I want to start here, because otherwise this conversation gets spicy and people start coming at me before we’ve even taken a breath.
If you prescribe weight loss, I don’t automatically think you’re a terrible practitioner. I don’t think you’re sitting there in clinic twirling an evil moustache wondering how to make your client’s relationship with food worse.
Pretty much all practitioners I know are genuinely trying to help. People come to us with blood sugar concerns, PCOS, fertility stuff, pain, fatigue, cholesterol, perimenopause, gut symptoms, inflammation, mobility concerns, body distress and the whole messy sitch of being a human with a body in this culture.
And yes, people ask for weight loss. Sometimes directly. Sometimes desperately. Or after a GP has told them to. Sometimes they ask for weight loss after years of being taught that shrinking their body is the path to health, acceptance, love, discipline, fertility, confidence, control or finally being “fixed”.
So I understand why weight loss ends up in the room. I understand that some practitioners have built their entire businesses around this work. I understand that some have trained in specific programs and genuinely believe in them. I understand that people have families to feed, rent to pay, and their own food/body/weight histories just like the rest of us.
This is not me sitting on some moral purity throne yelling “bad naturopath” or “shitty nutritionist” at everyone who has ever used a weight loss treatment plan.
And. If weight loss is part of your work, disordered eating literacy is not optional.
Especially not now, when diet culture is especially feral. You may have noticed that extreme thinness is back. GLP-1s are being treated like casual lifestyle tools, and unregulated peptides are floating around. People are openly joking about barely eating, losing their appetite, living on protein bars and coffee, or “forgetting food exists”, and everyone is meant to clap because their body is shrinking.
That cultural backdrop matters. Our clients are not asking for weight loss in a vacuum. They’re asking inside a culture that massively rewards thinness, praises restriction when it produces the “right” body, and disturbingly, often calls disordered eating “discipline” until the person looks sick enough to worry about.
So here are five things I wish more practitioners knew if weight loss is part of their clinical work.
1. You cannot tell who is healthy by looking at them
This is basic bitch stuff, but apparently it still needs saying.
You can’t look at someone and know their blood pressure, glucose, lipids, liver enzymes, menstrual function, strength, sleep, pain, fitness, digestion, mental health or relationship with food. You also can’t look at someone and know whether they are restricting, bingeing, purging, compulsively exercising, skipping meals, abusing laxatives, using unregulated peptides, under-eating on GLP-1s, or spiralling in private while being praised in public.
A thin client may be profoundly unwell. A larger-bodied client may have stable markers, good function and a life that does not need to be overrun by yet another weight-loss attempt. A larger-bodied client may also need medical support. The point is: we need assessment, not assumption.
The 2025 Lancet Commission framework is useful here, even though I don’t love the language. It pushes the conversation beyond BMI as an individual diagnosis and separates “clinical obesity” from “preclinical obesity”. In plain English: body size alone does not tell us enough.
The Commission is basically arguing for what many weight-neutral, HAES-aligned and ED-informed practitioners have been saying for years: look at actual health, symptoms, organ function, daily functioning, risk and context, instead of treating BMI as the whole clinical story.
I can feel every weight-neutral practitioner rolling their eyes painfully hard at the “well, duh” of it all. We’ve been saying this shit for years.
Still... it is useful to have a major Lancet Commission lay it out so clearly, because it gives practitioners another way to push back against lazy “body bigger = prescribe weight loss” thinking.
This doesn't mean body size is never relevant to health. That would be too simplistic too. It means body size alone is not enough information to decide someone needs weight loss, restriction, GLP-1s, or any other intervention aimed at shrinking them.
There is also research describing metabolically healthier larger-bodied people, including this 2024 paper showing that adults classified as metabolically healthy in larger bodies had higher brown adipose tissue volume and activity than metabolically unhealthy counterparts. That doesn’t magically mean “everyone in a larger body is healthy forever”. But it does show how nuts it is to assume one body size equals one metabolic story.
We need to stop pretending we can diagnose health with our eyeballs.
