Open vs. Blind Weighing for Eating Disorders

Overseen By Jamal Essayli, Ph.D

Age: < 65

Sex: Any

Trial Phase: Academic

Sponsor: Milton S. Hershey Medical Center

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

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: Unknown

Duration: 60 weeks

70 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial aims to improve treatments for adolescents and young adults with eating disorders by reducing anxiety about weight gain. It compares two methods: open weighing, where participants see and discuss their weight, and blind weighing (also known as discreet weighing), where they do not see their weight to lessen focus on it. The goal is to determine which method better manages anxiety and improves treatment outcomes. Suitable candidates for this trial are English-speaking individuals aged 12 to 24 with an eating disorder such as anorexia or bulimia, especially if they worry about gaining weight. As an unphased trial, this study offers a unique opportunity to contribute to innovative treatment approaches for eating disorders.

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.

Is there any evidence suggesting that this trial's treatments are likely to be safe?

Research shows that both open and blind weighing are safe for people with eating disorders. Open weighing means knowing your weight, while blind weighing means not knowing it. Both methods are part of cognitive-behavioral therapy, a well-known treatment for eating disorders.

Studies have found that open weighing can reduce anxiety about gaining weight by challenging fears and beliefs about weight. In contrast, blind weighing helps individuals focus less on weight as a central part of their identity. Both methods have been used in treatment without major safety issues.

No specific negative effects have been reported in the data, and these methods don't involve medication, which lowers the risk of side effects. Prospective participants should discuss any concerns with the trial coordinators, who can provide more detailed information based on individual needs. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about the trial comparing open weighing and blind weighing for eating disorders because it explores new ways to address the psychological aspects of these conditions. Unlike traditional treatments that often focus on counseling and nutritional guidance, open weighing directly challenges beliefs about weight gain by visually tracking predicted versus actual weight, helping patients confront their fears. On the other hand, blind weighing shifts focus away from weight altogether, encouraging patients to stop associating their weight with self-worth by not revealing their weight to them. These approaches aim to change how patients perceive and react to weight, potentially offering more effective ways to manage eating disorders.

What evidence suggests that this trial's treatments could be effective for eating disorders?

Research has shown that open weighing, one method studied in this trial, involves seeing one's actual weight and can help reduce anxiety about weight gain in people with eating disorders. This approach encourages individuals to confront and understand their concerns by predicting their weight and then seeing the real number. Studies indicate that this can lead to better results by directly addressing fears about weight. In contrast, blind weighing, another method in this trial, involves not showing the person their weight, aiming to lessen the focus on weight and its effect on self-esteem. While both methods help manage eating disorders, open weighing has shown promise in directly reducing anxiety about weight gain. ^{1 2 3 4 5}

Who Is on the Research Team?

Jamal Essayli, Ph.D

Principal Investigator

Penn State University

Are You a Good Fit for This Trial?

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

Timeline for a Trial Participant

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

What Are the Treatments Tested in This Trial?

Interventions

• Blind weighing
• Open weighing

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.

How Is the Trial Designed?

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+

Published Research Related to This Trial

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 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]

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]

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]

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]

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]

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]

Citations

1. nationaleatingdisorders.org nationaleatingdisorders.org/

NEDA | Eating Disorders Support, Awareness & Recovery Access support, explore resources, join community events, and take a free eating disorders screening—start your recovery journey with NEDA!

2. jeatdisord.biomedcentral.com jeatdisord.biomedcentral.com/articles/10.1186/s40337-020-00316-1

Blind versus open weighing from an eating disorder patient ... Weighing is a key component in the treatment of eating disorders. Most treatment protocols advocate for open weighing, however, ...

3. clinicaltrials.gov clinicaltrials.gov/study/NCT06085092

Open vs. Blind Weighing Study In Adolescents and Young ... Participants must also present with an eating disorder (ED) diagnosis that is characterized by anxiety about weight gain, such as anorexia nervosa (AN), Bulimia ...

4. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC8380001/

The open versus blind weight conundrum - PubMed Central This multisite randomized controlled trial will provide the first known data on the impact of open versus blind weighing practices upon weight-related distress ...

5. withpower.com withpower.com/trial/phase-anorexia-9-2023-b7f60

Open vs. Blind Weighing for Eating Disorders Current treatments for adolescents and young adults (AYAs) with eating disorders (EDs) do not effectively address a central ED symptom - anxiety about ...