Spring 2025 Issue

Safe Space for All Bodies: Providing a Safe Space for All Bodies
By Trish Otto
Social Work Today
Vol. 25 No. 2 P. 12

The NASW Code of Ethics is inclusive of protected classes as they are defined in various state and federal laws.1 However, like these laws, the Code of Ethics falls short when it comes to matters of body size. Recognizing the concerning prevalence and impact of weight stigma and the antifat bias of diet culture should motivate social workers to identify their own implicit biases, provide judgment-free spaces for all bodies, and even advocate for people who live in larger bodies. This work becomes more important as the increasing availability of glucagonlike peptide-1 (GLP-1) agonist drugs reinforces cultural assumptions about fatness and intensifies the obligations people feel toward changing their bodies.

Weight Stigma and Diet Culture
In 1998, Harvard University initiated an online implicit association test that created a virtual laboratory to help understand the cultural evolution of various biases. The test covers six social-group attitudes. A comparative analysis of 13 years of data collected from nearly 4.5 million participants revealed explicit response changes toward attitude neutrality in all categories except one: body weight.2 While categories of sexuality and race bias saw dramatic attitude shifts toward neutrality, negative body weight attitudes increased 40% toward prothin, antifat bias.2 While the rate of fatness is rising globally, attitudes are moving further from neutrality about what makes a body “good” or “bad.”

In the United States, people in 48 states can legally earn lower wages, be overlooked for promotion, or be fired because of their body size.3 Health care providers spend less time developing rapport with plus-size patients and commonly misdiagnose them.4 Research shows that people who experience weight stigma exhibit a decrease in health-seeking behaviors. Weight stigma leads to increases in cortisol levels, engagement in eating disorder behaviors, and risk for other psychological problems.4 Experiencing bias in health care settings decreases trust in medical providers and contributes to avoidance or delay of seeking treatment.

Indeed, weight stigma penetrates and impacts many areas of life. Informing this stigma, and where antifat bias appears most overtly, is diet culture. In her book Anti-Diet: Reclaim Your Time, Money, Well-Being, and Happiness Through Intuitive Eating, journalist and dietitian Christy Harrison, MPH, RD, CEDS, defines diet culture as: “A system of beliefs that equates thinness, muscularity, and particular body shapes with health and moral virtue; promotes weight loss and body reshaping as a means of attaining higher status; demonizes certain foods and food groups while elevating others; and oppresses people who don’t match its supposed pictures of ‘health.’”5

Diet culture’s messages pervade Western society. Children and adults alike absorb these messages from their families, friends, and media, and they assess and compare their bodies based on social expectations of what a good or right body should look like. Diet culture seizes on the insecurities it provokes, stepping in with solutions. Each new diet offers the promise that one can, and should, change one’s body.

But body size is the result of a complex set of genetic and behavioral factors, limiting long-term success at changing one’s body size through dieting. Only 5% of dieters sustain their weight loss long term.6 Most dieters return to predieting weight and may gain additional weight on top of their starting weight within five years.6 Dieting often leads to weight cycling, which consists of repeated attempts at weight loss. Evidence shows weight cycling to be linked to the potentially negative health outcomes society blames on body size, such as metabolic and cardiovascular risk factors.7 It is important to note that these outcomes occur across a range of body sizes, although the impacts may vary depending on individual and contextual factors.

GLP-1 Agonist Drugs
2017 saw the approval of Danish pharmaceutical company Novo Nordisk’s Ozempic (semaglutide), a GLP-1 agonist drug and a groundbreaking medical intervention for type 2 diabetes. Ozempic has made major strides in managing risk associated with type 2 diabetes, including reducing blood sugar and inhibiting the body’s ability to raise its own blood sugars in response.

