Toward Weight-Inclusive Family-Based Treatment: Clinical Considerations and Opportunities for Change
- 1Faculty of Social Work, University of Calgary, Calgary, AB T2N 1N4, Canada
- 2Chicago Center for Evidence Based Treatment, Chicago, IL 60602, USA
- 3Monte Nido, Miami, FL 33143, USA
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 the existing literature, with additional insights from an author-developed Clinical Teaching Day, 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 around weight-inclusive care, 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’ ability to achieve FBT’s fundamental aims across the weight spectrum.
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BibTeX
@article{nicula2026toward,
title = {{Toward Weight-Inclusive Family-Based Treatment: Clinical Considerations and Opportunities for Change}},
author = {Maria Nicula and Kristen Anderson and Gina Dimitropoulos and Rebecka Peebles},
journal = {Journal of Clinical Medicine},
year = {2026},
month = oct,
doi = {10.3390/jcm15218221},
url = {https://www.mdpi.com/2077-0383/15/21/8221},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Toward Weight-Inclusive Family-Based Treatment: Clinical Considerations and Opportunities for Change
AU - Maria Nicula
AU - Kristen Anderson
AU - Gina Dimitropoulos
AU - Rebecka Peebles
PY - 2026
DA - 2026/10/22
JO - Journal of Clinical Medicine
DO - 10.3390/jcm15218221
UR - https://www.mdpi.com/2077-0383/15/21/8221
AB - 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 the existing literature, with additional insights from an author-developed Clinical Teaching Day, 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 around weight-inclusive care, 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’ ability to achieve FBT’s fundamental aims across the weight spectrum.
SN - 2077-0383
ER -