Normative Does Not Mean Inclusive: A Diverse Approach to Size in Public Health Training​

Normative Does Not Mean Inclusive: A Diverse Approach to Size in Public Health Training​ poster

Audio Presentation:

Audio Transcript


Research Authorship:

Courtney Boggs & Melinda Rule

Faculty Mentor:

Dr. Kassie Terrell | Brooks College of Health | Department of Public Health


Western cultures, like the United States, typically adhere to the medicalized model of weight and weight loss (Kasardo, 2018; Matacin & Simone, 2019). The medicalized model upholds a Weight Normative Approach which assumes that: weight and disease are positively and causally related, weight loss correlates to better health, bodyweight is controllable, and significant weight loss is possible and sustainable for the majority of people (Calogero, Tylka, Mensinger, Meadows, & Danielsdotir, 2018). This model stigmatizes fat people in order to promote health; it may also create socialized internal weight stigmas (Calogero et. al., 2018). Internalized weight stigma is associated with stagnate improvements in disordered eating behavior and overall difficulty in weight loss (Mesinger, Calogero, & Tylka, 2016). A lack of diversity training regarding size and its intersectionality has been observed across several training curriculums including social work, nursing, and professional counseling programs (Brochu, 2018; Kasardo, 2018). Our project aims to advocate for a Weight Inclusive Approach–an approach that sees size as a natural expression of diversity and is linked with greater positive health outcomes–within the University of North Florida’s health and wellness training programs, specifically in the Brooks College of Health (Calogero et. al., 2018). Accordingly, our project will uphold an empowerment-based approach–an approach aimed to embrace terms that have historically been used to shame and marginalize certain populations for their representations of diversity. Terminology, like fat, will be utilized as a process of reappropriation and normalization, as fat is the preferred term within the fat acceptance movement (Meadows & Danielsdottir, 2016).

Hi my name is Melinda Rule and today I will be presenting an advocacy project done by Courtney Boggs and Melinda Rule. We are both members of the clinical mental health counseling program here UNF. The title of our research is called “Normative Does Not Mean Inclusive: A Diverse Approach to Size and Public Health Training”. The objective of this project is to advocate and educate for a weight inclusive approach. This is an approach to see size as a natural expression of diversity and it is linked with greater positive health outcomes. Terminology like “fat” will be used as a process of reappropriation and normalization as “fat” is the preferred term within the fat acceptance movement.

So what is the weight inclusive approach? This is the model that upholds that body diversity is a natural part of the human experience and that people have the right to be fat without prejudice. This model sees health and wellness can be fostered independent of weight. It sees that that health and medical intervention should do no harm. It says that peoples health cannot be separated from the circumstances of their lives and working to improve health and well-being means attending the circumstances and the systems that dictate them. A weight inclusive approach sees that eating patterns, physical activity patterns, availability of social support, stress reduction, and self-care practices should be utilized as tools for health promotion rather than food restriction and yo-yo dieting. Overall a weight inclusive reproach meet people where they are and takes a protective stance on health by encouraging sustainable practices that do not endanger peoples health under the guise of health promotion

So what’s the weight normative approach? To better understand what this approach is we listed a few medical myths; A weight normative Approach thinks that weight and its management are the central determinants of health. It believes that weight and disease are positively and casually related. A weight normative approach thinks that BMI is a meaningful proxy for determining health. It thinks bodyweight is controllable and should be managed. Weight normative approach also believes that a significant weight loss is maintainable and sustainable for the majority of people through dieingt and exercising. It’s that the pursuit of weight loss is safe and its benefits outweigh any risks. And that stigmatizing fat people will promote health and motivate people to lose weight.

So how does a weight inclusive look in reality? In reality socioeconomic status, access to healthcare, harassment based on size, and social location are strong determinants of weight gain and disease progression. Body weight co-occurs within certain conditions, it is not the soul or casual determinate. Physical strength, metabolic fitness, biomarkers, eating habits, and physical activity are more reliable determinants of health than someone’s BMI. Lower income communities usually have less access to resources like nutrient rich foods and safe nearby recreational areas. This makes dieting and exercising unmaintainable and sustainable for many communities. Weight cycling through dieting compromises physical and psychological health. This means that maintaining weight no matter the size is usually a lot healthier for you than gaining and losing weight rapidly.

So what does this look like in our training. We have done some research and found that there is a lack of size in diversity training. Research shows that courses relating to professional counseling, marriage and family therapy, and social work do not include adequate training in size. The coverage in diversity courses are limited and typically do not cover the idea of sizeism or the impact that it can have between healthcare providers and their patients and clients. Majority of the time when weight is mentioned in a health training textbooks is referred to as eating disorders. Not acknowledging sizesim and diversity training adds too the stigma and the medicalization of size. It does not allow clinicians the ability to explore their own biases within their trainings. Clinicians are more likely to pathologize fat clients than nonfat clients and they expect fat clients to put forth less effort in obtaining better health. So there is an impact that health healthcare providers have with their clients based off of their idea of size

So what can we do? We can acknowledge that fat oppression and its impact on clinical work, including the problems presented in a weight normative society. We can recognize that sizeism is a part and should be included in the social categorizations of intersexuality. We could acknowledge the existence of sizeism and include as a dimension in diversity training courses. And we can finally view fat through a social justice lens by representing size as a diversity dimension, correcting weight normative and anti-fat ideology and advocating for weight inclusive approach.

We want to thank you for listening to our research that we’ve done today and hope that through this research we can work towards a more way inclusive model in our society. If you’re interested in any of the research that we have done we recommend three sources to find out some more information:, and Thank you for listening to our presentation.

5 thoughts on “Normative Does Not Mean Inclusive: A Diverse Approach to Size in Public Health Training​”

  1. Great job! Talk about calling attention to a topic in need of more thoughtful research and advocacy!

  2. Very impressive, Melinda and Courtney! I am so proud of all your creativity, initiative, and hard work in coming up with this advocacy project—and combining this with your skills in research! I hope you pursue this very interesting topic!

  3. Kassie Terrell

    Congratulations! I love that you all are bringing awareness to this topic. So much advocacy work is needed. This is an excellent first step. I’m excited to take this project to the next level!

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