Patient’s weight
Patients with eating disorders are often highly fixated on their weight and body image. Desired weight loss is a common driver behind patients’ decision to restrict food intake. As a result, it may be in a patient’s best interest to:
- Refrain from discussing weight loss or gain.
- Encourage removal of scales at home (or at least removal of patient access to scales at home).
- At medical visits obtain “closed” weights (weight number is kept “closed” or unknown to patient)
- Omit weights on any documents provided to patients during visits.
- Focus on other health markers when making nutrition changes. For example, increased energy, improved mood, stronger hair or nails, decreased muscle fatigue during sports, etc.
Please note:
- Exposure and Response Prevention (ERP) is a treatment modality where use of scale/weight exposure may therapeutically be recommended.
- Family-Based Treatment (FBT) traditionally uses open weights in therapeutically recommended ways.
“Closed” weight at medical office
IMPORTANT: keep the weight/number "closed" (unknown to patient).
1. Encourage the use of bathroom prior to weight check.
2. Take off shoes and any heavy clothing patient is wearing, this includes jackets, sweatshirts/sweaters, and any items in pockets (cellphones). It's okay to weigh patient wearing a light layer of clothing. If treatment team or caregiver(s) suspect that patient is hiding weighted items in pockets, bras, and underwear then collecting an examination gown weight would be encouraged (pending clinic protocols).
3. Keep your patient from touching nearby furniture or walls.
4. Place a light covering over the “number” screen (a post-it note typically works well), so that only clinician can see the number.
5. Have patient get on the scale backwards.
6. Do’s:
- Omit weights on any documents provided to patient during visit.
- Refrain from discussing weight at all with patient (leave this up to treatment team to deem what is best for each individual patient).
- Provide caregivers with weight information separately from the patient.
Telehealth
In preparation for a telehealth visit, an updated weight check should be completed ideally the day of, or up to 2 days prior to the telehealth visit. This updated weight could be obtained through a “weight check” at the primary care office or at home, if a caregiver has access to an accurate home scale (see instructions below). In either situation, it is recommended that the weight/number is "closed".
“Closed” weight at home
If family has an accurate home scale, a closed weight check can be completed at home by following these steps. IMPORTANT: keep the weight/number "closed" (unknown to patient).
1. Encourage the use of bathroom prior to weight check.
2. Take off shoes and any heavy clothing your child is wearing. This includes jackets, sweatshirts or sweaters. It's OK to weigh your child wearing a light layer of clothing.
3. Keep your child from touching nearby furniture or walls.
4. Use the scale on a solid ground (tile/vinyl/laminate/cement flooring; not carpeting).
5. Place a light covering over the “number” screen (a post-it note typically works well), so that only parent/guardian/caregiver can see the number.
6. Have your child get on the scale backwards.
7. Return the scale to a location where the child does not have access to the scale to weigh themselves.
8. Communicate updated weight privately with healthcare team. Caution should be exercised if the child has access to the electronic medical records for this data to be seen in a chart message.
9. Refrain from disclosing weight or weight trends at all with the child; encourage them to speak directly to treatment team with questions and/or concerns.