You can’t look at someone and know their blood pressure, glucose, lipids, liver enzymes, menstrual function, strength, sleep, pain, fitness, digestion, mental health or relationship with food. You also can’t look at someone and know whether they are restricting, bingeing, purging, compulsively exercising, skipping meals, abusing laxatives, using unregulated peptides, under-eating on GLP-1s, or spiralling in private while being praised in public.
A thin client may be profoundly unwell. A larger-bodied client may have stable markers, good function and a life that does not need to be overrun by yet another weight-loss attempt. A larger-bodied client may also need medical support. The point is: we need assessment, not assumption.
The 2025 Lancet Commission framework is useful here, even though I don’t love the language. It pushes the conversation beyond BMI as an individual diagnosis and separates “clinical obesity” from “preclinical obesity”. In plain English: body size alone does not tell us enough.
The Commission is basically arguing for what many weight-neutral, HAES-aligned and ED-informed practitioners have been saying for years: look at actual health, symptoms, organ function, daily functioning, risk and context, instead of treating BMI as the whole clinical story.
I can feel every weight-neutral practitioner rolling their eyes painfully hard at the “well, duh” of it all. We’ve been saying this shit for years.
Still... it is useful to have a major Lancet Commission lay it out so clearly, because it gives practitioners another way to push back against lazy “body bigger = prescribe weight loss” thinking.
This doesn't mean body size is never relevant to health. That would be too simplistic too. It means body size alone is not enough information to decide someone needs weight loss, restriction, GLP-1s, or any other intervention aimed at shrinking them.
There is also research describing metabolically healthier larger-bodied people, including this 2024 paper showing that adults classified as metabolically healthy in larger bodies had higher brown adipose tissue volume and activity than metabolically unhealthy counterparts. That doesn’t magically mean “everyone in a larger body is healthy forever”. But it does show how nuts it is to assume one body size equals one metabolic story.
We need to stop pretending we can diagnose health with our eyeballs.
2. “They asked for weight loss” is not informed consent
This is the bit that tends to make people defensive. And I get it. We care about autonomy. We don’t want to be paternalistic. We don’t want to dismiss someone’s lived experience in their own body. We don’t want to say, “No, you’re not allowed to want that.”
But informed consent has to mean more than, “Do you want to lose weight?” Of course many people will say yes. Look at the fucking world we live in. To put it lightly, it is easier to exist as a thin or "straight" bodied person than as a larger bodied person. Another topic for another time.
A better conversation asks what dieting has already cost them. Whether they binge after restriction. Whether they skip meals and then feel out of control at night. Whether they feel anxious when they don’t know what’s in their food. Whether they body check, weigh frequently, avoid social eating, feel morally good or bad depending on what they’ve eaten, or feel like they can’t trust themselves around food.
We need to ask about eating disorder history. We need to ask if they’ve ever wondered whether their relationship with food wasn’t okay. We need to ask how much mental space food, weight and body take up. We need to ask what they believe weight loss will give them, and what happens if it doesn’t.
That is not being annoying. That is not making it weird, or over-therapising. That is much, MUCH closer to consent than “cool, here’s the plan!”.
A client asking for weight loss is not the end of the conversation. It is the beginning of a better one.
But informed consent has to mean more than, “Do you want to lose weight?” Of course many people will say yes. Look at the fucking world we live in. To put it lightly, it is easier to exist as a thin or "straight" bodied person than as a larger bodied person. Another topic for another time.
A better conversation asks what dieting has already cost them. Whether they binge after restriction. Whether they skip meals and then feel out of control at night. Whether they feel anxious when they don’t know what’s in their food. Whether they body check, weigh frequently, avoid social eating, feel morally good or bad depending on what they’ve eaten, or feel like they can’t trust themselves around food.
We need to ask about eating disorder history. We need to ask if they’ve ever wondered whether their relationship with food wasn’t okay. We need to ask how much mental space food, weight and body take up. We need to ask what they believe weight loss will give them, and what happens if it doesn’t.
That is not being annoying. That is not making it weird, or over-therapising. That is much, MUCH closer to consent than “cool, here’s the plan!”.
A client asking for weight loss is not the end of the conversation. It is the beginning of a better one.
3. A shrinking body is not automatically a sign of better health
This feels especially important right now.
