Pages

Tuesday, February 5, 2013

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.

11 comments:

  1. I'm not recovering from an eating disorder, so I don't know if I really get to comment about this (I was about to say "weigh in"...sorry). But so my story: I recently decided to try to put on some muscle, so I started eating a little bit more and lifting heavier weights. Somehow I had been expecting a small, linear weight gain, but it seems like nothing in the human body works like that, and I put on five or six pounds relatively suddenly. Despite the fact that I meant for this to happen, I freaked out, because I was suddenly what seemed like way above what I felt I "should" weigh. After a while, I started to feel better about it and think of the new number as normal. I guess I'm very number-focused, and I prefer to know rather than not know. But I'm glad my doctors haven't commented at all, that would be difficult to bear.

    ReplyDelete
  2. I have been working on my recovery from anorexia for 3 years. I had been weighed weekly, but have graduated to monthly!! I know my weights because my imagination would run wild if I didn't know how I was doing. I think not knowing would cause me to restrict because I would assume that I had gained a TON of weight...even though history has proven that to be false! My doctor and I have discussed whether to have blind weigh-ins or not, but she agrees with me and trusts me enough to allow me to see it.

    I am far less focused on the number than I used to be, but I still get a little anxious for my weigh-ins. I have worked on this extensively with my therapist and I have strategies in place to shift my focus away from the number and toward my worth as a person. I try to think about what my body can do and who I am beyond my weight. I generally need a bit of time to process my weight (up, down or stable), but I can then move on. This was not an easy process and I am in such a different place now than I was when I started treatment.

    ReplyDelete
  3. There are few more conflicting topics to talk about then weighing while in recovery. Knowing my weight, not knowing my weight, or being weighed period has been triggering at different stages of my recovery. If I know my weight when I am underweight, the e.d. has suggested I need to loose more weight to be 'acceptable' or my critical voice has used it as proof that I suck at recovery. During the re-feeding process I tend to do well knowing my weight initially. While it is always distressing, knowing the rate of weight gain is reassuring to me. That works well until I reach my phobic weight, the weight that says that if I gain any more weight than this, I will be fat and have to work at loosing again. This is usually at a BMI of 20. When I hit this weight, I would prefer not being weighed at all. Being weighed then triggers so much shame that I can't bear to have my care provider see it. Knowing I have hit that absolute maximum weight has sofar always triggered a relapse. My health care providers have been clear that I don't need to gain anymore weight which leaves me scared shitless that if I do gain, they will be displeased. But that is a different issue. I think you can't really have a black and white policy about weighing. For one person it might be very helpful while for another it might be harmful. I think it is an individual thing that need ongoing evaluation.

    ReplyDelete
  4. I use to weigh myself probably about 75 times a day. I just went almost 2 weeks without weighing myself, partly because I was on vacation. My therapist weighs me and lets me see my weight. I probably wouldn't weigh myself if she didn't weigh me, but I weigh myself before I go get weighed because I need to know if I'm going to "make weight."

    I think it depends on the person, whether or not they should see their weight. Sometimes it's helpful for people, sometimes it's not. I'm not really sure where I am with that. I am pretty sure that if I saw a higher number than I want, I'd freak out and start working out more and restricting.

    ReplyDelete
  5. Having recovered from an eating disorder in the past year, I had an interesting experience with being weighed. At first I very much wanted to know that my weight was stable and not going up, so my nutritionist tracked my weight on a graph that did not show any numbers - just showed what my weight was doing on a week to week basis. Sometimes it went down a pound, sometimes it went up a pound, sometimes it stayed the same. But I realized that this was only playing into my desire to still be disordered. For instance, when my weight went down, my eating disorder got excited and I tended to restrict a little more the following week. When my weight went up, I (and my eating disorder) went into panic mode and would focus on that for the entire week, hoping that at my next weigh in my weight would go down again. Really, it would have been helpful for me to not know at all and shift the focus purely to eating what I needed to eat and being healthy. Eventually I almost stopped going to my nutritionist because at one appointment she told me that I had gained more weight than normal and I had a very hard time with this. We decided that I would no longer be weighed, and that is what ended up working for me.

