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August 31, 2020

Weighing in on Weigh-ins in Eating Disorder Treatment

Weighing in on Weigh-ins in Eating Disorder Treatment

There is likely no topic more on the minds of clients than weight. While the degree of preoccupation with weight varies—some clients admittedly experiencing little to none—weight is a construct that carries extraordinary meaning within and outside of the eating disorder experience. For those with and without these disorders, weight is a common source of concern and is often given disproportionate influence as a vital sign measure.

We live in a society that obsesses over weight. It erroneously conflates weight with health, attaching both social and moral significance to our body size. Weight bias is pervasive, and people who live in larger bodies face discrimination in settings from the workplace to the doctor’s office.

Eating disorders often compound the significance of weight even more. When we have these illnesses, the number on the scale can operate as a definition of who we fundamentally are. Our essential value as a person becomes attached to that numeric value. While we may know rationally that weight should not hold so much power, eating disorders are not rational illnesses. Therefore, the topic of weighing in eating disorder treatment is not simple at all.

On the one hand, we very much want to diminish the power of the scale. We want to reduce the intensity of emotions experienced when our weight is presented to us. On the other hand, our weight may provide insight into our progress in recovery. It is one piece of information that, when taken with other measures, may not only help us monitor weight restoration but also indicate the presence of eating disorder behaviors. Weight is also a metric used by insurance companies to help determine levels of care, though in this case it is unfortunately often overemphasized as a reliable marker of health or progress in treatment.

We know that for most people with eating disorders, weight is not the primary determinant of health. And still, it is a number that clients, providers, and insurance companies—and our culture at large—are all interested in, at least in part. Because of this incredible tension, the question often comes up: Should my weight be invisible or visible to me in eating disorder treatment?

The primary argument for keeping weight invisible is to diminish the power of that number and to redirect attention to overall health and other indicators of recovery. Keeping weight invisible, however, can inadvertently strengthen its power, swathing the number in stigma and secrecy.

The argument for visible or “open” weigh-ins is to try to take away the power of the number—to learn to treat it as just one variable in these complex illnesses. However, knowing one’s weight can be very triggering, angering, and disappointing. The knowledge could potentially impact the ability to engage in treatment.

Ultimately, we’d like to get to a place in recovery where it is inconsequential to know our weight. We want to remove its ability to impact us beyond what would be expected for any other simple metric.

Whether and when we practice open weighing, however, depends on each client and their unique place in recovery. At The Emily Program, we embed this topic into therapy and nutrition counseling. We don’t want weight to be the single factor by which we judge our health, but we also don’t want any anxiety surrounding weight to compromise our recovery.

Learning to be okay with our weight and to separate it from health is a very specific goal in treatment at The Emily Program. In becoming free from our eating disorders, we aim to no longer care about the scale, to not be bothered whether we are weighed, and to understand that weight is just one aspect to consider.


Mark Warren headshot

Mark Warren, MD

Mark Warren is the Chief Medical Officer of The Emily Program. He is also one of the original founders of the Cleveland Center for Eating Disorders, which became The Emily Program – Cleveland in 2014. A Cleveland native, he is a graduate of the Johns Hopkins University Medical School and completed his residency at Harvard Medical School. He served as Chairman of the Department of Psychiatry at Mt. Sinai Hospital and Medical Director of University Hospital Health System’s Laurelwood Hospital. A past vice-chair for clinical affairs at the Case School of Medicine Department of Psychiatry, he continues on the Clinical Faculty of the Medical School, teaching in both the Departments of Psychiatry and Pediatrics. He is currently a faculty member and former chair of the Board of Governors at the Gestalt Institute of Cleveland. Dr. Warren is a Distinguished Fellow of the American Psychiatric Association, a two-time recipient of the Exemplary Psychiatrist Award of the National Alliance for the Mentally Ill, and a winner of the Woodruff Award. He leads the Males and Eating Disorders special interest group for the Academy of Eating Disorders.

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