Clinicians' practices regarding blind versus open weighing among patients with eating disorders

Forbush, Kelsie T.; Richardson, Jonathan H.; Bohrer, Brittany K.

doi:10.1002/eat.22369

Cited by 23 publications

(28 citation statements)

References 25 publications

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“…Strategies for safely weighing and assessing an athlete’s body composition include gaining explicit consent for every measurement (verbal), checking in with the athlete prior to the measurement and offering to ‘blind weigh’ the athlete so that they do not see the results of the examination. 64 If there is any distress about being weighed or measured, this needs to be taken seriously and the coach and CMT need to discuss the appropriate course of action for this athlete. There are some ED treatment modalities which include viewed weighing as a form of exposure therapy and monitoring (eg, enhanced cognitive therapy), 65 however these should not be undertaken by anyone who has not been appropriately trained or does not have adequate support from the CMT and clinical supervision.…”

Section: Preventionmentioning

confidence: 99%

The Australian Institute of Sport (AIS) and National Eating Disorders Collaboration (NEDC) position statement on disordered eating in high performance sport

Wells¹,

Jeacocke

Appaneal³

et al. 2020

Br J Sports Med

156

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Identification, evaluation and management of disordered eating (DE) is complex. DE exists along the spectrum from optimised nutrition through to clinical eating disorders (EDs). Individual athletes can move back and forth along the spectrum of eating behaviour at any point in time over their career and within different stages of a training cycle. Athletes are more likely to present with DE than a clinical ED. Overall, there is a higher prevalence of DE and EDs in athletes compared with non-athletes. Additionally, athletes participating in aesthetic, gravitational and weight-class sports are at higher risk of DE and EDs than those in sports without these characteristics. The evaluation and management of DE requires a cohesive team of professional practitioners consisting of, at minimum, a doctor, a sports dietitian and a psychologist, termed within this statement as the core multidisciplinary team. The Australian Institute of Sport and the National Eating Disorders Collaboration have collaborated to provide this position statement, containing guidelines for athletes, coaches, support staff, clinicians and sporting organisations. The guidelines support the prevention and early identification of DE, and promote timely intervention to optimise nutrition for performance in a safe, supported, purposeful and individualised manner. This position statement is a call to action to all involved in sport to be aware of poor self-image and poor body image among athletes. The practical recommendations should guide the clinical management of DE in high performance sport.

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Section: Preventionmentioning

confidence: 99%

The Australian Institute of Sport (AIS) and National Eating Disorders Collaboration (NEDC) position statement on disordered eating in high performance sport

Wells¹,

Jeacocke

Appaneal³

et al. 2020

Br J Sports Med

156

View full text Add to dashboard Cite

show abstract

“…Conversely, blind weighing involves the therapist not sharing the patients' weight with her or him. When patients are blind weighed, they are usually asked to step on the scale backwards and the weight is not explicitly discussed [3]. The rationale for blind weighing includes the desire to minimise anxiety and distress that may result from patients seeing their weight (especially when it increases), reduce the patients' focus on the specific number on the scale, and expose patients to weight uncertainty [3,5].…”

Section: Introductionmentioning

confidence: 99%

Blind versus open weighing from an eating disorder patient perspective

2020

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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.

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“…, meaning that open weighing of patients with eating disorders is not used by the majority of clinicians in routine practice (e.g.,Forbush et al, 2015;Mulkens et al, 2018;Waller et al, 2012). Although demand characteristics mean that the proportion of clinicians stating an intention to weigh patients was much higher in this study, the patterns of difference and association allow us to reach firm conclusions about the patient factors (diagnosis and weight distress) and clinician factors (lower belief in the positive value of weighing and making broken leg exceptions) that reduce compliance with guidelines on weighing patients.This study had a number of limitations, which should be addressed in future research.…”

mentioning

confidence: 59%

“…Guidelines for CBT‐ED and most evidence‐based therapies for eating disorders stress the importance of weighing patients routinely (Waller & Mountford, ), ensuring safety and patient learning. However, guidelines are routinely underused (e.g., Shafran et al, ), meaning that open weighing of patients with eating disorders is not used by the majority of clinicians in routine practice (e.g., Forbush et al, ; Mulkens et al, ; Waller et al, ). Although demand characteristics mean that the proportion of clinicians stating an intention to weigh patients was much higher in this study, the patterns of difference and association allow us to reach firm conclusions about the patient factors (diagnosis and weight distress) and clinician factors (lower belief in the positive value of weighing and making broken leg exceptions) that reduce compliance with guidelines on weighing patients.…”

Section: Discussionmentioning

confidence: 99%

“…Unfortunately, when reporting on routine clinical practice, patients and clinicians alike report that many clinicians offering CBT do not weigh their patients at all (e.g., Cowdrey & Waller, 2015;Mulkens et al, 2018;Waller et al, 2012) or weigh them blindly, without telling the patient their weight (Forbush, Richardson, & Bohrer, 2015). These deviations from protocol are likely to mean that many patients do not get the optimum experience of CBT-ED, as they do not experience the emotional or cognitive challenges that open weighing can afford them.…”

mentioning

confidence: 99%

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Clinician and patient characteristics and cognitions that influence weighing practice in cognitive‐behavioral therapy for eating disorders

Daglish

Waller

2019

Intl J Eating Disorders

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Objective Clinicians commonly fail to weigh patients appropriately in cognitive‐behavioral therapy for eating disorders (CBT‐ED), despite guidelines stressing the need to do so. This study considered the possible patient‐ and clinician‐based reasons why this element of treatment is omitted. Method Seventy‐four CBT‐ED clinicians were presented with vignettes that varied in patient diagnosis and distress levels, to determine whether those characteristics influenced different clinician weighing practices. Clinicians' own attitudes to weighing and their anxiety levels were also assessed to determine whether they were related to weighing intentions. Results Clinicians were more likely to weigh patients with anorexia nervosa than patients with bulimia nervosa, probably due to focusing on physical risk. However, they were less likely to weigh patients who were distressed at the prospect, despite that course of action being particularly clinically indicated. Clinicians were more likely to weigh patients if they had positive beliefs about the value of doing so, and if they were not prone to making unsupported exceptions in delivering this technique. Discussion This study provides evidence that clinicians use weighing differently according to the patient's presentation and their own beliefs, rather than working within guidelines. Education, training, and supervision are suggested to help clinicians address this failure to weigh patients in the most therapeutic way.

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Clinicians' practices regarding blind versus open weighing among patients with eating disorders

Cited by 23 publications

References 25 publications

The Australian Institute of Sport (AIS) and National Eating Disorders Collaboration (NEDC) position statement on disordered eating in high performance sport

The Australian Institute of Sport (AIS) and National Eating Disorders Collaboration (NEDC) position statement on disordered eating in high performance sport

Blind versus open weighing from an eating disorder patient perspective

Clinician and patient characteristics and cognitions that influence weighing practice in cognitive‐behavioral therapy for eating disorders

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