As a professional social worker, I am committed to creating compassionate environments where people work and live, which includes addressing topics that may stimulate discomfort for some people. In this article, I focus on weight stigma. According to Rebecca Puhl, PhD, the deputy director of the Rudd Center for Food Policy and Obesity at the University of Connecticut, weight stigma includes “widespread stereotypes ingrained in American society about people who have a higher body weight or larger body size” that results in many people being “blamed, teased, bullied, mistreated and discriminated against” (The Conversation, June 1, 2021, https://bit.ly/3N7DAMB). Weight stigma appears throughout society, including in schools, workplaces, media, interpersonal relationships, and health care settings. Dr. Puhl posits that 40% of U.S. adults report past experiences of “weight-based teasing, unfair treatment, and discrimination.” Further, her research found that physicians were a common interpersonal source of weight stigma. The prevailing view that people are individually responsible for their weight contributes to weight stigma. We see this belief in judgments that overweight individuals are “lazy, unmotivated, or lacking willpower” and in the well-intentioned advice to “eat less and exercise more.” In fact, obesity experts now understand that encouraging individual behavioral change through diet and exercise often fails — in part because the body is biologically hardwired to maintain homeostasis (see the cover story on obesity in the May 2023 issue of Caring). Rather than obesity being an individual issue, experts understand it as the cumulative effect of multiple factors that impact an individual. These factors include genetics and epigenetics — our susceptibility to weight gain encoded in our genes — as well as our physical and food environments, social lives, socialization, popular culture exposure, experiences of trauma (in particular, childhood sexual abuse) and inequality, and other social determinants of health. Stigma can also impact individuals’ mental and physical health, including their weight, functional mobility, and mortality. This is in part because stigma can activate stress hormones such as cortisol, which impact metabolic regulation; high amounts of cortisol are associated with weight gain and other comorbidities (Am Psychol 2020;75:274–289). For instance, people with larger body sizes may experience feeling unwelcomed and excluded in many settings, including clinical settings. As U.K. researchers Luna Dolezal, PhD, and Matthew Gibson, PhD, noted in their article on the principles of a shame-sensitive practice, “Interactions with care professionals can compound feelings of shame, as these interactions often involve unequal power relationships, a fear of being judged, the scrutiny and exposure of one’s potentially ‘shameful’ past, circumstances, lifestyle, coping behaviors, body, illnesses, along with other vulnerabilities” (Humanit Soc Sci Commun 2022;9:214). Experts now recognize that trauma can have a cumulative effect on our health, especially if we are consistently experiencing retraumatization. As with stigma, trauma and retraumatization activate stress hormones. For women who have experienced unwanted sexual attention or sexual abuse, weight gain may actually serve as a defense mechanism in the form of a physical barrier (Psychol Today, Jan. 8, 2020, https://bit.ly/41zZLPD). Trauma-informed care recognizes the pervasive nature of trauma and integrates principles and practices to promote healing and recovery. Trauma-informed principles include safety; trust and transparency; collaboration and mutuality; empowerment, voice, and choice; peer support; and attention to cultural, historical, and gender issues. Let’s look at a few of these principles in relation to weight stigma. Do individuals of all body types and sizes, including families and staff, feel safe in your community? Creating a physically safe nursing home environment is paramount and includes well-trained staff, necessary equipment, and security. Safety also includes social and moral elements such as individuals feeling like part of a group, being heard, and having an environment that actively prioritizes integrity and compassion. Here are a few ways to help people feel safe.•Do a community assessment and invite the residents with larger body sizes and their families to participate. Consider the physical environment as well as the emotional landscape. What do you identify as areas of unmet need? What areas are functioning well?•Meet the physical needs of the residents with larger body sizes and weights by maintaining an adequate supply of equipment like beds, commodes, shower benches, gowns, Hoyer slings, and blood pressure cuffs to maintain their dignity, trust, and safety. Ensure that all supplies and equipment are available and are in good working order before individuals arrive.