A recent discussion on a professional listserv was regarding whether or not providers weigh patients and communicate their weight to them. At about the same time, a normal weight patient in the process of learning Intuitive Eating commented to me that she felt that being weighed by her dietitian went counter to learning IE, which I thought was an interesting point, so I brought this question to the listserv.

Everywhere I have ever worked has not shown the weights to patients, instead making the treatment team responsible for weights and encouraging patients to not focus on weight, but to instead focus on becoming healthy. Which is what still makes the most sense to me. Weight has recently been such a topic of debate within the field, with of course the “old school way” being to focus likely too much on weight, which has resulted in many problems getting appropriate insurance coverage for EDs. The insurance industry took the height/weight numbers identified in the DSM, and used these to justify terminating treatment ridiculously early. As a result, I believe the weight criteria will be removed for the DSM-V, but don’t quote me on that. But then the “new school” seems to, in my opinion, go a little overboard in saying we shouldn’t care about patient weights at all, and instead focus solely on physical signs of starvation.

Personally, I think it is more realistic to be in the middle ground. Reality is that weight is one of the more concrete indicators we have to work with in treating eating disorders. But, it certainly is not the be all and end all, since reality is nobody can ever know what is the “right” weight for someone. So, I both track patient weights, through a dietitian or physician, but also ask patients questions that assess for cognitive and physical effects of starvation. I don’t think you can do just one or the other because, in my experience, sometimes the cognitive effects don’t necessarily change immediately upon the patient seeming to get to a healthy weight, but instead develop over the next little while, while they maintain that healthy weight.

I think most everyone agrees we need to weigh patients who need to gain weight; I saw no debate of that point. But then there’s the debate of whether the weight should be shown to the patient. I can see benefits to showing the weight, especially for patients who dramatically overestimate what they weigh or how quickly they are gaining. But I guess I’m not sure why we would show weights for any other reason. To show weights seems, to me, like it perhaps reinforces the message that the weight is important. Though, again, I’m sure there’s a middle ground wherein the weight is shown, but also discussed as being not nearly as important as physical and emotional health. I guess I’m just concerned that showing weights could end up taking up more therapeutic time than if the individual just learns to not focus on weight without seeing and reacting to it.

To address my question of weighing in those of normal weight and learning Intuitive Eating, Elyse Resch, one of the authors of Intuitive Eating, did confirm what my patient  had said, and argued that patients who are learning IE, should not ever be weighed, as this does propagate the focus on weight and number. But then, we have had patients who want to turn over weighing to us for fear that if their weight is not tracked, they will gain weight and nobody will know. But then others feel shame and guilt even stepping on the scale, perhaps due to things like weigh-ins at Weight Watchers.

So, as you can see, this is proving to be a bit of a confusing topic! As far as I heard on the listserv, nobody has ever actually researched the effect of doing blind vs non-blind weights. So, I thought we should do our own, terribly informal, qualitative research here, and ask for your thoughts on blind vs non-blind weights. Please, comment away!!