Weighing In: Can't Bear to See it or Can't Tolerate Not Knowing?

You might imaging all kinds of things are happening
to your body if you don't have the facts.

It's time to hear from you. That is, if you have an opinion on knowing your weight. Does anyone not have strong feelings on this topic? I'm prompted to write this post having recently debated the merits of having clients see/not see their weights. And among us eating disorder professionals, opinions are pretty strong about what's the best approach. And we don't all agree.

On the one hand, whether you're dealing with anorexia, bulimia, or binge eating disorder, seeing your weight early in treatment can be a disaster. It can distract you from trusting the benefits of eating better, of listening to your body, and of nourishing yourself, shifting the focus simply to the number and all you associate with it. It can derail you from staying the course and normalizing your eating--because your preoccupation with the number stops you in your tracks. Often I address the relative change in weight--whether it increased, decreased, or stabilized, is in range, is 'where it needs to be', is 'as expected'--whatever language we've decided would be tolerated, patient by patient.

That of course can lead to use of your very creative imagination! If I say 'things are going well, we don't need to make a change this week' you might jump to conclusions and imagine that you've gained ten pounds or so. Or you might assume that since you've gained--while eating less than you were supposed to--that you'd better cut back this week. Or it might provide reassurance that your worst fears didn't come true, that all is safe--as long as you trust my feedback.

Some providers approach it completely differently. They tell patients their weight, and then they spend time debriefing about it in a very therapeutic way. It removes the 'what if's', because you know exactly what happened. But it can also cause panic and halt your progress; it may make it challenging to continue to stay on course with your eating.

Ultimately, as providers I believe we need to assess where each individual is at. Are you at a place where you can take in information about your weight? Are you able to look at weight change in perspective, or will it cause a set back?

What's your thoughts on knowing your weight as you change your relationship with food? What would you recommend to your provider about weighing and giving you feedback about your weight?

Thanks for taking the time to comment.

Advice for Your Doctor for NEDAW

Call me crazy, but I’m tempted to respond to a doctor’s closed-ended questions in ways that would knock his socks off. When he asks me about alcohol, for instance, he frames it something like this “you don’t drink much, right?” Or perhaps to assess risk of STDs he suggests “just one partner—you’re married, right?” Well, yes, he’s right, but would I ever say anything other than what he’s led me to believe is the only acceptable answer possible?

Isn't it time to get the support you need?

This brings me to the important topic of educating your healthcare team, your doctor, in particular, about how to truly support you. In honor of National Eating Disorder Awareness Week (NEDAW) (here in the States) I thought that health care providers could use a bit of awareness, to hopefully make your visits, and your life, a bit less stressful. Please consider adding your own two cents to the comments—then pass it on to others—and your providers! While this is prompted by NEDAW, I’ve included recommendations that are worth sharing regardless of whether you struggle with an eating disorder, disordered eating, or simply are outside of what the BMI chart says you should be.

Unsolicited Advice From One Healthcare Provider To Another

On weighing your patient

Please weigh patients with their back to the scale. Have them remove all layers possible—most individuals, regardless of their weight, want the weight to reflect what’s real. Weighing with shoes, heavy belts, and jackets doesn’t contribute much valid information. Oh, and have them empty their pockets!

That said, some do want to misrepresent their weight—so less is always better—with regards to clothing. And have them empty their bladder first!

A poker face and restraint from commenting is wise. That is until you’ve gotten to assess their weight in context. Imagine if you said to an overweight patient—“great, you’ve dropped a ton of weight” only to realize that they had a rapidly growing cancer? 

Weight change must be evaluated relative to behavior. Someone who lost weight (regardless of how appropriate you thought it was for them to drop some pounds) may very well have gone about it the wrong way. 

Consider this—they may have been starving themselves, resulting in messing up their periods, their metabolic rate, their mood, their sleep, their thoughts, their relationships.  This is nothing to offer positive reinforcement for. There is nothing healthy about losing weight this way. Perhaps they are compulsively exercising, or dehydrated from purging or laxative abuse. No, weight would not be a good measure of health then.

Similarly, your patient with a high BMI might have simply maintained her weight. But she feels well, is active and fit, and is healthy by all measures. Maybe she has even turned things around, if her weight had previously been climbing. Sure, you can explore other risk factors, such as quality of her diet—as I hope you would do with your slim patients, too. But if all looks good, perhaps you can accept that her stable weight is just fine for her.

Perhaps if she’s been climbing in weight that might warrant some probing about recent lifestyle changes—stressors, activity, diet—to help with better self care and disease prevention.