•Create weight-inclusive environments that focus on well-being for everyone across all areas of health, not just weight. Encourage healthy behaviors without mentioning size.•Improve the sleep conditions and reduce stress in the nursing home for everyone, regardless of weight. What are specific actions that the staff integrate in their daily interactions to support relationships founded on trust and transparency? The trauma-informed principle of trust means people feel safe to be vulnerable. Asking an individual to share personal information, which may include feelings of shame, requires a relationship built on trust. Transparency means that daily operations and decisions are made visible and are predictable. Suggestions include:•Cultivate empathy, which nonviolent communication trainer Aya Caspi defines as “the quality of understanding another person’s experience that provides caring accompaniment without judgment.”•Talk transparently about weight bias and strategize how to address it in your facility. Rather than engaging in an antiobesity campaign, focus on eliminating weight stigma. Does the facility actively cultivate the conditions to include everyone so that true collaboration and creativity can take place? These principles emphasize partnership between staff and residents/families, which includes leveling power differences and meaningful sharing of decision-making. In an opinion piece about weight stigma and the obesity epidemic, A. Janet Tomiyama, PhD, of the University of California–Los Angeles and coworkers pointed out, “The provider–patient relationship is one that is inherently unequal, with healthcare providers holding the power to profoundly affect patient’s thoughts, feelings, and behaviors” (BMC Med 2018;16:123). To address collaboration and mutuality, facilities can review the care plans of residents with larger bodies and weights.•Are the goals and approaches in alignment with what individuals want for their health and life?•Do you notice any language that could be perceived as shaming an individual or passing judgment? Does your facility cultivate the conditions for people to share feedback in a way that is experienced as safe and comfortable? Are people comfortable saying no when asked to do something they don’t want to do? Collectively, these principles incorporate an individual’s strengths and create viable pathways for their choices and wishes to be heard and integrated in the outcome. This means that we recognize the ways that power and privilege impact our interactions and actively seek out the needs, opinions, and preferences of all people, including the people with less power (which often includes all residents and patients as well as those with larger body sizes). Suggestions include:•Teach and model person-first language. Instead of “obese patient” say and document “patient with a larger body or weight.”•Consider treating a person for obesity only if they have actual markers for poor metabolic health. This is consistent with the Association for Size Diversity and Health’s Health at Every Size recommendations (https://bit.ly/3BkKff2). Has your facility addressed these issues with policies and procedures and with diversity, equity, and inclusion (DEI) training? To create inclusive environments, a set of principles must address unconscious bias, discrimination, and stereotypes. At the organizational level, the policies and procedures are responsive to the racial, ethnic, and cultural needs of people in the long-term care community, and there is recognition of the impact of historical trauma that is transmitted over generations (e.g., slavery, genocide, oppression, victimization, and the Holocaust). Policies and procedures should include ways to address stigma around individuals with higher body weights. Facilities can:•Integrate the “Joint International Consensus Statement for Guidance on Eliminating Weight Bias and the Stigma of Obesity” (Nat Med 2020;26:485–497).•Consider the inclusion of body size in the facility’s DEI plan, including holding training sessions to eliminate weight stigma. The way I see it is that there are many actions we can take to address weight stigma and create more trauma-informed communities. By collaborating with staff, residents, and families with a genuine spirit of creativity based on shared humanity, I believe it’s possible to come up with solutions we haven’t yet considered. The most important approach is to focus on changing the behaviors and attitudes of individuals and workplaces that participate in stigmatizing others rather than focusing on the targets of the discrimination, stigmatizing, and bullying. Ms. Hector is an author, speaker, and educator specializing in clinical operations for the interdisciplinary team, process improvement and statistical theory, nonviolent communication, risk management, and palliative care, among other topics. She is associate editor and a member of the Editorial Advisory Board for Caring for the Ages. The author’s views are her own and do not represent those of the Society or any other entity.