Self-weighing behavior in individuals with eating disorders

Attitudes to Three Weight Maintenance Strategies: A Qualitative Study

Weight loss maintenance can be difficult and ultimately unsuccessful, due to psychological, behavioural, social, and physiological influences. The present study investigated three strategies with the potential to improve weight maintenance success: daily weighing, missing an occasional meal, habitually changing high energy foods. The principal aim was to gain an understanding of attitudes to these strategies in participants who had recent experience of weight loss attempts, with or without maintenance. This was a qualitative study involving semi-structured interviews, with 20 participants aged 18–67 (twelve females), analysed using thematic analysis. Most participants disliked daily weighing and missing an occasional meal for long-term maintenance and were concerned about potential negative effects on mental health. All participants had experience of habitual changes to high energy foods and regarded this strategy as obvious and straightforward. Replacement of high energy foods was favoured over elimination. Participants preferred strategies that felt flexible, “normal” and intuitive and disliked those that were thought to have a negative impact on mental health. Further investigation is needed on whether concerns regarding mental health are well founded and, if not, how the strategies can be made more acceptable and useful.

Habits and attitudes about eating and self-weighing among adults who are recovered, recovering, or partially recovered from eating disorders: an open-ended survey study

PURPOSE

The purpose of this study was to add experiential data from individuals with lived experiences of eating disorder recovery to the existing literature, regarding daily habits and attitudes toward eating and self-weighing.

METHODS

An anonymous open-ended online survey was completed by 32 adults. One was excluded due to current eating disordered behaviors. Remaining participants were divided into three self-identified groups: Recovered from an eating disorder, Recovering from an eating disorder, and Partially Recovered from an eating disorder.

RESULTS

Results showed the Recovered group reported more years of recovery than the other two groups, named "recovered" as part of their identity, practiced intuitive or regular eating instead of a prescribed meal plan, and held negative attitudes about self-weighing. The Recovering group reported, "I will always be recovering," and either followed prescribed meal plans or weighed themselves and did not expect to change those behaviors. The Partially Recovered group did not see themselves as recovered, but aspired to become recovered, and if they followed a prescribed meal plan or self-weighed, then they expected to change these behaviors in the future.

CONCLUSIONS

There is a difference in years of recovery, meal planning, and scale attitudes, among people who self-identify in the recovery categories of Recovered, Recovering, and Partially Recovered. These results can (1) help providers better serve clients with eating disorders; (2) help researchers better understand individuals who have suffered from eating disorders and are in the recovery process; and (3) offer guidance and hope for those in recovery.

LEVEL OF EVIDENCE

Level IV, Evidence obtained from multiple time series analysis such as case studies. (NB: Dramatic results in uncontrolled trials might also be regarded as this type of evidence).

Exploring occupation in recovery from bulimia nervosa: An interpretative phenomenological analysis

Introduction

Recovering from bulimia nervosa challenges a person to learn, revise, and do occupations that contribute to rather than detract from health. This study utilized Interpretative Phenomenological Analysis to (a) explore the recovery experiences of six adult women with histories of bulimia nervosa and (b) interpret how their accounts reflected the assumptions and characteristics of occupation.

Methods

Data were collected via audio-recorded, semi-structured interviews. Data analysis within and between cases identified six superordinate themes, which included interpretation in terms of criteria of occupation.

Findings

Superordinate themes reflect (1) occupation emerged in recovering from bulimia nervosa through committed action, not doing what fueled bulimia nervosa, adopting new ways of living, prioritizing self-care, connecting with others, and creating supportive environments and (2) recovery from bulimia nervosa can be construed as an occupation.

Conclusion

This study provides insight into nuances of recovery from bulimia nervosa. Results offer novel implications distinct to an occupational therapy lens, for example, consideration of self-care beyond eating and meal preparation; modification of the home, work, and social environment; and setting goals associated with not doing versus doing. Further, the interpretative finding of recovery as occupation holds implications for the evolving philosophical considerations within occupational science and therapy.

Weight misperception and its associations with eating disorder symptoms over the course of residential eating disorder treatment

OBJECTIVE

Although individuals with eating disorders (EDs) often experience significant body dissatisfaction and perceptual body image distortions, the presence and impact of weight misperception in clinical samples have been minimally examined. The aims of this study were to quantify weight misperception in individuals with EDs, examine whether weight misperception predicts ED severity at treatment discharge, and explore changes in weight misperception across treatment.

