This is the most prominent theme. Participants envision a weight neutral system that moves away from focusing on weight and BMI to a more holistic health approach that actively reduces stigma. This includes:

• No BMI surveillance or weight-based diagnostic criteria.

• Removal of terms like "healthy weight" and "weight management."

• Focus on health gain rather than weight loss.

• Understanding that weight is an outcome of metabolic dysfunction, not the cause.

• No “weight management” services, pathways, or KPIs.

A significant change is expected in how patients are treated and how they feel about accessing care:

• More cancer screening engagement in a higher weight population.

• Doctors who truly listen and see the patient as a whole person.

• Patients feeling they can access support without judgement and stigma.

• Reducing stigma and rebuilding equity for higher weight patients.

• More respectful language used when discussing HEALTH.

• Increased patient engagement among those previously delaying or not attending.

Beyond individual ‘blame’ interactions, the 10-year plan should influence

• More size inclusive long term conditions care, size inclusive nutrition support and size inclusive physical activity programs for people of ALL sizes.

• Improved and more accessible mental health support.

• Representation - Promotion of different body sizes, abilities and ethnicities in healthcare.

The language used around HEALTH needs to evolve:

• Person first language is still very ‘othering’ it still problematises weight for everyone and does not align with The Lancet / NICE guidelines agreeing that body weight is over-diagnosed and over-treated.

• Exclusion of BMI and “weight management” in guidelines and policies.

The plan envisions changes that empower healthcare professionals to provide better care:

• As a social justice issue; bias and stigma awareness training that goes beyond ‘being nice to fat people’ and creates real equity and rebuilds trust.

• Healthcare professionals feel able to support people in living well.

• Better education for healthcare professionals on the impact of weight stigma on physical and mental health.

• Healthcare professionals remove weight from the therapeutic conversation as it is neither a diagnostic tool nor a targeted outcome.

• Health professionals having the time to actually listen to patients and families; Over the long term, weight neutral / inclusive care should reduce the burden on the NHS and free up resources to allow this.

Respondents hope for repurposing resources and capacity, currently used ineffectively for ‘weight management’, to support the desired changes:

• Enough resources to do what needs to be done in a timely manner.

• Increased focus on prevention - of poor health NOT ‘obesity prevention’.

Size Inclusive Long Term Conditions Care - Actionable Steps:

Core Principles:

• Avoiding Weight as a Default Diagnosis: Healthcare professionals should avoid defaulting to weight as the cause of a suspected condition and instead conduct thorough assessments that consider all contributing factors - this aligns with NICE Guidelines 1.9.1 Avoid attributing all symptoms to overweight or obesity (diagnostic overshadowing). If the person is presenting with another health problem or condition (such as hip pain), address this problem or condition. [2025]

• Reframing Common Conditions: A shift in approach is needed for conditions like Type 2 Diabetes and osteoarthritis, moving away from the assumption that they are solely driven by weight and focusing instead on underlying factors like inflammation and stress - both of which also drive weight gain.

• Addressing Complex Factors: Care should be tailored to address the combination of complex factors that individuals face, recognising that these factors need support alongside the long-term condition.

• Patient-Centred Approach: The emphasis is on listening to the patient's experience, understanding their individual definition of health, and avoiding assumptions based on size.

• Holistic Understanding: Moving beyond weight as the focus, the responses call for a deeper understanding of the complex factors that contribute to health, including inflammation, stress, poor sleep, environmental challenges (e.g. endocrine disrupting chemicals), caring responsibilities, disabilities, genetics, income, bereavement, and mental health. Intersectionality is explicitly mentioned, recognising the interconnectedness of these factors.

• Stigma-Free Services: Creating a safe and inclusive environment where individuals feel comfortable accessing care without fear of weight stigma is crucial. This will enable people who have historically avoided services to receive the support they need.

• Peer Support: The value of peer support within the community is recognised as an important component of long-term condition management.

Underlying Rationale:

The overarching rationale is that all people deserve access to healthcare that meets their needs. By providing appropriate support and reducing stigma, individuals will be more likely to engage with healthcare services, leading to better management of their conditions and a reduction in complications.

Core Principles:

• Equitable Food Access and Nutritional Balance NOT Energy Deficits: The emphasis should be on making improved nutrition the easiest to access, rather than deficit models.

• End NCMP: Use National Child Measurement Programme funding to roll out Stigma Informed Systems training and Body Image sessions in Schools instead. Utilise positive food education to be empowering, avoiding shame and stigma.  A growing body of evidence demonstrates that weight/ BMI surveillance programmes not only do not deliver improvements but result in weight gain over time and an increase in maladaptive behaviours.

• Equitable Approach to Food: A decolonial lens is needed to address the deep roots of oppression that influence food access and choices. This includes understanding the impact of trauma, challenging binary thinking around food, and fostering more connected food cultures. The individualistic construct of "health" should be replaced with a more community-focused approach.

• Addressing Social Determinants: Services must acknowledge and address the social, economic, and environmental factors that limit food choice and access. This includes empowering communities to improve nutrition on their own terms.

• Early Influencers: Weight neutral support should begin early, including breastfeeding, weaning, and early years nutrition, as well as parenting skills. Stigma free services focused on these early stages, such as practical cooking sessions and help with ‘picky’ eating, are crucial.

• Understanding How External Companies impact NHS services:.Services should resist the impact of commercial interests in shaping the healthcare narrative. Financial support of CPD by pharmaceutical companies, diet companies, food manufacturers etc. should be strongly discouraged. In this day and age of virtual meetings, there is no need for dietetics and general practice conferences to be sponsored by Coca Cola et al.

