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Graduate Student Journal of Psychology
Fall 2025 - Vol. 25

Copyright 2025 by the Department of Counseling and Clinical Psychology
Teachers College, Columbia University

A Conceptual Model for Addressing Weight Stigma and 
Health: Guiding Practitioner Conversations for Weight 

Health

     People don't care how much you know until they 
know how much you care.      

— Attributed to Theodore Roosevelt
 People need support. Every person faces adversi-
ty, and health is a universal concern – whether young 
or old, rich or poor, all contend with morbidity and 
mortality. Compassionate individuals are empowered 
by a deep desire to promote the well-being of others. 
Whether they work in medicine, health psychology, or 
public health, their passion for care sparks career inter-
ests and fuels professional diligence. However, how can 
healthcare practitioners (some researchers prefer prac-
titioner to provider; Scarff, 2021) from distinct train-
ing backgrounds and professional roles navigate the 
complexities of weight-related health and weight stig-
ma? This paper reconciles promoting health behavior 
and reducing stigma for weight health by proposing a 
novel conceptual model for practitioners. The model 
resolves a dilemma faced by many practitioners: saying 
too much (e.g., prescriptive weight-related health ad-
vice exacerbating stigma) versus too little (e.g., ignor-
ing insufficient health behavior engagement). To fully 
articulate the model, it is first necessary to review the 
evidence demonstrating the importance of weight-re-
lated health and discuss weight stigma as a barrier to 
health.
Weight Health
 Weight-related health is a principal public health 
concern globally (Okunogbe et al., 2022; Safaei et al., 
2021). Being of higher body weight due to an excess of 

adiposity large enough to cause reduced health or lon-
gevity – at least probabilistically over time – is linked to 
morbidity and mortality, is largely considered a com-
plex lifestyle concern, and its consequences are associ-
ated with increased risk for a myriad of cardiometabol-
ic diseases (Allison et al., 2008; Fruh, 2017; Safaei et al., 
2021). Indeed, higher-than-optimal body weight has 
been linked to increased risk, or at least concomitant 
to, “... nearly every chronic condition, from diabetes, 
to dyslipidemia, to poor mental health. Its impacts on 
risk of stroke and cardiovascular disease, certain can-
cers, and osteoarthritis are significant” (Hruby & Hu, 
2015, p. 10). Whether certain ranges of body weight 
(e.g., body mass index > 30; Allison et al., 2008; Katz, 
2014) are to be medically considered a disease is irrel-
evant to the development of the model. The strength 
of evidence demonstrates that it is beyond a reasonable 
doubt that being of higher body weight due to exces-
sive accumulation of adipose tissue is related to poorer 
cardiometabolic health and well-being (Hruby & Hu, 
2015; Pi-Sunyer, 2009; Robinson et al., 2020; Visscher 
& Seidell, 2001). Although weight-related health and 
associated conditions are complex in their etiology 
and maintenance, consequences related to morbidity 
and mortality are considered largely preventable or 
reducible (Fruh, 2017; Hruby & Hu, 2015). Promi-
nent health organizations educate practitioners and 
patients about the negative impacts of higher-than-op-
timal body weight. The World Health Organization, 
Centers for Disease Control and Prevention, and the 

Colter K. Clayton, MA 
Department of Psychology, University of Mississippi, USA

Practitioners working in a variety of healthcare settings increasingly face a dilemma when speaking with patients 
about weight health. On one hand, prescriptive weight-related health advice can exacerbate stigma, while on the oth-
er, ignoring insufficient health behavior engagement limits health and increases the risk of other adverse weight-re-
lated health conditions. Research has demonstrated that higher-than-optimal body weight is a correlate of morbidity 
and mortality, but has also demonstrated that weight stigma is pervasive, negatively impacting health, health be-
havior, and well-being. This article introduces a novel conceptual model to help practitioners initiate conversations 
about weight health by striving to support health behavior change in a way that deactivates and disempowers weight 
stigma. By advancing the acceptance principle from motivational interviewing and adapting its scope, the model 
focuses on destigmatizing attitudes and assumptions related to weight health to prevent or reduce generalized and 
internalized weight stigma. The model also focuses on limiting interpersonal stigma and its disruptive role in prac-
titioner-patient communication by supporting personal autonomy for a lifestyle of health behavior. This article re-
ports results from a rapid review and calls for research efforts to examine the potential causal role of active acceptance 
for reducing weight stigma. Overall, the conceptual model simultaneously promotes health behavior and reduces 
weight stigma for weight health.
 Keywords: weight stigma, weight health, health behavior, motivational interviewing, healthcare practitioner



