Work

Expanding the Scope of Open Weighing to Target Anxiety About the Consequences of Weight Gain in Cognitive‐Behavioral Therapy for Eating Disorders

Year: 2025

Type: article

Abstract: OBJECTIVE: Anxiety about weight gain is a central feature of eating disorders (EDs) and plays a key role in maintaining ED symptomatology. Cognitive-behavioral therapy (CBT) experts have observed that patients with EDs often believe regular eating will lead to immediate, dramatic, and/or uncontrollable weight gain, prompting interventions like "collaborative weighing" and "open weighing" that help patients develop a realistic understanding of eating-weight relationships. However, patients also report anxiety about the consequences of weight gain (e.g., social rejection, self-hatred, permanent body dissatisfaction). While various CBT interventions address concerns about the consequences of weight gain, we propose that open weighing sessions-when patients confront weight increases and process accompanying emotional responses-provide underutilized therapeutic opportunities to work with these beliefs in real-time. METHOD: This paper outlines three clinical enhancements that systematically leverage open weighing sessions to address consequence-related beliefs: (1) identifying catastrophic beliefs about weight gain consequences through guided inquiry, (2) integrating cognitive restructuring by framing weight restoration as a behavioral experiment, and (3) combining in vivo weighing with imaginal exposure to feared weight gain consequences. RESULTS: These enhancements may provide complementary techniques for capitalizing on patients' real-time emotional activation during weighing, potentially enhancing existing CBT protocols' effectiveness in addressing a key mechanism underlying restrictive EDs. DISCUSSION: Future research might include randomized controlled trials comparing various weighing approaches, mixed-methods evaluations exploring weight-related fears across ED diagnoses and weight status, and mechanistic studies examining how addressing consequence-related beliefs improves treatment outcomes.

Source: International Journal of Eating Disorders

DOI: 10.1002/eat.24571

Authors: Jamal H. Essayli, Kaitlin A. Hill, Hana F. Zickgraf, Lauren N. Forrest, Cheri A. Levinson

Institutions: Pennsylvania State University, Rogers Behavioral Health, University of Oregon, University of Louisville

Language: English

Topic: Eating Disorders and Behaviors

Subfield: Clinical Psychology

Field: Psychology

Domain: Social Sciences

SDG: Good health and well-being

Open Access status: hybrid

Estimated APC paid: $4,300