The current GLP-1 conversation has made appetite suppression sound almost glamorous. People are talking about not eating with this strange little sparkle, as if hunger disappearing is always a win, as if eating very little is fine as long as it comes in a medical-looking package, as if “I can’t finish a meal anymore” or only being able to et toddler-sized portions is automatically good news.
GLP-1 medications can be useful and important for some people. There may be real benefits for people with diabetes, insulin resistance, PCOS, cardiovascular risk, or other clinical contexts where glycaemic control and metabolic markers genuinely need support.
I am not anti-medication or anti-pharma, and I am not pretending metabolic health doesn’t matter.
What I'm very much against is the casual normalisation of under-eating, muscle loss, nutrient inadequacy, digestive symptoms, food avoidance, body obsession and eating disorder relapse in the name of weight loss. There is a big bloody difference between thoughtful prescribing with proper screening and monitoring, and a culture that treats “I can barely eat anymore” like a cute little success story.
Chuck unregulated peptides and wellness-world “hacks” into the mix and it gets even messier.
Weight loss can look like it’s “working” while someone’s relationship with food is getting worse.
The client loses weight. Their blood markers may even improve temporarily. They feel motivated. People praise them. The intervention looks successful from the outside.
Underneath, food becomes more rigid. Eating out becomes harder. Anxiety increases. Bingeing escalates. Exercise becomes compulsive. They stop trusting hunger. They become terrified of weight regain. They feel ashamed when they can’t maintain the plan.
That isn't a miniscule side issue.
If our version of health makes someone more frightened of food, more disconnected from their body, more obsessed with control and more vulnerable to relapse, we need to stop and look harder at what we are calling “success”.
The current GLP-1 conversation has made appetite suppression sound almost glamorous. People are talking about not eating with this strange little sparkle, as if hunger disappearing is always a win, as if eating very little is fine as long as it comes in a medical-looking package, as if “I can’t finish a meal anymore” or only being able to et toddler-sized portions is automatically good news.
GLP-1 medications can be useful and important for some people. There may be real benefits for people with diabetes, insulin resistance, PCOS, cardiovascular risk, or other clinical contexts where glycaemic control and metabolic markers genuinely need support.
I am not anti-medication or anti-pharma, and I am not pretending metabolic health doesn’t matter.
What I'm very much against is the casual normalisation of under-eating, muscle loss, nutrient inadequacy, digestive symptoms, food avoidance, body obsession and eating disorder relapse in the name of weight loss. There is a big bloody difference between thoughtful prescribing with proper screening and monitoring, and a culture that treats “I can barely eat anymore” like a cute little success story.
Chuck unregulated peptides and wellness-world “hacks” into the mix and it gets even messier.
Weight loss can look like it’s “working” while someone’s relationship with food is getting worse.
The client loses weight. Their blood markers may even improve temporarily. They feel motivated. People praise them. The intervention looks successful from the outside.
Underneath, food becomes more rigid. Eating out becomes harder. Anxiety increases. Bingeing escalates. Exercise becomes compulsive. They stop trusting hunger. They become terrified of weight regain. They feel ashamed when they can’t maintain the plan.
That isn't a miniscule side issue.
If our version of health makes someone more frightened of food, more disconnected from their body, more obsessed with control and more vulnerable to relapse, we need to stop and look harder at what we are calling “success”.
4. Good intentions do not remove clinical risk
I know many practitioners are super kind and compassionate. These practitioners care deeply. I know many of them are trying to support people who feel awful, dismissed, ashamed or stuck in their bodies.
I also know many of us were trained inside models that made weight loss seem like the obvious path to better health. Many practitioners have seen clients feel better with food changes. Many are surrounded by an industry that rewards certainty, protocols, transformations, “after” bodies and confident claims.
So yeah, I understand how we got here. Good intentions still don’t make an intervention safe.
A warm, compassionate practitioner can reinforce food fear. A trauma-informed practitioner can prescribe a plan that intensifies restriction. A practitioner with beautiful values can miss red flags. A practitioner who cares deeply about metabolic health can pour kerosene on a binge-restrict cycle without meaning to.
This is not a character assassination. It is clinical reality. It is much more useful to say, “I need more training here,” than to insist, “But I care about my clients.”
Of course you do. That is why this matters.
