Though weight stigma is a well-researched and documented phenomenon, understanding how body size affects fat clients is not well understood. This paper seeks to develop a framework for clinicians in integrating body size as an identity dimension into their work with clients in therapy by proposing an addition to Hays' ADDRESSING framework. First, the well-documented phenomenon of weight stigma is reviewed, focusing specifically on how it affects people with fat bodies. The current literature indicates intervention is mainly focused on weight loss, which suggests that fatness is something to be changed or controlled. Then, differing historical viewpoints related to how body size has been viewed by Western society historically are explored to contextualize our current understandings of weight stigma. The existing ADDRESSING framework is overviewed and then the addition of interventions and clinical considerations related to body size are discussed. Some of these techniques include therapist exploration of weight and body size status and how this has influenced their reactions and understandings related to body size and specific questions to ask oneself when working with a fat clients. Finally, intersectionality and body size are explored to provide therapists with a more thorough/nuanced picture of the multiple identities one's clients will hold. Hays' ADDRESSING framework provides structure in exploring fatness as an identity dimension, which is newly considered in a psychotherapeutic context. Finally, strengths, limitations, and future directions are discussed.