The Problem of Frequent Weighing and Body Checking
People with eating disorders such as Anorexia and Bulimia Nervosa share a central problem, and that is what we call an “over-valuation” of weight and shape. This over-valuation means that people with eating disorders judge their self-worth largely, or even exclusively, in terms of their weight, shape and their ability to control these. Because these individuals place so much importance on their weight and shape, a range of problematic behaviours can develop in an attempt to control them, such as dietary restriction, excessive exercise, misuse of laxatives and so on. Other common problem behaviours that arises from this over-valuation of weight and shape are frequent weighing and so-called “body-checking”.
Why is frequent weighing and body checking a problem?
The intense concern about weight leads many people with eating disorders to weigh themselves frequently, often several times a day. This frequent weighing sets up a vicious cycle, in which the preoccupation with weight causes frequent weighing, and the frequent weighing maintains the preoccupation with weight. Similarly, frequent body-
checking (such as looking at thighs and stomach in the bathroom mirror, measuring leg circumference with hands and so on) is caused by the over-valuation of shape, and it also maintains the preoccupation with shape by ensuring the person is always thinking about it!
As well as acting to maintain the preoccupation with weight, frequent weighing is problematic in other ways. An individual’s weight naturally varies within a range of 2 or 3 kilograms, depending on factors such as hydration levels, contents of bladder and bowel, stage of the menstrual cycle, and recent meals and drinks. Frequent weighing is likely to result in over-interpretation of insignificant fluctuations in weight, and often leads to further restriction of food intake. If the reading is the same or higher than a previous reading, the individual may interpret this as indicating that she or he needs to diet harder, and if the reading is lower than a previous one the individual may interpret this as indicating that the dieting is working, and that she or he needs to persist with it.
A helpful parallel comes from considering a person who has experienced an episode of cardiac arrhythmia. As a result of this episode, s/he may become over-concerned about pulse rate, and so feel the urge to check it frequently. The frequent checking maintains the over-concern, as it keeps thoughts about the pulse rate in the forefront of the mind. It also makes it likely that insignificant changes in pulse rate will be over-interpreted, causing anxiety and unnecessary or unhelpful behaviour changes, such as presenting at hospital, stopping exercise, avoiding caffeine and so on.
The situation with body checking is similar. As well as maintaining the preoccupation with body shape, body checking usually has the effect of increasing dissatisfaction with body shape, leading to renewed efforts to control it with more exercise, increased dietary restriction and so on. Body checking also often generates low mood and increased anxiety.
Treatment for an eating disorder will have to address the central problem of over-valuation of weight and shape and their control. Therefore any behaviours, such as frequent weighing and body checking, that are reinforcing this over-valuation will have to stop.
Limiting weighing to once a week during therapy sessions is likely to be a very important factor in breaking the vicious cycle of weight preoccupation and frequent weighing. In fact, assessing weight over the past four weeks is the best way to obtain a reasonable idea of any actual weight changes; using this longer time period has the effect of over-riding inconsequential day-to-day variations. Plotting weekly weights on a graph allows interpretation of any overall trend, which is obviously more meaningful than focusing on any individual points on the graph.
It is often extremely anxiety-provoking for someone with an eating disorder to consider limiting weighing to once a week. Removing home scales from sight, and limiting their accessibility is likely to be important, as well as avoiding other opportunities for weighing – such as scales in gyms and chemists. However, once weighing has been limited in this way, the individual’s preoccupation with their weight often reduces fairly quickly, gratifying quicker than the person expected that it would.
Body checking behaviours are treated in a similar manner. Clients learn to recognise and spot body checking behaviours, and are helped to stop these behaviours altogether. Mirrors are for hair, make-up and a brief clothing check only!
If you struggle with an intense concern about your weight and shape, and as a result weigh yourself frequently or engage in body checking behaviours please consider making an appointment with me at Eating Disorders Brisbane, so that we can discuss ways to break this distressing vicious cycle.