A side effect of this drug is that it also slows down digestion, decreasing appetite and contributing to weight loss. As a result, GLP-1 agonists, especially Novo Nordisk’s Wegovy, are now touted as ways to “lose weight and keep it off.” This corporate messaging reinforces weight stigma. Coupled with diet culture, it perpetuates a two-part message: People now have a more effective way to get out of their larger bodies, and as such, they have a social and moral responsibility to do so. More so now than ever, existing in a larger body is perceived as the fault of the individual.8

Cultural Competence
Body size is a neutral characteristic, but it is too often imbued with cultural meanings that lead people to experience social and psychological distress. The term “obesity,” for example, pathologizes body size based on a formula that fails to account for individual variability and was originally rooted in racism.9 Such diagnostic labels do not align with the values of ethical social work, which center on respect for all individuals, regardless of how they conform to socially constructed ideals of beauty and health.

Cultural competence in social work includes understanding how social norms and biases shape perceptions of body size. It also encourages curiosity about factors preventing people from feeling at home in their bodies as they are. While body positivity may be an unreachable goal for some due to deep-seated cultural conditioning, the aim should be to promote body neutrality. This approach recognizes that people’s worth is not determined by their body size or the degree to which they actively try to change it. Everyone has the right to live a fulfilling life without the burden of social judgment based on appearance. Medical Students for Size Inclusivity recommends that an alternative to weight loss medications and dieting is to make no change at all. “Weight alone does not determine health, and there are other markers of well-being that are more accurate and useful.”10 Cognitive shifts away from how someone feels about their body toward how someone feels being in their body is where the magic starts to happen.

Social workers have the opportunity to address weight stigma and challenge harmful cultural narratives about body size. This includes creating safe, nonjudgmental spaces where people of all body types can feel accepted and supported, advocating for clients who experience bias or discrimination based on their body size, and working to shift attitudes toward greater acceptance of diverse bodies.

By adopting a compassionate, body-neutral approach to care, social workers can help clients navigate the complex relationship between body image and self-worth. This involves challenging harmful stereotypes and recognizing that all bodies deserve respect, dignity, and care—no matter their size.

— Trish Otto is a second-year MSW student at Florida Gulf Coast University. She is a certified Intuitive Eating Lay Facilitator and her interests lie in the field of eating disorder treatment, recovery, and authentic self-development through a Health at Every Size (HAES) framework.

Steps for Social Workers to Provide Space for All Bodies
• Increase professional knowledge about antifat bias and weight stigma.

• Address implicit bias and the way it shows up covertly when interacting with others.

• Adopt a weight-neutral practice approach.

• Advocate for body size to be included as a legislatively protected class on state and federal levels and legally ban discrimination on the basis of size.

• Make physical environments accessible to all bodies by providing seating that does not have restrictive armrests and is designed with higher weight limits in mind.

References
1. NASW Code of Ethics. National Association of Social Workers website. https://www.socialworkers.org/About/Ethics/Code-of-Ethics/Code-of-Ethics-English. Updated 2021.

2. Charlesworth TES, Banaji MR. Patterns of implicit and explicit attitudes: I. long- term change and stability from 2007 to 2016. Psychol Sci. 2019;30(2):174-192.

3. Campaign for size freedom. National Association to Advance Fat Acceptance website. https://naafa.org/sizefreedom

4. Abrams Z. The burden of weight stigma. Monitor on Psychology. 2022;53(2). https://www.apa.org/monitor/2022/03/news-weight-stigma.

5. Harrison C. Anti-Diet: Reclaim Your Time, Money, Well-Being, and Happiness Through Intuitive Eating. Boston, MA: Little, Brown; 2019.

6. Dulloo AG. Jacquet J. Montani JP. How dieting makes some fatter: from a perspective of human body composition autoregulation. Proc Nutr Soc. 2012;71(3):379-389.

7. Montani JP, Schutz Y, Dulloo AG. Dieting and weight cycling as risk factors for cardiometabolic diseases: who is really at risk. Obes Rev. 2015;16 Suppl 1:7-18.

8. Tomiyama AJ. Behavioral medicine in the GLP-1 era. Ann Behav Med. 2025;59(1):kaae069.

9. Strings S. Fearing the Black Body: The Racial Origins of Fat Phobia. New York City, NY: NYU Press: 2019.

10. Medical Students for Size Inclusivity. GLP-1 agonist medications: informed consent resource. https://sizeinclusivemedicine.org/wp-content/uploads/2023/11/MSSI-GLP1-Informed-Consent-1-1.pdf. Updated November 2023.