6

WEIGHT AND STIGMA

National Institutes of Health use websites1* to pub-
licly disseminate the latest research on risk factors and 
best-practice health strategies to educate practitioners 
and patients.
 Healthcare practitioners know that weight loss 
(when needed) has a large impact on improving health 
through lowering risk for disease (e.g., type 2 diabe-
tes, hypertension, dyslipidemia; Haase et al., 2021) 
and is linked to improvement in current health con-
ditions (Pojednic et al., 2022). Even modest amounts 
of weight loss (e.g., >5% of body weight) are associated 
with clinically significant improvements in cardiomet-
abolic health and emotional well-being (Fruh, 2017), 
and weight loss at higher levels can lead to further 
improvements (Ryan & Yockey, 2017). More engage-
ment in health behaviors is needed; physical activity, 
eating a healthy diet, and obtaining quality sleep are 
vital for health. For example, in the United States, only 
about 1 in 4 adults meets physical activity guidelines, 
and engagement is even lower among those with lower 
incomes (Elgaddal et al., 2020). 
 Practitioners also know that physical activity has 
health benefits independent of body weight. For ex-
ample, among people with higher body weight, phys-
ical activity has demonstrated positive changes at the 
cellular level (e.g., improved enzyme function), along 
with improved metabolic function (e.g., increased in-
sulin sensitivity), and better cardiovascular outcomes 
(e.g., decreased arterial stiffness; Pojednic et al., 2022). 
Thus, physiologic improvements observed with in-
creased physical activity are observed despite starting 
weight and irrespective of whether weight loss occurs, 
and cardiorespiratory fitness is an indicator of meta-
bolic health (Ortega et al., 2013). Given that health be-
haviors such as physical activity contribute to health, 
increased adherence and implementation are needed.
Weight Stigma
 Practitioners are increasingly becoming aware of 
how health stigma and discrimination limit social ac-
ceptance and opportunity, and how they exacerbate 
inequality, which are well-documented barriers to en-
gagement in healthcare and health behaviors (Hatzen-

1 *https://www.who.int/health-topics/obesity#tab=tab_1; 
https://www.who.int/news-room/fact-sheets/detail/obesi-
ty-and-overweight; https://www.cdc.gov/family-healthy-weight/
php/recognized-programs/index.html; https://www.cdc.gov/
obesity/php/about/obesity-strategies-what-can-be-done.html; 
https://www.niddk.nih.gov/health-information/weight-manage-
ment/adult-overweight-obesity/health-risks

buehler et al., 2013; Stangl et al., 2019). Weight stigma 
is a form of health stigma. It refers to reduced social 
status due to excess body weight, and weight-related 
negative attitudes are linked to discriminatory actions 
such as unfair treatment in healthcare (Rubino et al., 
2020). A landmark study at the turn of the century 
by pioneering weight stigma researchers introduced 
its negative impact on employment, education, and 
healthcare (Puhl & Brownell, 2001). Subsequent re-
search has solidified weight stigma as a major health 
issue: at least 1 in 2 adults experience stigma related 
to their weight, which is associated with less regular 
medical checkups, healthcare avoidance, and worse 
healthcare quality experiences (Puhl et al., 2021). Re-
cent international research initiatives to address weight 
stigma have called for more actions from the medical 
community to promote the education and training of 
healthcare professionals to practice without participa-
tion in or perpetuation of weight stigma (Puhl et al., 
2021; Puhl, 2023; Rubino et al., 2020). 
 Healthcare practitioners are increasingly recog-
nizing that weight stigma is not helpful or healthy. A 
major concern of weight stigma is its negative effect on 
health behaviors: decreased physical activity, decreased 
healthcare engagement, and paradoxically, even weight 
gain (Tomiyama, 2014). Weight stigma has negative 
impacts in laboratory and real-life contexts (Major et 
al., 2014; Panza et al., 2023; Puhl & Suh, 2015; Rubi-
no et al., 2020). For example, brief exposure to reading 
or watching weight stigma can elicit cardiovascular re-
activity and increase overeating behavior (Major et al., 
2014; Panza et al., 2023). The everyday consequences 
of weight stigma include maladaptive eating behaviors 
(e.g., binge eating), lower engagement in physical ac-
tivity, and unhealthy weight gain (Puhl & Suh, 2015). 
Dilemmas of Weight Health and Stigma 
 Saying too much can exacerbate stigma. For ex-
ample, some researchers have called for increased so-
cial pressures (e.g., societal shame) to help individuals 
become more aware of their weight and associated 
stigmatization (Callahan, 2013), but subsequent stig-
ma research did not support social pressure as a viable 
method to improve weight health (Puhl et al., 2021). 
Conversely, saying too little may condone poor health 
behaviors. The Health at Every Size (HAES) approach 
is a product of both academic research and social 
movements that challenge weight stigma, deprioritize 
weight and weight-related biomarkers of health, and 