And if your underweight anorexic patient has increased his weight, please similarly temper your response! While you may be delighted, he (or she) may not be. It’s a mixed bag, gaining weight, even for those who are trying to gain weight. There’s the healthy side of them that really wants to recover. And then there’s the eating disorder voice that sees weight gain as a failure, as a “you can’t do anything right”, pulling them back to restricting again. It’s more valuable to elicit a sense of what they are thinking and feeling about the change. How does it fit with what they expected? What are the benefits of the changes they’re making? Focusing on the behaviors that contributed to the weight shift is more valuable than discussing the weight itself.

If your patient isn’t doing well, rest assured that they are as frustrated—even more so, really—than you are. The impact is far greater on them than on you, that’s for certain.

Hooray! You got your period back!

It’s not healthy to lose one’s period due to such factors as anorexia, restrictive eating, or compulsive exercising. We all know that. But while getting a period back is a good sign, it is not always well-received by patients. For some, getting a period equals “I must be fat now”. For others, it means they are done with their efforts to change their eating and behaviors. And that may be the worse thing for them to conclude.

Periods may return before weight is restored and before behaviors are normalized. Or they may come back after 4-6 months after stabilizing in a healthy range. Or they may never have disappeared, as was the case of a patient of mine who conceived 5 children through her years living with anorexia. The point? Consider where your patient is at before you rejoice in their body’s normalizing their periods!

Don’t Ask, Don’t Tell? I Don’t Think So.

If you don’t ask the right questions, you won’t get the real answers. So do ask open- ended questions—different than what my MD thought to ask—to obtain valuable information. If you’re discussing weight or body dissatisfaction, do ask if they’ve used laxatives, or diet pills, or vomiting or restricting—in the past, or currently. Suggest a frequency, in a non-judgmental way. If a patient says she purges daily, follow with a question like “how many times per day?” And when he says twice, follow with “And what’s the maximum?”  Just like if they say they have a couple of drinks, follow with what’s a couple—4? 5? 2? Per day? Per week? Suggest a range of possibilities, without raising an eyebrow.

 

We can only help our patients if we can accurately assess their situation. And, we can’t begin to do so if they feel they can’t trust us. So do your part. Ask your questions in open-ended ways, and be careful how you react. Ask how you can help, what they need from you. Are they connected with appropriate resources, or do they need guidance?

Encourage a follow-up sometime soon! 

Suggesting a 3 or 6-month follow-up visit certainly sends the message that their situation simply isn’t worth your taking too seriously. And as a result, they will undoubtedly convince themselves that really everything is fine, that nothing really needs to change.

And if you don’t believe me, read the comments from those in the know, below.

Thanks for taking the time to read this.

Trust Yourself. Except When You Can’t Be Trusted.

6:04 PM

Hi Lori,

 Could I bother you for some support again?? Am *really* struggling with wanting to weigh myself. If you had a moment could you please remind me why this is not a good idea.

Wouldn't it be great if there were a similar warning posted above
your scale? TURN BACK NOW! Or face the consequences!

Here’s what I’ve got:

• It's  too high god knows what I’ll do – and that is not good for my safety
• If it’s where I want it to be or lower then ED is the one telling me how to feel
• I really do want to be rid of all this, and weighing myself will only prolong my recovery
• It will be 13 weeks tomorrow without weighing myself – and I’m proud of that
• I really feel that my recovery only started for real when I stopped weighing

Any other thoughts would be really gratefully appreciated

Thank you

And here was my response last night:

"I think you nailed it, PJ. Weighing yourself messes with your head. Not weighing yourself allows you to take charge a bit. Body mass doesn't change in 24 (or 72 hours) in any measurable way. But changes in weight may reflect bowel function, hydration, menstrual status, fluid retention, to name a few. It takes 3,500 calories per week (above whatever is required to maintain your weight) to gain a single pound, more than that if your metabolic rate is on its way up.

You are worth more than your weight in pounds (or kilos). Also, not weighing yourself may increase your anxiety. Be sure to acknowledge that and add some stress reduction (non-exercise focused) activities to help you cope."

This isn’t to say that nobody should weigh herself. It really depends on what your issue is and what kind of place you are in.

A 2005 study from a Brown University psychologist showed that regular weighing was associated with better maintenance of weight loss in an obese population of women. Perfect! I think I’ll start daily weighing, I bet you’re thinking. Not so fast, not so fast.

Lot's of steps before you reach your goals.
Is it worth it?

Weight management isn’t the only outcome we should be addressing. What about the impact, not on pounds, but on perceptions? Are you grounded enough that if the scale changes, yet you know in your heart you have been sticking to your goals and feeling in control of your eating behaviors, listening to and respecting your body, that you will be able to dismiss it as a senseless measure?

