Showing clients their weight during eating disorder treatment is supposed to reduce fear and assist recovery, but the evidence suggests it tends to do the opposite.
Many clinicians already sense this. Around 54% of eating disorder clinicians use blind weighing in practice, including many trained in CBT-Enhanced (CBT for eating disorders) and family-based treatment (FBT), both of which prescribe showing clients their weight are a core tenent of the therapy (Forbush et al., 2015). Many clients actively resist stepping on the scales- regularly, and often at every stage of treatment. Both groups are told this is the problem to overcome. The research suggests that the resistance of both clinicians and client alike is justified.
The experimental evidence is fairly direct. A randomised study of women with high weight and shape concerns found that those shown their weight felt progressively more anxious across the study period, while those who weren't shown it felt less anxious.
Both groups showed increased weight preoccupation on weighing days, but the open weighing group showed a clearer pattern of urges to restrict and control food intake in the days that followed (Froreich et al., 2021). Patient reports are consistent with this. A qualitative study of women with anorexia and bulimia found the majority preferred not being shown their weight, particularly early in treatment - describing reduced anxiety, less preoccupation with the number, and better ability to engage in treatment. Those who were shown their weight described increased vigilance, more intrusive thoughts, and stronger urges to restrict (Froreich et al., 2020).
Graphing weight over time and reviewing it as a central treatment metric compounds this. The literature around body checking indicates that repeated weighing, measuring, and monitoring the body functions similarly to compulsive checking in OCD - it provides brief relief that quickly fades, then drives more checking, and keeps weight at the centre of attention rather than reducing its importance. Daily diary research with women with anorexia found that body checking on one day predicted greater food restriction the following day (Lavender et al., 2013). A weight graph reviewed weekly in therapy is, for many clients, the same mechanism playing out in a clinical setting.
The theoretical justification assumes the problem is the number itself - that seeing it repeatedly will make it less frightening over time. But the fear in eating disorders is rarely the number. It's what the number means: about control, the future, other people's judgement, self-worth. Exposure to the number doesn't touch any of that. The researchers behind the first multisite randomised trial comparing open and blind weighing noted this directly: no best practice guidelines currently exist, and the assumption that anxiety reduces with repeated weight exposure has not been adequately tested (Murray et al., 2020).
Medical monitoring of weight has its place and is sometimes essential. But that is a separate question from whether making clients see their weight, and using weight as the centrepiece of psychological treatment is therapeutic - and the evidence for that specific claim is weaker than most training programs have led clinicians and clients to believe.
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