7

CLAYTON

promote bodily acceptance to improve health and 
well-being (Bombak, 2014; Penney & Kirk, 2015). Fa-
cilitating access to healthcare that is free of shame is a 
prominent virtue of this framework. However, while 
intending to reduce stigma, dismissing (whether delib-
erately or inadvertently) physical health recommenda-
tions may occur. 
 People with higher weight report negative psy-
chological reactions to receiving weight-related advice 
from healthcare practitioners (Standen et al., 2024), 
which may explain why some groups reject and even 
criticize weight health recommendations as unethical 
(e.g., HAES). Self-affirmation theory describes how 
people maintain integrity to themselves (Steele, 1988). 
In weight stigma research, this theory may explain why 
people may be motivated to maintain a positive self-
view regarding their weight when perceiving weight 
stigma. For example, a healthcare professional recom-
mending weight loss may evoke a patient’s efforts to 
maintain self-integrity, where healthcare recommen-
dations related to body weight are perceived as attacks 
on personal identity; this may be a reason that recom-
mendations can fail to produce motivation for change. 
Thus, practitioners must simultaneously preserve pa-
tients’ self-integrity and recommend health behavior 
change. 
 Given the interacting complexities of weight-re-
lated health and stigma, practitioners face a daunting 
responsibility to care for patients. The dilemma prac-
titioners face is two competing risks: over-alerting pa-
tients can be counterproductive, eliciting societal or 
personal shame and exacerbating the distress of stigma; 
conversely, under-alerting patients to weight-related 
health risks fails to promote positive health behavior 
change. A paradigm grounded in theory and evidence 
is needed to guide practitioners as they navigate the 
complexities of weight-related health. 

Developing the WHISTLE Model
 Research on the biopsychosocial factors of 
weight-related health and healthcare has led to theo-
retical and conceptual models that are comprehensive 
and often complex (Marks, 2015; McCabe et al., 2023; 
Michie et al., 2014; Plotnikoff et al., 2007). How-
ever, such models are not specific to stigma, though 
one model of weight stigma has emphasized a vicious 
feedback loop of stigma and weight gain (Tomiyama, 
2014). Thus, existing models fall short of offering a 