    ReplyDelete
  6. I don't know how much I weigh. Not really, anyway. I don't want to know because I'm fairly sure I will become upset and anxious about the number even though rationally I know it's fine to fluctuate. However, I asked the doctor to check my BMI a few months ago and it's normal so that's good. Though my ED was mildly disappointed. I think stepping on the scales and looking down is going to be a hugely important moment in my recovery but I'm not there yet.

    ReplyDelete
  7. i don't think there is one right answer. For a while, it was best for me to not see my weight but to have a really thorough conversation with my RD about what her words did and didn't mean and what she would do/say to me if my weight "suddenly got out of control." That was necessary, I believe, for me to connect with what really matters and for me to learn to connect with my self and my body. I always knew I wanted to be able to "face my weight" and not have an emotional or bheavioral reaction. I knew I didn't want to live in a way that I couldn't know my weight b/c that seemed like I was letting fear or the ED win. Plus, there are certain situations (like wearing a harness while jumping on a trampoline, or traveling on a very small commuter plane) when you need to know your weight. And I didn't want to be scared to go to a new doctor out of fear that I'd see my weight. So, then I transitioned to seeing my weight and worked to see it and get to my goal place - a place wehre I had no visceral emotional or behavioral reaction. Now, I'm so glad that I have the connection with my body and myself and that weight truly takes a back seat in my life AND I don't have to tip toe around situations that might require me to know my weight or might accidentally result in me finding out my weight.

    ReplyDelete
  8. Mentally I tend to be on the fence between knowing or not but often fall onto the side of cant stand to not know. Yet my focus on the number itself when overall I feel pretty good bugs me. I nearly drove myself nuts 2.5 years ago after gastric bypass weighing myself every day and stressing about not having lost "enough". Now I try not to focus too much on the number and more on how I feel. Not always easy. As much else in life it's a work in progress.

    ReplyDelete
  9. What a coincidence, I just wrote a similar post today
    I've battled with this question a lot
    Do I want to know my weight?
    Or is ignorance bliss?
    For the first few years of my illness I had no idea what my weight was and I didn't care
    Then doctors started weighing me
    The number seemed to be important to them so it became important to me
    I used to weigh countless times a day
    Obsessing over every little gain or loss
    In treatment I found that there was too much emphasis on weight
    Far too much
    For the last year my therapist has weighed me once a week
    It can be very upsetting but sometimes it eases my mind that I haven't gained 10lbs
    So in my opinion it's better not to know
    It's just not worth the stress

    Hope this helped x

    ReplyDelete
  10. I also don't think their is one right answer. If someone asks me to discuss their actual weight with them, I usually ask them to tell me why knowing their exact weight will be beneficial to their recovery and try to sort it out that way. I always ask my clients how they will react and handle things if they hear a number they desire and also how they will react and handle things if they hear a number they are fearful of. I have found that getting behind their motives is key in deciding which route to go. Wanting to work through weight fears, learn to accept their weight and body regardless of the number on the scale, etc are all positive reasons in my mind to giving consideration to discussing weight with an ED client. However, reasons that seem more ED related (ex: "it is my right to know exactly how much weight you made me gain this week" or reasons that reassure the ED and cloud the ability to work through therapeutic issues) make me think twice about discussing it. Granted, I work in a residential treatment center so I have the structure in keeping someone from weighing themselves while they work with me. It's a whole other ball game when someone is telling you they are going to step on the scale the minute they leave your office (or immediately upon discharge from a treatment program) and make snap decisions about whether to engage in their ED. Mostly, it is a game of weighing out the pros and cons. I always find it helpful to involve the other members of the treatment team (if possible) in the discussion of whether or not to have the weight talk with a client. With some clients, I don't discuss much about weight or trends at all unless a meal plan change is needed; with others, I discuss numbers on a once per week basis; some, I just discuss trends with; and with some clients, I agree to graph out their weight (I usually white out the numbers though).

    ReplyDelete
  11. Such a great conversation going here on this post!
    And I completely agree with the perspective that it not only depends on the patient, but also where they are in recovery.
    My GP was the only one I would allow to weigh me but she would never let me look. She would them tell my dietician the number. Eventually I let my dietician tell me the number - it was not easy to hear, but it was a much safer place to find out the number than if I had weighed myself at home alone.
    In hindsight I think their system worked well, as my GP appts are too short for me to have received the support I needed to fully process the number - time which my dietician appts could accommodate.
    xCate

    ReplyDelete