weight-related health conditions and incorporate that into their treatment. In other words, I have very detailed discussions with my clients around how we will go about treating their eating, their body image, their weight and any co-occurring health conditions.

What upsets me is that when I see clients who tell me their therapist NEVER discussed a treatment plan, or never did a proper assessment of eating behaviours, and immediately focused on body acceptance as the only goal of treatment. They come and see me and say “I was told to accept my diabetes, and not lose any weight.” I tell my clients that would be fine, if the treating therapist explained why they chose that particular approach. More often than not, the therapist does not provide an explanation of their approach, and treating everyone as if they would slip into deadly eating disorder behaviours may be a noble, conservative and valid approach to treatment. However, I also view it as kind of a scorched-earth approach to treatment. I encourage people to find therapists who are thorough, comprehensive and willing to adapt to the person in front of them.

I will never forget a client I saw, who during our first session started crying, when I said I would focus on her weight loss and her medical conditions, as well as body acceptance. When I asked her a typical therapist question "What are the tears for?" she replied "After years of trying I have finally been heard."

Practitioners Need to Stay in their Lanes

I will ask every single client I see whether they have any co-occurring medical conditions related to their obesity. I will further ask if they have seen their doctor within the last year. I will directly ask what their physician says about any obesity-related issues, and how actively they are being treated. I ask this for so many different reasons, but primarily I to ensure that I am NOT endangering the health of a client by not supporting the treatment goals of a physician.

I am not saying in any way that physicians are “royalty”, and that they need to be treated with deference. What I am saying though, is that I have no medical training in any obesity-related conditions. If a physician says the priority should be weight loss, then that should be a goal of treatment. What training or credential do I have to say otherwise?

Therapists Need to Be Very Careful Regarding Stating Their Own Opinions

Most therapists believe in one way or another that the “therapeutic relationship” is the main engine of healing for clients. While such relationships are intricate and complex, there are some basic rules to them. One of them is that the therapist’s own personal opinions should only be stated if tactically or strategically beneficial to the advancement of the therapeutic relationship.

For example, I have worked with many clients whose views of covid and/or vaccinations are diametrically opposed to mine. What I tune-in to is a client’s psychological suffering in regard to these issues, because that is what needs to be addressed. Not my views on covid, not trying to convince my client about my views of covid, and/or not engaging in a general discussion of these issues.

In my view it is exactly the same with weight, and/or weight-related conditions. Clients are not there to hear me prioritize their health for them, they are there so that I can help them address the suffering around their health.

There is a famous Gestalt therapist, Ervin Polster, who says that “Doing therapy to address the anxieties of the therapist is a lousy therapy model.” So I don’t see why it is necessary to bring-in my views about body acceptance, etc… on a regular or unprompted basis, unless it is somehow justified in advancing the therapeutic relationship and/or alliance - or if there is a strong risk of eating disorder behaviour present or likely. Otherwise, I will trust the client to prioritize things in a way that works for them.

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