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Best Practice: Weighing Eating Disorder Patients

Best Practice: Weighing Eating Disorder Patients

For eating disorder patients, weighing can be a sensitive topic, especially during the early phases of their treatment.

Previously, we have discussed the connection between bodyweight and mental health, which also plays a part in this topic.

But weighing eating disorder patients is an integral part of the treatment. That’s why there’s such significant debate surrounding open weighing or blind weighing for patients with eating disorders.



Why Is Weighing Necessary for Patients With Eating Disorders?

The most important reason for weighing eating disorder patients is not for the patient but actually for the treatment team.

By setting targets, the treatment team can evaluate a patient’s body and determine whether it has been negatively impacted by their eating disorder. Unhealthy dieting can result in a loss of muscle and necessary fat stores, and can even affect vital organs and bones.

There are two methods for weighing eating disorder patients: blind weighing and open weighing, and there are significant benefits for both options. According to the Journal of Eating Disorders, 50% of treatment professionals use open weighing, while 50% use blind weighing.



What is Blind weighing?

Blind weighing involves using a scale with a discreet indicator. This means that the treatment professional can see the weight on the scale but the patient cannot. The motivation for doing this is to remove the patient’s focus from the number and instead divert it

There are a few variations of blind weighing, which is up to the clinician.


On Track

Aside from not giving a patient any indication to their weight change, this option provides a little context. This notifies the patient that they’re heading in the right direction. It can give them a little sense of accomplishment and improvement, without bringing their actual weight into the discussion.


Direction of Weight Change

Alternatively, telling the patient the direction of their weight change is another option. This can give the patient some context, without giving them an exact number.



What Are the Benefits of Blind Weighing?

One of the main benefits of blind weighing is decreasing the patient’s anxiety. This study found that patients associated open-weighing day with anxiety, fear and stress. Knowing that it was coming up impacted their sleep and triggered their desire to participate in negative behaviour. They also reported negative moods after open weighing.

Blind weighing, on the other hand, caused no negative thoughts or effects, bar when they stepped onto the scale. As the study showed, concealing the patient’s weight can remove the anxiousness surrounding weighing day, making them more willing to be weighed and enabling them to recover quickly.

Relinquishing control over their weight can not only foster trust in their clinician, but can also help them overcome their eating disorder. By removing the temptation to carry out negative behaviours, clinicians can help patients focus on treatment. This will help patients to promote medical stability before their weight is introduced into the regime.

Gaining weight is one of the scariest things for eating disorder patients, to the point where the fear of weight gain is fundamentally linked to carrying out ED behaviours. Participants in this study noted that open-weighing influenced their motivation and compliance to their treatment.

Carrying out blind weighing can remove the focus on the number, which can remove its power and help patients realise that it’s just that - a number. By doing this, patients can overcome their obsession with numbers and concentrate instead of overall health.

Some patients have even reported not weighing themselves after their ED treatment, because they connect the need to know and control their weight with their eating disorder.



What Is Open Weighing?

Open weighing, on the other hand, involves sharing a patient’s exact weight with them. Clinicians do this to remove the stigma surrounding a patient’s weight and help them to learn to face their weight. This can help to reduce anxiety in the long term.


What Are the Benefits of Open Weighing?

While at first open-weighing may be stressful for a patient, in the long run the exposure to their weight can help reduce fear. Encouraging patients to learn their weight, acknowledge it, and come to terms with it can lead to better outcomes in the future.

Some patients find that participating in blind-weighing feels like losing control and makes them feel powerless and like a child. When their weight was shared with them, it made them feel like a normal person, who could be trusted and could take responsibility.

Others commented that being kept in the dark about their weight puts even more emphasis on it. By telling patients their exact weight, the fear and significance of these numbers can be interrupted.

It’s also possible to help patients more by incorporating weighing into the treatment. This enables patients to go through their reaction to a weight increase with their clinician. These reactions can then be addressed immediately by a professional who can help them manage and come to terms with the changes.

It has also been highlighted that a number of patients saw issues after leaving treatment when blind weighing was used. They found that they were not properly prepared for taking control of their weight again.



Additional Factors

In addition to the numerous benefits for both options, there are also significant factors that should be taken into account when deciding how to weigh eating disorder patients.

Patient’s Characteristics

Almost 25% of clinicians reported that if a patient shows excessive worry or obsessiveness about their weight, then they’re less likely to openly weigh them. They believed that patients would be more likely to carry out negative behaviours in these scenarios.


Weighing Outside Treatment

A number of treatment professionals stated that their clients weighed themselves at home, or they believed they did. This led them to use open-weighing.


Type of Eating Disorder

For eating disorder patients who suffer from Anorexia Nervosa and Bulimia Nervosa, weight may play a large role. Therefore, it may be preferable to engage in blind weighing, at least at the beginning of their treatment. In fact, this study discovered that the majority of patients prefer this.


Blind Weighing vs Open Weighing

Ultimately, there are a number of factors that should be taken into account when making this decision. However, ¾ of patients prefer blind weighing to open weighing and from our research above, it does seem that this is preferable, at least at the beginning.



Further Reading

There is a clear connection between physical health and body weight, but what about mental health and body weight? Find out in this blog post.

Choosing how often to weigh yourself can be a difficult decision. In this blog post, we look at the positives and negatives of the various options.

If you’re trying to lose weight, then you may be determined to lose as much weight as possible, as quickly as possible. In this blog post, we explain why that’s a bad idea.