Toward Weight-Inclusive Family-Based Treatment: Clinical Considerations and Opportunities for Change
Abstract
Family-based treatment (FBT) is an evidence-based treatment for adolescents with restrictive eating disorders (EDs). However, FBT is delivered within social and healthcare environments where weight stigma and diet culture remain pervasive. This creates a paradox: young people are asked to challenge fears of weight gain, restore weight, and normalize eating, while encountering messages that reinforce thinness, weight loss, and restrictive behaviours. These tensions are particularly salient in FBT, where weight restoration, parent-led renourishment, and discussions of growth and body change are central. In this narrative review, we examine how weight stigma may enter or interfere with FBT principles through the people and processes involved in treatment. Drawing on existing literature and an author-developed clinical training workshop, we propose practical considerations for delivering weight-inclusive FBT while preserving its core therapeutic functions. These include ongoing clinician self-reflection, weight-inclusive treatment environments, and team alignment on weight goals, alongside FBT-specific approaches to recognizing illness and activating urgency, establishing treatment targets and supporting weight restoration, supporting parent-led renourishment, navigating weighing and body changes, returning autonomy, and relapse prevention. Weight-inclusive practice need not compete with FBT fidelity; recognizing and addressing weight stigma may instead strengthen clinicians’…
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