• Inclusivity and Accommodation: Nutritional support must be inclusive and accommodate all types of diets and cultures (vegan, vegetarian, halal, kosher). Existing health conditions that impact nutrition management (e.g. allergies, low blood sugar) must also be taken into account.

• Holistic Approach: Managing health should be understood as a combination of stigma free physical exercise, nutrition, sleep function, mental health and stress reduction. Collaboration between schools, the NHS, experts, food banks, and supermarkets is essential to redress historical harms by an outdated weight centric system.

• Shifting Clinical Referral Practices: Using money spent on tiers 1 and 2 to invest in universal nutritional and metabolic support. Robust informed consent processes must be adhered to for tiers 3 and 4. We need to recognise that support isn’t linear or one-way. A postoperative gastric sleeve patient still needs support with nutrition and size acceptance. Similarly someone who has tried GLP-1’s and stopped and had their weight naturally rebound also needs a shame free structure around them.

• No Wrong Door Entry and Re-Entry: The emphasis for change needs to fall back onto the system to explicitly reduce stigma and help citizens feel activated in their own care once more. The impact of weight stigma on a person's physical and mental health must be centered at every stage of engagement and we need our beloved NHS to lead on this and no longer prop-up damaging diet culture.

Underlying Rationale:

The evidence shows that systems focused on ‘solving obesity’ not only fail to improve overall health but contribute to worsening health. Re-engaging people with stigma-free and stigma-informed care systems leads to better health outcomes. Most individuals have been bombarded with conflicting information about what to eat, from both credible and unreliable sources, leaving them uncertain about how to approach nutrition.

Nutritional advice should focus on repairing metabolic function damaged by weight-loss dieting and maximising good nutrition within the context of patients’ own preferences, culture, and needs.

Approaches are needed that don’t encourage them to work against their biology. Restrictive diets often lead to bingeing and self-shame.

The majority of fat people do not eat ‘too much food’ – most eat less than their body needs, with metabolic function largely determined by genetics. Dieting can disrupt metabolism, making the body more likely to store energy as fat. Endocrine-disrupting chemicals, stress, and insufficient sleep also impair metabolism, and attempts to restrict calorie intake often drives weight rebound and additional weight gain.

While some foods are undoubtedly more nutritious than others, the first priority must be ensuring that everyone has enough to eat and is eating regularly, ideally every 3–4 hours throughout the day. Decades of evidence show that dieting and caloric restriction fail to achieve long-term weight loss or health benefits. Instead, the focus should shift to promoting consistent and sufficient nourishment as the foundation for overall health, prioritising markers like blood glucose, insulin, inflammation, immunity, and mood over unreliable weight changes.

Size-inclusive nutrition promotes eating in a way that feels right for the body, without the pressure to drastically reduce calories or underfeed oneself. This is an urgent priority.

Core Principles:

• Exercise as Enjoyment, Not Weight or Body Composition Change: The primary focus should be on exercise as an enjoyable part of life, not as a tool for weight change or targeting body parts.

• Exercise to Build Strength and Mobility: emphasis placed on building strength and function, rather than focusing on weight change or body composition monitoring.

• Active Decoupling of Exercise and Weight Loss: This goes beyond simply not mentioning weight loss; it involves actively stating that weight loss is not a health-promoting or likely outcome of exercise, while simultaneously highlighting the numerous other benefits of physical activity.

• Representation and Imagery: More representation and imagery of larger bodies and fat people exercising is needed to normalise exercise for all body types. Exercise should not be promoted as a tool for changing appearance. Appearance changes may or may not occur, but using this as a goal actually diminishes exercise enjoyment and discourages long-term exercise.

• Inclusive Training Curricula: Inclusive training curricula are essential for sport and exercise science students, PE teachers, coaches, fitness professionals, and personal trainers. Collaboration between universities, the education sector, lived experience and fitness training providers is crucial.

• Accessibility and Affordability: Gyms and fitness facilities should be cheaper and more accessible, with free options for low-income citizens. "Inclusive" gyms should genuinely be inclusive and not charge higher prices that exclude those who would benefit most.

• Safe Spaces: Safe spaces and available time slots for women and LGBTQI+ people are necessary to create truly equitable environments.

• Positive Education: Health is so much more than what we eat and how we move our bodies. Education on lifestyle should encompass stigma-free physical exercise, nutrition, sleep, movement, social and community support, mental health and well-being, framed positively, not negatively. Collaboration between schools, experts, voluntary, community, lived experience and social enterprise (VCSE) organisations, and the NHS is essential.

• Mental Health and Motivation: Mental health significantly influences motivation and willingness to exercise. Exercise should be promoted as fun and joyful, not mandated.

• Decoupling of Weight and Health: It should be acknowledged that weight does not equal health, fitness, or performance. The harmful and ineffective focus on weight as a goal should be removed.

• Standardised Inclusive Guidelines: Standardised inclusive guidelines are needed for all sport and exercise settings on how to create supportive and inclusive environments for everyone. This includes guidance on advertising, accessible equipment, training for fitness centres and professionals, etc.

Underlying Rationale:

Motivation for exercise varies. Intrinsic motivation (doing something for its own benefit) is the most effective for long-term engagement. Introjected or external motivation (doing something out of shame, guilt, obligation, or external pressure) leads to less engagement,a more aversive experience, and fewer benefits. While exercise is beneficial for all systems of the body, it is not an effective tool for weight loss in most individuals. Focusing on weight loss often leads to discouragement and cessation of exercise, depriving individuals of the numerous health benefits that can be gained even without weight change. Focusing on appearance can be counterproductive. Physical activity for its own benefits will deliver the greatest long term health outcomes.