simple and practical framework to begin helpful dis-
cussions about weight health and stigma. The novel 
Weight Health through Integrated Stigma-Reduction 
and Lifestyle Engagement (WHISTLE) model serves 
as a guide for practitioners. In contrast to the tradition-
al "sick" role of passive prescriptions, contemporary 
healthcare increasingly prioritizes enhancing patient 
agency to boost health outcomes through more ef-
fective health behavior (Armstrong, 2014). However, 
healthcare practitioners may feel uncomfortable or in-
competent in discussing weight with patients (Pont et 
al., 2017). The WHISTLE model aids practitioners as 
they practice attitudes of acceptance to reduce weight 
stigma when opening a conversation about weight-re-
lated health that facilitates the encouragement of 
health behavior change by using a patient-centered ap-
proach.
 Health behavior change is facilitated through the 
atheoretical principles of motivational interviewing. 
At its core, motivational interviewing is an empirically 
supported, patient-centered approach to talking with 
people in a way that strengthens their own motivation 
and commitment for behavioral change (Miller & 
Rollnick, 2023). Reflections and questions by prac-
titioners help patients work through the natural am-
bivalence they experience when facing decisions about      
behavioral change. The proposed mechanism that has 
received the most empirical support is practitioners’ 
use of selectively reinforcing patients’ own motiva-
tional statements for behavior change (Bischof et al., 
2021). Research on motivational interviewing as a fa-
vorable intervention for positive health behavior (e.g., 
physical activity) and weight-related health outcomes 
is mixed (Amiri et al., 2022; Frost et al., 2018; Lundahl 
et al., 2013; Makin et al., 2021; Michalopoulou et al., 
2022). However, motivational interviewing as an em-
pirically supported way of effectively being in a help-
ing relationship (e.g., practitioner engagement) and 
facilitating behavior change has received substantial 
empirical support across healthcare settings (Bischof 
et al., 2021; Lundahl et al., 2013; Luty & Iwanowicz, 
2018; Magill et al., 2018; Miller & Rollnick, 2023; Ru-
bak et al., 2005). 
 While motivational interviewing principles broad-
ly support behavioral change, they do not address the 
issue of stigma – particularly weight-related stigma – 
in weight-related health outcomes. The novel WHIS-
TLE model is a person-centered framework that tar-



8

WEIGHT AND STIGMA

gets weight health conversations and was derived from 
a component known as acceptance. The WHISTLE 
model’s guiding principle of acceptance was based on 
a previous edition of the motivational interviewing ap-
proach created by Miller & Rollnick (2013) with four 
‘A’s: absolute worth, accurate empathy, affirmation, 
and autonomy support. In the WHISTLE model, 
the four ‘A’s function as fundamental assumptions, 
attitudes, and actions for practitioners working with 
patients and weight health concerns. Thus, the WHIS-
TILE model provides a foundation to simultaneously 
reduce stigma and encourage health behavior change. 
 In the WHISTLE model, practitioners assume 
and adopt an attitude that each patient has inher-
ent worth irrespective of weight, health, or behavior, 
and that each person is innately capable of behavior-
al change. Actions of practitioner acceptance include 
expressing accurate empathy and communicating a 
genuine interest in understanding the patient’s expe-
riences and situation (Schumacher & Madson, 2014). 
Practitioners also provide affirmations and statements 
to help patients see their own strengths and resourc-
es and champion patients’ autonomy as they choose 
whether and how to make behavioral change. Since 
patients with a history of weight stigma report being 
less heard and respected by their healthcare practi-
tioner (Puhl et al., 2021), the WHISTLE model’s as-
sumptions, attitudes, and actions function to reduce 
self-stigma, stigma in the practitioner-patient relation-
ship, and prevent or reduce generalized weight stigma 
from interfering with healthcare discussions about 
weight health (see Figure 1). 
 Weight stigma interferes with practitioner-patient 
communication through shameful language and im-
paired emotional engagement, which are associated 
with healthcare disengagement and avoidance (Puhl, 
2023). Practitioners with higher weight stigmatizing 
attitudes report feeling less confident in offering weight 
health recommendations and less likely to use a per-
son-centered approach when speaking with patients 
(Bennett & Puhl, 2024). On the other hand, within 
a motivational interviewing approach, patients who 
talk about plans for behavior change show better body 
weight outcomes over time (Copeland et al., 2017). Pa-
tients can feel simultaneously motivated to lose weight 
and feel bad (e.g., guilty) regarding their weight-relat-
ed health (Standen et al., 2024), highlighting the need 
for concurrent stigma reduction and health behavior 