METHOD

Participants were 98 women seeking residential treatment for their ED who reported weekly on their perceived weight. Objectively measured weight was subtracted from perceived weight to determine weekly "weight misperception." Participants completed the Eating Disorder Examination Questionnaire (EDE-Q) at intake and discharge to assess ED severity. Weight misperception at intake and change in weight misperception over treatment were examined as predictors of ED pathology at discharge.

RESULTS

Approximately 74.5% of the sample overestimated their weight, with an average weight misperception of 2.7 (SD = 5.6) pounds (1.2 kg; SD = 2.5). Weight misperception spanned from -6.2 to 43.6 pounds (-2.8 to 19.8 kg) and did not differ based on ED diagnosis. On average, weight misperception increased throughout treatment. Greater weight misperception at intake as well as greater increases in weight misperception over treatment significantly predicted EDE-Q scores at discharge.

DISCUSSION

Findings highlight that weight misperception is not limited to underweight patients. Misperceiving one's weight may predict symptom severity across a range of EDs, and future research is needed to examine whether targeting weight misperception during residential treatment could improve treatment outcomes for individuals with EDs.

Self-weighing behavior in individuals with binge-eating disorder

This study examined self-weighing behaviors and correlates in patients with BED. Hypotheses: (1) women would weigh more frequently than men, (2) > weekly weighers would have higher restraint scores than < weekly weighers, (3) the self-weighing-restraint relationship would be stronger in women, (4) self-weighing frequency would be inversely related to BMI, and (5) self-weighing frequency and depression would be independently but not interactively related to BMI. The EDE, administered by trained doctoral-level interviewers, assessed self-weighing and eating-disorder psychopathology in 423 treatment-seeking individuals meeting DSM-5 BED criteria. Self-weighing frequency (1) did not differ by gender (Wald = 1.3; p = .3). (2) > weekly weighers reported significantly higher restraint (2.0±1.2 versus 1.6±1.3; t(421) = 3.1, p = .02). (3) No significant gender*self-weighing interaction on restraint (p = .99). (4) Self-weighing is inversely correlated with BMI (rho = -0.20; p < .001). 5) Self-weighing nor depression, nor self-weighing*depression interaction predicted BMI (p = .51). These analyses lay the groundwork for further investigation of the role of self-weighing in BED treatment.

Self-weighing among young adults: who weighs themselves and for whom does weighing affect mood? A cross-sectional study of a population-based sample

BACKGROUND

Self-weighing is widespread among young adults and is sometimes recommended by healthcare providers for weight management. The present study aims to deepen our understanding of who is frequently self-weighing among young adults, and to examine for whom self-weighing impacts mood based on weighing frequency and other eating and weight-related characteristics.

METHODS

Survey data were collected from a large population-based sample of young adults (31.1 ± 1.6y) participating in Project EAT-IV (n = 1719). Cross-sectional data were stratified across sex and analyzed with chi-square, t-tests, and linear and logistic regressions controlling for age, ethnicity/race, education level, and income.

RESULTS

Self-weighing frequency was higher among male and female young adults with a current eating disorder, those trying to lose weight or who endorsed any disordered eating behaviors or cognition, and females with higher BMI. Young adult females were significantly more likely than males to report that self-weighing impacted their mood (53% vs 27%, p < 0.05). Among both male and female young adults, there was a higher probability of participants reporting that self-weighing impacted their mood among those who were self-weighing more frequently, had higher BMI, were trying to lose weight, and endorsed disordered eating behaviors or cognitions.

CONCLUSION

Findings suggest that for many young adults, particularly females and those with weight-related concerns, self-weighing is a behavior that comes with emotional valence. The emotional consequences of self-weighing should be considered when making public health and clinical recommendations regarding the usefulness of self-weighing.