I also know many of us were trained inside models that made weight loss seem like the obvious path to better health. Many practitioners have seen clients feel better with food changes. Many are surrounded by an industry that rewards certainty, protocols, transformations, “after” bodies and confident claims.
So yeah, I understand how we got here. Good intentions still don’t make an intervention safe.
A warm, compassionate practitioner can reinforce food fear. A trauma-informed practitioner can prescribe a plan that intensifies restriction. A practitioner with beautiful values can miss red flags. A practitioner who cares deeply about metabolic health can pour kerosene on a binge-restrict cycle without meaning to.
This is not a character assassination. It is clinical reality. It is much more useful to say, “I need more training here,” than to insist, “But I care about my clients.”
Of course you do. That is why this matters.
5. If you prescribe restriction, you need a pause button
I don't think every naturopath, nutritionist or herbalist needs to become an eating disorder specialist. That isn't the point at all.
The point is knowing enough to recognise when something is not a simple food conversation anymore. Knowing when to slow down, when to screen, when to ask better questions, when to stop making weight loss the centre of the room, when to stabilise before you protocol, when to refer, when to collaborate, when to document, and when to have the awkward conversation instead of just hoping the red flags sort themselves out.
If someone has a current eating disorder, a past eating disorder, or clear signs of disordered eating, that should be a giant-ass pause button before prescribing weight loss. Not a tiny note in the intake form. Not something we “keep in mind” while continuing with the exact same plan, albeit a "gentler" version of it.
I’m saying this because clients have told me this exact story. They disclosed active binge eating disorder, for example, and still walked away with a weight-loss plan - sometimes from practitioners using systems like Metabolic Balance, sometimes from other nutrition or naturopathic models that swear they’re being “balanced” and “not restrictive”.
But the client still heard: your body needs to shrink, and food control is the way we’re going to get there.
For someone already stuck in a binge-restrict cycle, that is not neutral. It can deepen shame, escalate the very behaviours we’re meant to be helping with, and teach the client that disclosure doesn’t actually make them safer in healthcare. It just means the same weight-loss plan gets wrapped in nicer language.
So no, a disclosed eating disorder history should not become a footnote while we keep punching on with weight loss.
It should change the plan. It should be a pause button. Like, a proper one.
And a pause button does not mean you abandon the client, shame them, or say, “Too complex, off you go!” It means you practise with more care. It means adequacy, regularity, nervous system safety, nourishment, connection and trust with food may need to come before the gut protocol, the fasting window, the detox, the metabolic reset, the appetite suppression or the weight-loss plan.
Restriction is not a harmless default. It lands (sometimes really fucking hard) inside a person’s history, nervous system, beliefs, shame, coping strategies and relationship with food.
We need to know what we’re walking into.
The point is knowing enough to recognise when something is not a simple food conversation anymore. Knowing when to slow down, when to screen, when to ask better questions, when to stop making weight loss the centre of the room, when to stabilise before you protocol, when to refer, when to collaborate, when to document, and when to have the awkward conversation instead of just hoping the red flags sort themselves out.
If someone has a current eating disorder, a past eating disorder, or clear signs of disordered eating, that should be a giant-ass pause button before prescribing weight loss. Not a tiny note in the intake form. Not something we “keep in mind” while continuing with the exact same plan, albeit a "gentler" version of it.
I’m saying this because clients have told me this exact story. They disclosed active binge eating disorder, for example, and still walked away with a weight-loss plan - sometimes from practitioners using systems like Metabolic Balance, sometimes from other nutrition or naturopathic models that swear they’re being “balanced” and “not restrictive”.
But the client still heard: your body needs to shrink, and food control is the way we’re going to get there.
For someone already stuck in a binge-restrict cycle, that is not neutral. It can deepen shame, escalate the very behaviours we’re meant to be helping with, and teach the client that disclosure doesn’t actually make them safer in healthcare. It just means the same weight-loss plan gets wrapped in nicer language.
So no, a disclosed eating disorder history should not become a footnote while we keep punching on with weight loss.
It should change the plan. It should be a pause button. Like, a proper one.