encouragement. Practitioners may be better equipped 
to work with weight health to deactivate stigma with 
acceptance-promoting statements.
 The WHISTLE model helps practitioners to 
channel an atmosphere of acceptance to 1) prevent 
generalized social stigma and their own potentially 
stigmatizing attitude from entering the relationship, 
and 2) reduce self-stigmatizing beliefs among patients 
(though the patient acts as the mediator of this relation-
ship; see Figure 1). Within this atmosphere, practicing 
acceptance moves generalized practitioner stigma and 
self-stigma further away from the patient to allow for 
increased patient self-efficacy, weight-related health in-
formation discussions, and encouragement of healthy 
lifestyle behavior. The figurative cloud represents the 
subjective, relational aspect in which practitioner-pa-
tient communication occurs. Statements of accurate 
empathy increase connection and empower patients’ 
autonomy for making behavioral health changes (see 
Table 1). Supporting autonomy is intended to have 
the dual effect of further reducing stigma while pro-
moting behavior change. Practitioners risk eliciting 
ambivalent or negative psychological reactions as they 
offer weight-related advice, but a two-way discussion 
is a characteristic of patients feeling motivated to be-
gin healthy behavior change (Standen et al., 2024). 
Practitioners using the WHISTLE model who create 
an atmosphere for health behavior change, champion 
patient autonomy, and affirm the value and ability of 
healthy lifestyle behavior will likely negate the adverse 
impacts of stigma on health and well-being. 
 The WHISTLE model extends behavioral change 
frameworks. For example, motivational interviewing 
and self-determination theory (i.e., an empirical frame-
work for enhancing behavior change) are conceptually 
related and aid practitioners in helping patients inter-
nalize their own motivation and ultimately foster voli-
tional health behavior change (Abildsnes et al., 2021). 
Although these informed the development of the 
WHISTLE model, this model uniquely highlights the 
necessity of averting weight stigma’s disrupting role in 
hampering practitioner-patient communication and 
provides a feasible template for accomplishing this 
task. It is also important to recognize that increasing 
sensitivity to perceived harm, such as weight stigma, 
may engender a sense of diminished perceived control 
among patients, which is a factor that has long been 
recognized as a facilitator of health behavior change 



9

CLAYTON

(Schwarzer & Fuchs, 1996; Strecher et al., 1986). Con-
versely, while self-affirmation can be a barrier, it is also 
a catalyst for behavior change (Cohen & Sherman, 
2014). Indeed, research has demonstrated the value of 
affirmation interventions, which are associated with 
better health, including increased health behavior and 
even lowering body weight toward healthier ranges 
(Epton et al., 2015; Ferrer & Cohen, 2019; Logel & 
Cohen, 2012). For example, self-affirmation is associ-
ated with greater acceptance of health information and 
stronger motivation for health behavior change when 
receiving health risk information (Epton et al., 2015).
 

Discussion
 The WHISTLE model is not a full-scale interven-
tion but rather emphasizes an attitude of acceptance in 
which practitioners harmoniously attend to disarming 
stigma and facilitating health behavior for weight-re-
lated health. Other researchers have developed a 
high-quality guide to foster practitioner-patient com-
munication within a motivational interviewing ap-
proach to reduce stigma in weight health (see Scherr 
et al., 2023, for a review). The WHISTLE model adds 
to this research by focusing on attitudes and actions of 
acceptance, and its primary purpose is to initiate con-
versations about weight health and behavioral change 
within an attitude of acceptance to prevent and reduce 
stigma. Beyond initial engagement and discussion 
about weight health using the WHISTLE model, prac-
titioners use methods and treatments congruent with 
their expertise, responsibility, and setting. More sim-
ply, a broad scope guideline to continue conversations 
is outlined within a Brief Action Plan (BAP), which is 
a person-centered approach to facilitate health behav-
ioral change and has supporting evidence across many 
healthcare settings (Jadotte et al., 2023). The WHIS-
TLE model’s biopsychosocial lens allows for a compas-
sionate and health-focused approach to reduce stigma 
and empower patients to participate in healthy lifestyle 
behaviors. Consistent with motivational interviewing 
principles, the WHISTLE model does not imply en-
dorsement of unhealthy behaviors but rather acts as a 
relational process in which an attitude of acceptance 
deactivates stigma while still facilitating health behav-
ior change. As practitioners within the WHISTLE 
model focus on empirically supported health behav-
iors in an atmosphere of acceptance that affirms one’s 
inherent value, defuses stigma, and supports autono-

