Open vs. Blind Weighing for Eating Disorders

Overseen by Jamal Essayli, Ph.D

Age: < 65

Sex: Any

Travel: May Be Covered

Time Reimbursement: Varies

Trial Phase: Academic

Recruiting

Sponsor: Milton S. Hershey Medical Center

Disqualifiers: Age, Non-English, Cognitive impairment, others

No Placebo Group

Trial Summary

What is the purpose of this trial?

Current treatments for adolescents and young adults (AYAs) with eating disorders (EDs) do not effectively address a central ED symptom - anxiety about weight gain - which contributes to poor outcomes. The proposed study evaluates the feasibility, acceptability, efficacy, and underlying mechanisms of an enhanced version of "open weighing," a cognitive-behavioral intervention designed to target anxiety about weight gain in AYAs with EDs. Understanding how to better treat AYAs with EDs, and identifying the mechanisms by which interventions lead to improvement, will aid in the development of more effective and personalized treatments, ultimately improving the lives of AYAs with EDs.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications. It's best to discuss this with the trial coordinators or your doctor.

What data supports the effectiveness of the treatment Blind weighing, Blind weighing, Discreet weighing, Open weighing, Open Weighing, Cognitive-Behavioral Intervention for Weight Anxiety?

Research suggests that blind weighing may reduce anxiety and concern with weight in patients with eating disorders, as it is perceived as more effective in the short term and may lead to reduced engagement in disordered eating behaviors compared to open weighing. ^{1 2 3 4 5}

Is blind weighing safe for individuals with eating disorders?

Blind weighing may be a safer approach to weight monitoring for individuals with eating disorders, as it tends to reduce anxiety compared to open weighing. However, both methods can temporarily increase weight-related concerns on weighing days. ^{1 3 5 6 7}

How does the treatment of blind weighing differ from other treatments for eating disorders?

Blind weighing is unique because it involves not sharing weight data with patients, which can reduce anxiety and concern about weight compared to open weighing, where patients are informed of their weight. This approach may be safer for monitoring weight in individuals with eating disorders, as it can decrease the urge to engage in weight-controlling behaviors. ^{1 3 5 7 8}

Research Team

Jamal Essayli, Ph.D

Principal Investigator

Penn State University

Eligibility Criteria

This trial is for English-speaking adolescents and young adults aged 12-24 with eating disorders like anorexia nervosa or bulimia, who are anxious about weight gain. They must be admitted to the Partial Hospital Program at Penn State Hershey. It's not for those under 12 or over 24, non-English speakers, people with cognitive impairments, or those without anxiety about weight gain.

Inclusion Criteria

I have an eating disorder with concerns about gaining weight.

You must be fluent in the English language.

I am aged 12-24 and admitted to the Penn State Hershey program for eating disorders.

Exclusion Criteria

I do not have a diagnosis of avoidant/restrictive food intake disorder.

I am between 12 and 24 years old.

Participants who have been identified as non-English speakers

Trial Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants undergo either open weighing or blind weighing interventions to address anxiety about weight gain

60 weeks

Weekly visits (in-person)

Follow-up

Participants are monitored for safety and effectiveness after treatment

4 weeks

Treatment Details

Interventions

• Blind weighing (Behavioral Intervention)
• Open weighing (Behavioral Intervention)

Trial Overview The study tests 'open weighing' versus 'blind weighing' to see which method better helps reduce anxiety about weight gain in young patients with eating disorders. The goal is to find more effective personalized treatments by understanding how these interventions work.

Participant Groups

Group I: Open weighing Experimental Treatment 1 Intervention

The open-weighing intervention aims to challenge beliefs about weight gain. The study coordinator (SC) will explain open weighing, discuss any concerns you have about your weight, and construct a weight graph with the number of weeks on the x-axis and weight in pounds on the y-axis. The SC will help identify beliefs about gaining weight, which will be written on a Feared Outcomes Form. The SC will ask you to predict your weight, mark the weight prediction on the graph, weigh you on a standing scale, record your weight, and discuss your responses to seeing your weight, including any reasons for a difference between your predicted and actual weight. Each week, the SC will graph your actual and predicted weights over time and discuss anything that you are learning from this process. The SC will ask you to complete the Feared Outcomes Form once per day over the next week, review it each week, and talk to you about what you are learning from this process.

Group II: Blind weighing Active Control 1 Intervention

The blind weighing intervention aims to help you see self-weighing as an eating disorder symptom that you should stop, and that weight is not important to your identity or selfesteem. To do this, the study coordinator will explain why blind weighing might be helpful. You will then be asked to step backwards on a standing scale. The study coordinator will record your weight, but will not share your weight information with you. The study coordinator will discourage you from thinking or talking about your weight.

Who Is Running the Clinical Trial?

Milton S. Hershey Medical Center

Lead Sponsor

Trials

515

Recruited

2,873,000+

Dr. Robert Harbaugh

Milton S. Hershey Medical Center

Chief Medical Officer since 2024

MD from Penn State College of Medicine

Don McKenna

Milton S. Hershey Medical Center

Chief Executive Officer since 2024

Master’s in Public Administration and Bachelor of Science in Business Administration and Marketing from Long Island University

Findings from Research

In a study involving 35 child/adolescent patients, 55 adult patients, and 36 parents, participants generally viewed blind weighing as more effective in the short term for managing eating disorders, although preferences varied among groups.