Examining Self-Weighing Behaviors and Associated Features and Treatment Outcomes in Patients with Binge-Eating Disorder and Obesity with and without Food Addiction

Food addiction (FA) has been linked to clinical features in binge-eating disorder (BED) and obesity. A feature of behavioral weight loss (BWL) treatment involves frequent weighing. However, little is known regarding how frequency of self-weighing and related perceptions are associated with BWL outcomes among individuals with BED and obesity stratified by FA status. Participants (n = 186) were assessed with the Eating Disorder Examination before and after BWL treatment. Mixed effects models examined FA (presence/absence) before and after (post-treatment and 6- and 12-month follow-up) treatment and associations with frequency of weighing and related perceptions (reactions to weighing, sensitivity to weight gain and shape/weight acceptance). Participants with FA reported more negative reactions to weighing and less acceptance of shape/weight throughout treatment and follow-ups, and both variables were associated with greater disordered eating at follow-ups among participants with FA. Sensitivity to weight gain decreased over time independent of FA status. Frequency of weighing was associated with a greater likelihood of achieving 5% weight loss only among those without FA. Reactions to weighing and sensitivity to weight gain are associated with FA and poorer treatment outcomes in individuals with BED and obesity. Targeting these features may improve BWL outcomes among individuals with BED, obesity and FA.

Relation of self-weighing to future weight gain and onset of disordered eating symptoms

OBJECTIVE

Frequent self-weighing is recommended in weight loss interventions and may prevent weight gain. However, concerns regarding the associations between self-weighing and eating disorders have been expressed and the relations between self-weighing and weight gain/eating pathology have not been examined prospectively. We tested whether (a) frequency of baseline self-weighing in college students with weight concerns predicted weight change over 2-year follow-up, (b) this relation was moderated by eating disorder symptoms, and (c) self-weighing predicted future eating disorder symptoms.

METHOD

Data were merged from two trials evaluating obesity/eating disorder prevention programs in 762 students (Mage = 18.7; 86% women). Participants reported how often they weighed themselves at baseline; body mass index (BMI) and eating disorder symptoms were assessed over 2-year follow-up.

RESULTS

Baseline self-weighing predicted weight gain, with more frequent weighers experiencing greater gains (i.e., +0.8 of BMI) over follow-up. This relation was moderated by the frequency of binge eating but not weight/shape concerns or compensatory behaviors; the combination of more frequent self-weighing and binge eating was associated with greatest weight gain (+1.6 of BMI). More frequent weighers also reported higher onset of compensatory behaviors, relative to non-self-weighers (odds ratio = 3.90, 95% confidence interval [1.76, 8.75]).

CONCLUSIONS

Young adults who weighed themselves more frequently had greater weight gain than those who self-weighed less frequently, especially those who engaged in binge eating, and were at risk for future unhealthy compensatory behaviors. Findings suggest that frequent self-weighing may have negative effects for some young adults, and that relations between self-weighing and weight control outcomes require further investigation. (PsycINFO Database Record

Eating pathology and psychological outcomes in young adults in self-regulation interventions using daily self-weighing

OBJECTIVE

Self-regulation interventions encouraging daily weighing prevent weight gain in young adults; however, concerns have been raised that such interventions may have undesirable effects on eating pathology, depression, and health-related quality of life (HRQL). The present study examined whether self-regulation interventions and self-weighing frequency were associated with these indices in normal weight individuals and those with overweight or obesity.

METHODS

Young adults (n = 599), 18-35 years with a body mass index (BMI) 21.0-30.9 kg/m² were randomized to control, self-regulation with small changes (SC) or self-regulation with large changes (LC). Interventions taught frequent self-weighing to guide behavioral changes. SC prescribed daily small decreases in intake and increases in physical activity. LC prescribed a 5- to 10-lb weight loss to buffer against anticipated gains. Psychological indices were assessed at baseline and periodically over 2 years of follow-up.

RESULTS

There was no evidence that the interventions increased depressive symptoms or compensatory behaviors or decreased HRQL relative to control. LC increased flexible and rigid control and SC decreased disinhibition. Results did not differ by weight status with the exception of rigid control; here, differences between LC and the other conditions were smaller among those with BMI ≥ 25. Greater self-weighing frequency over time was associated with increases in flexible and rigid control, dietary restraint, and improvements in HRQL.

CONCLUSIONS

The self-regulation interventions and increases in self-weighing had no untoward effects. Encouraging weight gain prevention in young adults through frequent weighing and self-regulation appears to be safe for normal weight young adults and those with overweight. (PsycINFO Database Record (c) 2019 APA, all rights reserved).