my for health behavior change, weight-related health is 
likely to improve. 
A Call to Healthcare Practitioners
 Psychological theories on behavior change are ad-
vancing the landscape of healthcare quality (Hilton, 
2023). Healthcare practitioners across training back-
grounds and treatment settings have a duty to promote 
weight health and well-being. Mental health clinicians 
are even emerging as important, supplementary prac-
titioners to weight-related health concerns (Dandgey 
& Patten, 2023; Murray et al., 2021). Given the rising 
adverse health consequences of higher body weight, 
inaction will have negative global impacts on health, 
well-being, and economic resources (Okunogbe et 
al., 2022). Although calls for systemic-based changes 
are increasing (and likely required) to effectuate last-
ing weight-related health improvements from a pub-
lic health perspective (Okunogbe et al., 2022; Puhl & 
Suh, 2015), practitioners maintain the responsibility 
to promote health behavior change.
 Health psychology research has recognized 
weight-related health as a persistent public health con-
cern despite decades of targeted resources and research 
(Brownell, 2010). Health psychologists have a duty to 
bilaterally support patients based on the advancing em-
pirical literature across health sciences. Just as weight 
stigma research is progressing, the data establishing 
the health benefits of healthy lifestyle behavior and 
the risks for morbidity and mortality related to higher 
body weight are also advancing. Health psychologists 
are well-positioned to handle potentially conflicting 
goals related to stigma, behavior, and weight health. 
However, to maintain this position, health psychol-
ogists and related professionals must maintain fidel-
ity to evidence demonstrating the negative impacts 
of higher body weight and strive to mitigate risks 
through facilitating health behavior. For example, con-
trary to HAES, health psychologists cannot maintain 
weight-related neutrality when presented with oppor-
tunities to promote weight-related health. Health be-
havior and weight-related health dialogue need not be 
removed nor disparaged to reduce weight-related stig-
ma. Promoting empirically supported health behav-
iors (e.g., physical activity) for weight-related health is 
vital for patients and a duty of practitioners. 
Future Research Directions
 The WHISTLE model has implications for at 
least three directions for research. First, there has been 



10

WEIGHT AND STIGMA

promising research on self-affirmation as a weight-re-
lated health treatment (Logel & Cohen, 2012). More 
research should test whether self-affirmation interven-
tions are effective for protecting patient self-identity in 
the context of receiving healthcare recommendations, 
reducing weight stigma, and facilitating health behav-
ior changes congruent with weight health recommen-
dations. Relatedly, compounding stigmas represent 
a greater health concern (Stangl et al., 2019), but re-
search has only recently begun to investigate weight 
stigma and diversity, such as the intersectionality of 
weight stigma, race, and gender. Experienced weight 
stigma is similar across racial and gender groups but 
internalized less among Black and Hispanic individu-
als relative to White individuals, and less among men 
relative to women (Himmelstein et al., 2017; Reece, 
2019; Wetzel & Himmelstein, 2024). Notably, low-
er self-compassion is associated with greater weight 
stigma across racial and socioeconomic backgrounds, 
which represents a potential target for reducing inter-
nalized weight stigma (Puhl et al., 2020). 
 Second, the impact of technical aspects of the 
WHISTLE model (i.e., acceptance statements and 
questions) should be empirically investigated to test 
the hypothesized effect of simultaneously reducing 
weight stigma and facilitating healthy lifestyle behav-
ioral change (Moizé et al., 2025). To operationalize the 
processes of the WHISTLE model, researchers could 
determine whether a practitioner’s statement (or ques-
tion) for initiating conversations about weight health 
is congruent with the four ‘A’s of acceptance. For ex-
ample, 1 = congruent, 0 = partially congruent, and -1 
= not congruent, with higher total scores reflecting 
higher adherence to the WHISTLE model. Table 1 
provides appropriate statements, each of which is con-
gruent with assumptions, attitudes, and actions of ac-
ceptance in the WHISTLE model. A randomized con-
trolled trial could be conducted to compare the weight 
stigma and behavioral outcomes of practitioners who 
use the WHISTLE model to initiate conversations 
with patients compared to an active control, such as 
practitioners’ treatment as usual, which often involves 
blunt recommendations to reduce body weight that 
exacerbate stigma (Standen et al., 2024). Behavioral 
outcomes may be measured by any relevant health be-
havior metric (e.g., change in total minutes per week 
spent participating in physical activity). Weight stig-
ma outcomes may be assessed using existing validated 