And a pause button does not mean you abandon the client, shame them, or say, “Too complex, off you go!” It means you practise with more care. It means adequacy, regularity, nervous system safety, nourishment, connection and trust with food may need to come before the gut protocol, the fasting window, the detox, the metabolic reset, the appetite suppression or the weight-loss plan.
Restriction is not a harmless default. It lands (sometimes really fucking hard) inside a person’s history, nervous system, beliefs, shame, coping strategies and relationship with food.
We need to know what we’re walking into.
This is why I created DECIDE
DECIDE exists because so many naturopaths, nutritionists and herbalists are already seeing disordered eating in clinic.
They’re seeing it in clients who come in for gut health, hormones, fertility, fatigue, blood sugar, weight loss, binge eating, food intolerance, GLP-1 support, “emotional eating”, perimenopause, anxiety, chronic dieting and all the rest of it.
A lot of practitioners were never properly taught how to recognise it early. Or how to ask about it. Or how to know what is in scope. Or how to respond without either overstepping or avoiding it completely.
I don’t think shame is going to fix that. I don’t think yelling “you’re all shit!” at natural health practitioners is going to create safer care.
I also don’t think silence is acceptable.
Clients are already in our rooms. Practitioners are already sitting there with that internal feeling of, “Oh shit. I think something is going on here, but I don’t know what to say or do.”
That moment is exactly why DECIDE exists. Not to turn you into an eating disorder therapist. Not to make you scared of food-based care. Not to shame you for everything you’ve ever done in clinic.
DECIDE helps you recognise the patterns earlier, ask better questions, use safer language, understand when restriction is risky, navigate weight-loss requests with more clarity, and know when to stabilise, support, refer or pause the plan altogether.
This is work we can get better at. And fuck, we need to.
DECIDE Cohort 2 is open now. Applications close Friday July 10. We start Wednesday July 15.
If you are a naturopath, nutritionist or herbalist who works with food, body, weight, gut health, hormones, metabolic health or mental health, and you do not want to keep winging it when disordered eating shows up in clinic, I would love to have you in the next round.
Apply here
And if you’re not ready to join, please keep learning about this anyway. Read the free things. Watch the videos. Ask better questions. Slow down before prescribing restriction.
Whether or not you ever join DECIDE, I want this profession to be part of the solution. Not another place in wellness where people are harmed in the name of health.
Casey Conroy
Dietitian | Naturopath | Credentialed Eating Disorder Clinician
They’re seeing it in clients who come in for gut health, hormones, fertility, fatigue, blood sugar, weight loss, binge eating, food intolerance, GLP-1 support, “emotional eating”, perimenopause, anxiety, chronic dieting and all the rest of it.
A lot of practitioners were never properly taught how to recognise it early. Or how to ask about it. Or how to know what is in scope. Or how to respond without either overstepping or avoiding it completely.
I don’t think shame is going to fix that. I don’t think yelling “you’re all shit!” at natural health practitioners is going to create safer care.
I also don’t think silence is acceptable.
Clients are already in our rooms. Practitioners are already sitting there with that internal feeling of, “Oh shit. I think something is going on here, but I don’t know what to say or do.”
That moment is exactly why DECIDE exists. Not to turn you into an eating disorder therapist. Not to make you scared of food-based care. Not to shame you for everything you’ve ever done in clinic.
DECIDE helps you recognise the patterns earlier, ask better questions, use safer language, understand when restriction is risky, navigate weight-loss requests with more clarity, and know when to stabilise, support, refer or pause the plan altogether.
This is work we can get better at. And fuck, we need to.
DECIDE Cohort 2 is open now. Applications close Friday July 10. We start Wednesday July 15.
If you are a naturopath, nutritionist or herbalist who works with food, body, weight, gut health, hormones, metabolic health or mental health, and you do not want to keep winging it when disordered eating shows up in clinic, I would love to have you in the next round.
Apply here
And if you’re not ready to join, please keep learning about this anyway. Read the free things. Watch the videos. Ask better questions. Slow down before prescribing restriction.
Whether or not you ever join DECIDE, I want this profession to be part of the solution. Not another place in wellness where people are harmed in the name of health.
Casey Conroy
Dietitian | Naturopath | Credentialed Eating Disorder Clinician
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