The Role of Regular Weighing in Eating Disorder Treatment

A standard focus of treatment since the beginning of the eating disorder field is weight. It’s easy to see why weight feels imperative to recovery and health, but the pitfalls of prioritizing weight are equally disruptive, if not counterproductive.

Almost any time someone starts eating disorder treatment, weight is one of the first things to be discussed and monitored. Typically, a dietitian or primary care doctor will weigh the person once weekly, thus establishing a precedent that weight is indeed a—if not the—most important data point in recovery.

People with eating disorders almost always are very focused on weight. The driving force for the disorder itself is most frequently about lowering or maintaining the number on the scale. By charting weight from the start, the treatment team sends a clear message: weight is the most important factor on treatment.

Unintentionally, the eating disorder thoughts feel vindicated! Someone with an eating disorder can’t easily tell themselves that weight is not important. Look at what the team is making a top priority. Rather than start the process of treatment towards health and meaningful parts of life, instead weight is still paramount.

How much eating disorder clinicians have gone in the wrong direction.

In the best case scenario, people in recovery don’t know their weight for years. Over time, they have less and less association with their weight. So when they finally know their weight again, years after they have been doing well, the number does not have much meaning anymore. This does happen often because it’s very hard to measure weight weekly and still tell the person weight does not matter. So the ideal way to manage this data point over time is a very unlikely scenario using the current treatment model.

A newer method of managing weight is to make the number on the scale an open part of treatment from the start. Patients will know their weight through the entire process of recovery. The goal is immediate exposure to the number, thereby placing weight as an equal measure of recovery along with meal plans, overall health and thoughts and feelings about recovery and life. At least this plan doesn’t make weight a magical number hidden from the patient.

A final idea is to measure weight much less frequently. Since insurance providers prioritize weight as a means to justify treatment, weighing people less is difficult. But treatment needs to consider how weight can derail care by reinforcing how important and powerful the number on the scale really is. Either making open weights part of recovery or weighing people less often are worthwhile directions in treatment to consider.