While a majority of adults preferred open weighing, about half of child/adolescent patients and a minority of parents favored it, indicating diverse attitudes towards weighing methods that may evolve with treatment experience.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Patient perceptions of blind and open weighing in treatment for eating disorders. Wagner, AF., Lane-Loney, SE., Essayli, JH.[2022]

The review highlights the significant variability among psychological therapists regarding the practice of weighing patients with eating disorders, influenced by differing clinical protocols and therapist-patient reluctance.

It advocates for the necessity of weighing patients during cognitive-behavioral therapy (CBT) sessions, emphasizing that awareness of weight can enhance cognitive, emotional, and behavioral progress in treatment.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Weighing patients within cognitive-behavioural therapy for eating disorders: How, when and why. Waller, G., Mountford, VA.[2018]

This study will evaluate the effects of open weighing (where patients are informed of their weight) versus blind weighing (where patients are not informed) on distress and symptoms in 216 patients with anorexia nervosa over a 4-week period.

The results will provide valuable insights into which weighing practice may reduce distress and improve treatment outcomes for patients with anorexia nervosa, as there are currently no established best practices for this aspect of treatment.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The open versus blind weight conundrum: A multisite randomized controlled trial across multiple levels of patient care for anorexia nervosa. Murray, SB., Levinson, CA., Farrell, NR., et al.[2021]

Clinicians are more likely to weigh patients with anorexia nervosa due to concerns about physical risk, but they often avoid weighing distressed patients, even when it is clinically necessary.

The likelihood of clinicians weighing patients is influenced by their personal beliefs about the importance of weighing and their tendency to adhere to treatment guidelines, suggesting a need for better education and training in this area.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Clinician and patient characteristics and cognitions that influence weighing practice in cognitive-behavioral therapy for eating disorders. Daglish, A., Waller, G.[2020]

In a study of 53 normal weight females with a high drive for thinness, participants who engaged in blind weighing reported less anxiety over time compared to those who participated in open weighing, suggesting that blind weighing may reduce psychological distress associated with weight monitoring.

Both groups experienced increased weight preoccupation and disordered eating behaviors on weighing days, indicating that while blind weighing may be safer, both methods can still lead to negative effects on mental health.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The psychological effects of blind and open weighing in women with a high drive for thinness: A mixed method inquiry. Froreich, FV., Vartanian, LR., Grisham, JR., et al.[2021]

Individuals with anorexia nervosa (AN) self-weighed most frequently, and more frequent self-weighing was associated with greater eating disorder severity, particularly in terms of restraint and shape concern.

Participants generally reacted negatively to prescribed weekly weighing, and no clear relationship was found between weighing frequency and body mass index (BMI), suggesting that self-weighing may not be a reliable indicator of weight status in eating disorders.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Self-weighing behavior in individuals with eating disorders. Pacanowski, CR., Pisetsky, EM., Berg, KC., et al.[2019]

In a study of 186 participants with binge-eating disorder (BED) and obesity, those with food addiction (FA) experienced more negative reactions to self-weighing and had less acceptance of their body shape and weight, which correlated with worse treatment outcomes.

Frequent self-weighing was linked to achieving a 5% weight loss only in individuals without FA, suggesting that addressing the negative perceptions related to weighing could enhance behavioral weight loss outcomes for those with BED and FA.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Examining Self-Weighing Behaviors and Associated Features and Treatment Outcomes in Patients with Binge-Eating Disorder and Obesity with and without Food Addiction. Wiedemann, AA., Ivezaj, V., Gueorguieva, R., et al.[2021]

Among 316 adults seeking bariatric surgery, both internalized weight bias (IWB) and externalized weight bias (EWB) were significantly associated with greater eating disorder symptoms and depressive symptoms, as well as lower weight-related self-efficacy.

Regular loss-of-control (LOC) eating was reported by over half of the participants and was linked to higher levels of IWB and EWB, indicating that addressing these biases may be crucial for improving psychological outcomes in individuals preparing for bariatric surgery.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Examining Weight Bias and Loss-of-Control Eating among Individuals Seeking Bariatric Surgery. Lawson, JL., Schuh, LM., Creel, DB., et al.[2022]

References

1. United States pubmed.ncbi.nlm.nih.gov

Patient perceptions of blind and open weighing in treatment for eating disorders. [2022]

2. England pubmed.ncbi.nlm.nih.gov

Weighing patients within cognitive-behavioural therapy for eating disorders: How, when and why. [2018]

3. United States pubmed.ncbi.nlm.nih.gov

The open versus blind weight conundrum: A multisite randomized controlled trial across multiple levels of patient care for anorexia nervosa. [2021]

4. United States pubmed.ncbi.nlm.nih.gov

Clinician and patient characteristics and cognitions that influence weighing practice in cognitive-behavioral therapy for eating disorders. [2020]

5. Netherlands pubmed.ncbi.nlm.nih.gov

The psychological effects of blind and open weighing in women with a high drive for thinness: A mixed method inquiry. [2021]

6. United States pubmed.ncbi.nlm.nih.gov

Self-weighing behavior in individuals with eating disorders. [2019]

7. Switzerland pubmed.ncbi.nlm.nih.gov

Examining Self-Weighing Behaviors and Associated Features and Treatment Outcomes in Patients with Binge-Eating Disorder and Obesity with and without Food Addiction. [2021]

8. United States pubmed.ncbi.nlm.nih.gov

Examining Weight Bias and Loss-of-Control Eating among Individuals Seeking Bariatric Surgery. [2022]