In traditional eating disorder treatment, weight is checked at either psychology, dietetic, or psychiatry appointments. It's graphed, discussed, and used as the primary measure of progress. Medical observations that might tell us something about how a person is actually functioning - heart rate, blood pressure, temperature - are largely left to the GP. The number on the scale has become the central organising feature of treatment across every discipline involved.
It's worth asking whether this has caused harm.
The research on weight-focused treatment is not reassuring. A meta-analysis of 35 randomised controlled trials found that specialised eating disorder treatments produced weight gains at end of treatment, but had no effect on psychological outcomes compared to control conditions (Murray et al., 2018). A separate network meta-analysis found that none of the specific psychological treatments for anorexia nervosa outperformed treatment as usual (Cortese et al., 2021). We have built a field heavily oriented around weight, and the psychological outcomes remain largely unchanged.
There is also evidence that the weight focus itself causes harm.
Research has found that maintaining a focus on weight in eating disorder treatment can intensify weight stigma among both patients and providers, leading to increased shame, increased internalisation of weight-based beliefs, and poorer outcomes (Nagata et al., 2023).
For clients who don't present with low weight (eating disorders occur across ALL body sizes) the weight focus in treatment can mean delayed diagnosis, inadequate care, and in some cases, clinicians inadvertently reinforcing the very disorder they're treating by directing attention toward weight as the measure of severity (Nagata et al., 2023; AMA Journal of Ethics, 2023).
There is also a clinical irony here that hasn't been adequately examined. Overvaluation of weight and shape - the degree to which a person's self-worth is organised around their body - is considered a core feature of eating disorder psychopathology across diagnoses. It is one of the strongest predictors of severity and poorer treatment outcomes. Treatment that foregrounds weight at every appointment, that graphs it and reviews it weekly, and that uses it as the primary indicator of recovery, is by design keeping weight central to the person's world. For clients whose eating disorder is not primarily organised around weight - and many are not - there is a real question about whether this introduces a weight preoccupation that wasn't there before.
This isn't an argument against medical monitoring. Vital signs matter, and for some presentations, weight monitoring is clinically necessary and appropriate. But vital signs belong in a medical context, and the question of whether weight should also be the centrepiece of psychological, dietetic, and psychiatric treatment - reviewed repeatedly across appointments - is a different question. One the field has not answered particularly well.
Anecdotally, psychologists have reported avoiding eating disorder work specifically because of discomfort with the weighing process and the weight focus it requires. If that's true on any level, this matters enormously. Eating disorder specialists are already in critically short supply - wait times at specialist practices commonly run between two and five months, and longer for senior clinicians. If traditional treatment's attachment to weight as the primary metric is narrowing the pool of clinicians willing to do the work. It's contributing to a workforce shortage that is leaving people without access to care.
There are clinicians working differently - weight-inclusive and weight-neutral approaches exist, and some practitioners have moved away from weight as the organising feature of treatment. But these approaches remain contested, and in many settings are still considered controversial. Which means the default for most clients, in most services, remains a model that places weight at the centre of everything.
A disorder defined by an overvaluation of weight is being treated in a system that has made weight the central organising feature of every appointment, every discipline, and every measure of progress. At some point that tension is worth taking seriously.
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