weight stigma measures such as the Perceived Weight 
Stigma Scale (PWSS; Schafer & Ferraro, 2011). 
 Third, researchers from disparate training back-
grounds (e.g., medicine, public health, psychology, 
sociology) may consider joint initiatives to synthesize 
data across biopsychosocial health science domains 
to elucidate weight health and stigma interactions. 
Results of such research would inform interventions 
to simultaneously reduce stigma and promote weight 
health and well-being. 
 A major limitation is that extant literature on mo-
tivational interviewing has not examined its potential 
effectiveness (i.e., its potential causal role) for reducing 
weight stigma, as evidenced by a systematic rapid re-
view (see Appendix) using Approach 3 by Tricco et 
al. (2016). However, there are theoretical reasons that 
suggest that acceptance would be potentially effective 
for reducing stigma given that motivational interview-
ing is efficacious for behavioral change among people 
with substance use issues, who experience substance 
use stigma (El Hayek et al., 2024; Kulesza et al., 2013; 
Magnan et al., 2024; Miller & Rollnick, 2023; Yang et 
al., 2018). The only study to quantitatively correlate 
motivational interviewing and weight stigma showed 
that physician experience with motivational interview-
ing was associated with more use of person-first lan-
guage and positive perceptions of patient adherence to 
treatment recommendations (Bennett & Puhl, 2024). 
Although the WHISTLE model’s foundation on pa-
tient acceptance and engagement lends itself well to 
reducing weight stigma in healthcare contexts (Moizé 
et al., 2025), the empirical research previously outlined 
is a necessary next step to evaluate the potential efficacy 
of the WHISTLE model. 

Conclusion
 The WHISTLE model is utilitarian, emphasizing 
action where health behavior promotion and an atti-
tude of acceptance to reduce stigma occur concurrent-
ly. At its basic level, the WHISTLE model is a unifying 
agent for practitioners and patients working together 
to improve weight-related health. Practitioners must 
engage in accepting and collaborative conversations 
to increase health behavior, whether preventive or 
reactive, focusing on person-centered care to foster 
weight health. Attitudes and actions demonstrated 
in an atmosphere of acceptance are likely to lead to 
reduced stigma and enhanced practitioner-patient 



11

CLAYTON

communication. Healthcare and mental health prac-
titioners who encourage health behavior and discuss 
weight health may face criticism from colleagues or 
patients who favor reducing stigma over promoting 
weight-related health as campaigns against weight 
stigma become increasingly heard and promoted (e.g., 
HAES). However, there is no need to campaign for 
avoiding conversations about health behavior and 
denigrate health science research for the destigmatiza-
tion of weight. Indeed, discussing the importance of 
fundamental health behavior (e.g., physical activity) 
may appear less popular, but it is more vital than ever. 
Overall, the WHISTLE model functions to increase 
patient-centered care by empowering practitioners to 
face the challenge of initiating weight-related health 
and health behavior change discussions in a way that 
deactivates the barriers of stigma. 

Acknowledgements
 I sincerely thank Dr. Andrew H. Hales for his pro-
fessorship and writing mentorship. 

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Figure 1.

The Weight Health through Integrated Stigma-Reduction and Lifestyle Engagement (WHISTLE) Model 



17

CLAYTON

Table 1.

Sample Statements to Initiate Weight Health Conversations Congruent with Acceptance

Note. Attuned readers may notice the conceptual overlap of the acceptance statements and even their near inter-

changeability. After each of these statements, an additional acknowledgement of patient autonomy may fit as 

well. For example, “And, of course, any changes (e.g., related to health, physical activity, eating) you choose to 

make would be completely up to you.” 



18

WEIGHT AND STIGMA

Appendix

Supporting Table 1. Search strategy for PubMed

Block 1: Motivational interviewing 

Block 2: Stigma

Block 3: Weight

Note. Database was accessed 4/2/2025. No filters or date ranges were applied. The three blocks were connected 

with the Boolean operator ‘AND’. The search yielded five results. Screening determined that no study examined 

the potential relationship between motivational interviewing and weight stigma.



19

CLAYTON

Appendix

Supporting Table 2. Search strategy for Scopus

Block 1: Motivational interviewing 

Block 2: Stigma

Block 3: Weight

Note. Database was accessed 4/2/2025. No filters or date ranges were applied. The three blocks were connected 

with the Boolean operator ‘AND’. The search yielded five results. Screening determined that no study examined 

the potential relationship between motivational interviewing and weight stigma.


