There is never a need to weigh yourself throughout your entire life span. Whether you watch a kettle reach a boiling point or not on the stove, it reaches its boiling point in its own good time. Your weight stabilizes whether you decide to hand a possible relapse to the eating disorder on a silver platter or not (weighing yourself is the surest and quickest way to precipitate relapse when you have an eating disorder).
We do a lot of things as human beings just because we can but not because it has any value. Sure we can check every single day and multiple times a day that gravity is still working—your weight is actually the calculation of your mass against earth's gravity and it’s relative to your position on the globe as well—but what purpose does it serve?
Even in a medical setting where some dangerous drug classes are prescribed based on weight, there is now growing evidence that this is a coarse way to determine accurate dosing for patients and puts patients who are above-average weight at risk. 1 If you are told you must be weighed to determine an accurate dose for a drug you are going to be taking, insist on a blind weigh-in (you are not facing the scale and you are not told the result either).
And in every day life you actually have no more need of knowing your weight than you might need to know your blink rate.
Not weighing yourself for the rest of your life is an opportunity to consciously remove an anxiety-crack cause and effect from your life. There are several leading eating disorder recovery specialists and treatment centers that will encourage someone with an eating disorder to get on the scale to neutralize the anxiety around knowing your weight. Unfortunately that is the wrong application to the wrong stimulus for exposure and response prevention.
Exposure and response prevention (ERP) is a psychoeducational treatment approach that was originally developed for the treatment of panic and obsessive compulsive disorders. In the 1960s, Drs. Raymond Levy and Victor Meyer developed an approach they called apotrepic therapy to help a patient prevent the application of rituals. The patients were monitored continually during waking hours, and even restrained (with their permission) to prohibit the application of rituals while they were exposed to situations that evoked the rituals in the first place. The rituals decreased, but instead of the expected increase in anxiety and depression, there was also a reduction in anxiety and depression. 2
Drs. Joanna Steinglass and Sarah Parker, researchers investigating the application of ERP therapy for treatment of those with eating disorders, noted that the anxiety underpinnings, if not addressed, predispose a patient to relapse:
“Anxiety has long been noted as a prominent feature of AN [anorexia nervosa], and a high rate of comorbidity between AN and anxiety disorders has frequently been reported. Though generalized anxiety improves as weight is restored, it does not necessarily normalize. Instead, most AN patients continue to show significant psychopathology after successful weight restoration, including abnormal eating behavior, over-concern with weight, and fear of fat.
Individuals who have shown improvement in many psychological symptoms still significantly restrict their eating when observed in a laboratory situation. Furthermore, restrictive eating patterns consisting of a monotonous low-energy, low-density diet have been shown to predict relapse. These restrictive eating patterns may be driven by underlying fear and avoidance of foods, along with fear of certain eating situations, which may in turn be the manifestation of underlying traits of high anxiety and high obsessionality.” 6
It is food that is the stimulus that must be approached so that the avoidant response can be prevented with therapeutic guidance and practice. Stepping on a scale is not necessary for enhancing any individual’s quality of life. If I have developed a phobia of putting on a spacesuit, and I am not an astronaut, then there is nothing about this intense fear that impacts my day-to-day quality of life. If I have developed a phobia of stepping on carpets, then there is no way that the fear will not impact my day-to-day quality of life.
Pick your battles. An eating disorder is an anxiety disorder and that means the food is the carpet and the scale is the spacesuit. If, after twenty years of practicing remission from an active eating disorder you want to gild the lily and practice ERP when it comes to how you feel when you find out gravity is still working, by all means take on the challenge if you wish at that time. But do not let your treatment team get distracted by the scales; it’s the food that needs ERP attention.
1. Kane-Gill, Sandra L., Nicholas P. Wytiaz, Lisa M. Thompson, Karina Muzykovsky, Mitchell S. Buckley, Henry Cohen, and Amy L. Seybert. "A Real-World, Multicenter Assessment of Drugs Requiring Weight-Based Calculations in Overweight, Adult Critically Ill Patients." The Scientific World Journal 2013 (2013).
2. ExpWoman. “Part 1: History of Exposure Threapy for OCD: Dr. Victor Meyer and Ritual Prevention.” Exposing OCD (blog), September 13, 2010, http://exposingocd.blogspot.ca/2010/09/part-1-history-of-exposure-therapy-for.html.
3. Steinglass, Joanna E., Robyn Sysko, Deborah Glasofer, Anne Marie Albano, H. Blair Simpson, and B. Timothy Walsh. "Rationale for the application of exposure and response prevention to the treatment of anorexia nervosa." International Journal of Eating Disorders 44, no. 2 (2011): 134-141.
4. Hildebrandt, Tom, Terri Bacow, Mariana Markella, and Katharine L. Loeb. "Anxiety in anorexia nervosa and its management using family‐based treatment." European Eating Disorders Review 20, no. 1 (2012): e1-e16.
5. Carter, Frances A., Virginia VW McIntosh, Peter R. Joyce, Patrick F. Sullivan, and Cynthia M. Bulik. "Role of exposure with response prevention in cognitive–behavioral therapy for bulimia nervosa: Three‐year follow‐up results." International Journal of Eating Disorders 33, no. 2 (2003): 127-135.
6. Steinglass, Joanna, and S. Parker. "Using exposure and response prevention therapy to address fear in anorexia nervosa." Eating Disorders Review 22, no. 5 (2011).