Embracing Fat Liberation and Health at Every Size in Therapy: An Intersectional Approach
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As a therapist committed to justice, compassion, and radical healing, I ground my practice in the principles of Fat Liberation, Health at Every Size (HAES), and intersectionality. These frameworks are not separate from the therapeutic process, they are central to it. Our bodies are not just vessels that carry us through life; they are deeply politicized, pathologized, and policed. To ignore that reality in therapy is to miss a crucial layer of our clients’ lived experiences.
What Is Fat Liberation?
Fat Liberation is a political and cultural movement that challenges the marginalization of fat people and the oppressive system (i.e., anti-fat bias, medical fatphobia, and diet culture) that harm them. It goes beyond body positivity, which often centers acceptability and marketability, and instead demands autonomy, dignity, and equity for people of all sizes.
As a fat liberationist therapist, we don’t see fatness as a problem to be fixed. We see fat clients as fully human, worthy, and capable of thriving exactly as they are, not "after" weight loss, not "when" they conform, but right now.
Understanding Health at Every Size (HAES)
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The Health at Every Size approach shifts the focus away from weight as a proxy for health. Instead, HAES emphasizes:
Respectful care
Eating for well-being
Joyful movement
Body diversity
A critical approach to health data and social determinants of health
In practice, this means I never encourage weight loss as a treatment goal. Instead, I support clients in reconnecting with their bodies, identifying internalized beliefs, and exploring what health and care actually mean on their terms, not society’s.
Therapy Through an Intersectional Lens
Fatphobia does not exist in a vacuum. It intersects with racism, ableism, classism, transphobia, and other systems of oppression. The body hierarchies that uphold fatphobia often mirror the hierarchies that devalue Black, brown, disabled, poor, and queer bodies.
Intersectionality, a term coined by Kimberlé Crenshaw, isn't just a buzzword. It's a tool for understanding how power works across identities. In therapy, this means I’m not just asking, “How do you feel in your body?” but also, “Whose gaze has shaped your relationship to your body? Who benefits from you feeling like you’re too much, or not enough?”
For example:
A queer fat client navigating anti-fat bias in dating also contends with heteronormativity.
A Black woman being told to “lose weight” by a doctor is also facing racism and misogyny in the medical system.
A disabled fat client may be judged not only for their size, but for how their body moves, or doesn’t move, through public spaces.
An intersectional therapeutic approach honors these complexities and validates that our struggles are not just internal, they are often rooted in systemic harm.
Therapy as a Site of Liberation
My goal is not to help clients “accept” oppression more gracefully. It’s to help them resist it, reimagine their relationship with themselves, and rediscover joy in embodiment. Therapy becomes a site of liberation when clients are encouraged to:
Name and reject the lies of diet culture
Grieve what’s been lost to body shame
Build community and solidarity
Trust their own wisdom
Cultivate radical self-compassion
Final Thoughts
If you’re fat, if you’ve been harmed by weight stigma, or if you've been made to feel that your health, worth, or success must come after your body changes, you are NOT broken. You are NOT failing. You are navigating a world that was not built with you in mind.
Therapy should be a space where your full self is welcomed, not just tolerated, but celebrated.
I’m here for that kind of therapy.
I’m here for you.
About the Author
Madeline Smith LCMHC, is a therapist who specializes in trauma-informed, fat-positive, and intersectional care. Their work centers on helping clients build more liberated relationships with their bodies and identities.