Or will this trigger more negative thoughts about your self, more obsessive thinking, and a sense of failure? If you are in a good place—grounded enough to roll with the scale fluctuations, which are sure to occur—you may be fine weighing your self. But please don’t make this decision on your own. Consult your supports.

First ask yourself “How will I feel if the results aren’t what I am expecting?” Am I truly more anxious not knowing my weight, or knowing it? Will it be destructive for me? If the answer is honestly no, then try the following.

Before getting on the scale, do a bit of a self-assessment. Ask yourself:

• Have I been honoring my hunger and eating when I need to?
• Have I been stopping when I’ve had enough, or when I’ve had what I think I should have based on unhealthy food rules I’m holding on to?        
• Am I respecting my activity goals, and listening to my body?
• Am I being honest with myself about my actions?
• How am I feeling? What positive changes have I made that I need to acknowledge?

And finally, have a plan before weighing. What do I know and plan to do differently, as a result of my self-assessment?

What can you take from my correspondence with PJ?

Here's the view from the top. Worth the trek? 

Like PJ, you probably have more sense than you realize. But if you are struggling with trust and feeling more vulnerable to your unhealthy behaviors, take a few pointers from her.

• Acknowledge you are struggling. 
• Whether you are working on weight restoration or are overweight and trying to lose weight and improve your relationship with food, be realistic. Change isn’t linear. In other words, there will be ups and down, progress and slips, moments of strength and times of hopelessness. That’s what recovery really looks like.
•  Reach out and ask for what you need. Not everyone around you is supportive, however (I’m sure you can provide plenty of examples for us!) So call, email, text, post an S.O.S. to those you feel you can count on.

Focus on what is in place. And make a plan for changing what needs to be changed.

Thanks, PJ, for allowing me to share this! 

Please add your thoughts and experiences to the comments. Looking forward to hearing from readers.

Weighing In

It was a charming, tiny, one bedroom Paris apartment we rented for the week, fully equipped with everything we needed—dishwasher, iron, espresso maker.  And a scale.  A scale! There was barely room to get off the bed, but by it’s side was a scale. What kind of vacation has room for a scale, I wondered? Who would choose to step on and off as they enjoyed the French food and wine?

Which brings me to my thoughts about weighing. 

Raise your hand if you think that weighing yourself is helpful in your quest to normalize your weight.  Okay, this is the virtual world, so I can’t see your hands, but I suspect that many of you believe that you need to weigh yourself. That if you don’t, your weight may just spiral out of control. And yet I know that most of you really know better.  If you really stop to think about it and remember the cycle you go through each time you weigh yourself you may not be raising your hand (and I’ll never know). So let’s consider the possibilities that may arise with weighing:

• You’re feeling good, thinking you are eating well to support your goal for weight management (whether it needs to go up, down or stabilize) so you step on the Detecto or other device. But the number is not what you were expecting. Perhaps because you have unrealistic expectations about how much change should occur. Perhaps because of normal fluctuation that has nothing to do with your efforts—hydration, constipation, PMS. You may feel disappointed, annoyed and frustrated with yourself, hopeless even. The result? You sabotage your efforts and undo the positive changes you were making as well as your progress. All because of this metal object determining your worth. Only moments ago, you were feeling good, remember?

• You’ve been off track in terms of your eating and activity and could tell that the scale will only share bad news. And it does. Does it help, seeing the number? You already knew where things were off track. Does the number help the situation, motivate you anymore? Or make you feel worse about yourself?

• You’ve been off track and were expecting the see it reflected in your weight, but lucky for you, that doesn’t occur. So maybe you continue to stay off track, thinking you could get by, and then later it shows up in a big way. Also, not helpful, right?


Before You Step On

So if you are determined to weigh yourself (which by now you can tell I don’t support on a regular basis) I have a few suggestions. Before you hop on the scale, try to do an honest self-assessment. 


• Have you been listening to your body’s signals and responding to them, eating when hungry and stopping when full? Or are you finding yourself detaching from your signals—using fluid loading (coffee, diet soda, water) to fill the void instead of food?


• Are you using food not for hunger but to satisfy many other needs—stress, depression, anxiety, loneliness or boredom? 


• Or because you feel you “ruined it” or “deserve it” or don’t deserve to get healthy and feel well? 


We eat and use food for so many reasons. Once you identify what behaviors are in place/not in place, then set a goal for change.  A practical goal. One you can achieve. And stick to it regardless of what the scale says.  Because you know better than that object on the floor where you stand!