Blind versus open weighing from an eating disorder patient perspective

Abstract

Background: Weighing is a key component in the treatment of eating disorders. Most treatment protocols advocate for open weighing, however, many clinicians choose to use blind weighing, especially during the early phase of treatment. Despite considerable debate about this issue in the literature, there is no empirical evidence supporting the superiority of one weighing approach over the other. In addition, little is known about patients' perspectives of open and blind weighing and which weighing practice they view as more acceptable and/or beneficial for their treatment. Methods: Semi-structured qualitative interviews were conducted with 41 women with a current or past diagnosis of Anorexia or Bulimia Nervosa: 26 were undergoing specialist inpatient treatment (n = 13 being blind weighed; n = 13 being open weighed) and 15 were community members who have recovered from an eating disorder. Interviews were audiotaped, transcribed verbatim and analysed thematically using framework methods. Participant demographics, clinical characteristics, weighing anxiety and weight concerns were also assessed. Results: Qualitative analyses yielded five themes: (1) therapy engagement and progress; (2) Control and tolerance of weight uncertainty; (3) treatment team relationships and autonomy; (4) life outside of treatment; and (5) weighing practice preferences and rationale. Participants stated that blind weighing decreased anxiety and eating disorder psychopathology (e.g., weight preoccupation) and increased treatment responsivity. For many, relinquishing control over their weight facilitated body trust and was a necessary step towards recovery. Participants found that not knowing their exact weight helped challenge their overconcern with weight. Lack of support post-discharge was identified as a major difficulty of blind weighing. Overall, the majority of participants preferred blind weighing, particularly at the early, acute stage of treatment, whereas open weighing was viewed as more suitable at later stages of recovery. Quantitative analyses found current blind-weighed patients felt significantly less anxiety around being weighed and had greater tolerance of weight uncertainty than current open-weighed patients. Conclusions: This study provided in-depth patient insights into open versus blind weighing practices. The next step for future research will be to supplement these insights with treatment outcomes gained from randomised controlled trials comparing the two weighing practices.

Feasibility and preliminary effectiveness of a cognitive‐behavioral, family‐centered partial hospitalization program for adolescents with anorexia nervosa and atypical anorexia nervosa at six‐ and twelve‐month follow‐up

“…For example, open weighing is a component of both CBT (Waller & Mountford, 2015) and FBT (Lock & Le Grange, 2015) for EDs, yet no participant with AN reported experiencing open weighing as part of outpatient therapy. This is consistent with prior research indicating that many providers who treat EDs recommend blind weighing over open weighing, which may be related to beliefs that blind weighing will make the process of weight gain easier (Forbush et al., 2015), patients' preferences for blind weighing (Froreich et al., 2020; Wagner et al., 2022), concerns that blind weighing will reinforce the fear that eating results in rapid weight gain (Murray et al., 2020), and/or therapists' own anxiety about making their patients feel distressed (Levita et al., 2016). In contrast to FBT (Lock & Le Grange, 2015), most participants reported that their parents did not participate in at least 50% of their therapy sessions.…”

Evaluating an implementation model of evidence-based therapy for eating disorders in non-specialist regional mental health settings

“…The second was the omission of regular weighing of the patient in session. Weighing in session is a central key component of most EBI [ 16 ]. The third was the emergence of COVID.…”

“…We also noted low levels of in-session weighing. While weighing is a routine practice for EBI in EDs [ 16 ] it is the least endorsed as being received by people describing what occurred when they received cognitive behaviour therapy [ 6 ]. Use of both a bulletin and a workshop on the importance of this weighing supplemented by strategies to manage patient refusal significantly improved occurrence of in-session weighing for face to face appointments, from 48% of sessions to 66.7%.…”

Therapy outcome of day treatment for people with anorexia nervosa before and during the COVID‐19 pandemic

“…Additionally, while at home patients were asked to self‐report their weight. This constant awareness of their own weight, without the support and reassurance of a clinician, may serve to increase anxiety and overconcern with weight (Froreich et al., 2020 ), therefore negatively impacting the ability to restore weight.…”