Have you ever booked a medical appointment about a particular concern, only to find the conversation turning to your weight?
Perhaps the symptoms you wanted help with were barely discussed. Perhaps you left with another diet referral, feeling embarrassed, frustrated and unheard.
And if you have spent years moving between dieting and binge eating, that appointment may have affected much more than your confidence in seeking help. It may have triggered some old intrenched thoughts: I need to be stricter. I’ve let myself go. Everything would be better if I could just lose weight.
Many of my clients describe experiences like this. When you are working hard to build a healthy relationship with food, a conversation that overlooks that work can feel deeply distressing.
You deserve healthcare that takes your symptoms, your eating history and your wellbeing seriously.
What is weight stigma?
Weight stigma means being judged, stereotyped or treated unfairly because of your body weight or size.
In healthcare, this might look like assumptions about what you eat or how much you move, dismissive comments, or focusing on weight before properly exploring the reason for your appointment.
While there are circumstances where weight is clinically relevant, what matters is whether your concerns are properly investigated and whether you are involved in decisions about your care.
Your body size should never replace a proper assessment.
Why it matters if you struggle with binge or emotional eating
If you already feel ashamed of your eating or your body, being judged in a medical setting can reinforce the belief that you are the problem.
A 2024 systematic review covering 242 articles found a consistent association between greater weight stigma and more disordered eating thoughts and behaviours, including binge eating, dietary restraint and body dissatisfaction. https://pubmed.ncbi.nlm.nih.gov/38278088/
For someone caught in a cycle of dieting and binge eating, an upsetting appointment might prompt another attempt to control food more tightly: skipping meals, cutting out favourite foods or setting stricter rules. If eating then feels out of control again, the self-blame can deepen.
This is particularly relevant to binge eating disorder. NICE guidance states that weight loss is not itself the target of psychological treatment for binge eating disorder. It also advises against trying to lose weight through dieting during treatment, because this is likely to trigger binge eating.
That is why your eating history must be part of the conversation whenever dietary changes or weight management are being considered.
Looking beyond weight to recognise eating disorders
Someone can be living in a larger body and struggling with restriction, binge eating, purging or intense fear around food and weight.
You cannot tell how much someone is struggling by looking at them. NICE specifically advises against using a single measure such as BMI to decide whether someone should receive eating disorder treatment.
If food is taking over your thoughts, eating feels out of control, or you are using behaviours to compensate for eating, those experiences need attention.
You do not have to become smaller, or more visibly unwell, to deserve support.
What current guidance says about discussing weight
NICE’s 2025 guidance on overweight and obesity management gives healthcare professionals clear advice:
Avoid attributing every symptom to weight.
Address the problem the person came about first.
Ask permission each time before discussing weight or taking measurements.
You should have space to explain your concerns, share your eating history and discuss how any proposed advice fits your needs. Knowing this guidance exists may help you feel more confident about asking questions or bringing the conversation back to the reason for your appointment.
Of course, finding the words can be difficult when you feel uncomfortable or put on the spot. Choosing one or two phrases beforehand and to take with you can help you feel more prepared.
Here are some suggestions you can adapt to suit you:
To keep the focus on your symptoms
“I’d like us to assess the symptoms I came about today. What possible causes do we need to consider?”
“If I were in a smaller body with these symptoms, what investigations or treatment would you recommend?”
To explain your eating history
“I have a history of binge eating and restrictive dieting. Please take that into account before recommending changes to my eating or weight”
“I’m working on improving my relationship with food. Weight-focused advice can make that harder for me, so I’d like us to discuss options that support my recovery.”
If you are asked to be weighed
“Could you explain what this measurement will help you assess or decide today?”
“If weighing is needed, could we discuss how to do that in a way that feels manageable? I would prefer not to see or hear the number.”
If weight management is suggested
“What are the potential benefits, risks and alternatives for me, given my eating history?”
“How would we monitor the effect on my eating behaviours and emotional wellbeing?”
“Please discuss any referral with me before making it.”
Where weight loss medication fits into this conversation
You may also be navigating conversations about weight loss injections, whether in appointments, among friends or online.
If you are already struggling with body image or binge eating, you might find yourself wondering: Should I be doing this too? Will people judge me if I don’t? Will people judge me if I do?
Before prescribing weight loss medication, healthcare professionals should assess for current or past eating disorders, disordered eating and body image concerns. If an eating disorder is current or suspected, this needs specialist assessment, with any decision about weight loss medication informed by that assessment. A previous eating disorder also warrants careful consideration of whether treatment could undermine your recovery.
You deserve to be heard in the body you have today
The responsibility for addressing weight stigma belongs with healthcare services, professional education and wider society.
You do not have to earn respectful care by losing weight, eating ‘perfectly’ or proving how hard you have tried.
Your symptoms deserve attention and your relationship with food matters.
If this resonates with you, and you’re tired of feeling that you need to try harder or be stricter with food, I’d love to offer you a different approach.
My best-selling book,📕 The Binge Freedom Method™️: Your Four Pillar Plan to Beat Emotional Eating for Good. explores a more compassionate approach to understanding your eating and provides the tools you need. Packed with practical strategies, science-based insights, nutritional wisdom, and compassionate guidance, it’s designed to help you reclaim control over your eating habits.
You can download a free chapter of my book HERE