In traditional eating disorder treatment, each appointment with a psychologist or dietitian typically starts off with the client being asked to step on the scales.
At Exhale Psychology Centre, not only do we not weigh our clients, we don’t even have scales in our office - and that includes our dietitians room too!
There are a number of reasons why our office is scale free, but some of the key ones are:
- Given that less than 6% of individuals with eating disorders are underweight*, scales are not a useful diagnostic tool for eating disorders. Using scales as a diagnostic tool can inadvertently perpetuate the idea that eating disorders are primarily disorders of being underweight, and that those who are not underweight are not as in need of help
- Scales are not a useful indicator of malnourishment, as individuals can be malnourished at any weight. Some individuals lose weight (sometimes significant amounts of weight) in the context of undereating, whereas others have a more adaptive metabolism that accommodates undereating through slowing down. Lack of weight loss in the context of malnourishment is particularly common in individuals that have had an eating disorder for many years. The scales do not reflect malnourishment in these cases, and many of our clients have reported receiving praise from health professionals for “doing well” (maintaining weight) when they were significantly undernourished. Some clients even report being told not to worry about their reported undereating because it has not resulted in weight loss
- The BMI is not a useful key determiner of health, and has been identified as perpetuating racist and fatphobic ideaology. The BMI was never intended to be used as a measure of health, and is unfortunately routinely used as a rationale for health professionals encouraging individuals to engage in disordered eating behaviours. We should never encouraged individuals to engage in ill-health behaviours, regardless what a number on the scale is
- Our dietitian is able to successfully monitor health using other, less problematic, markers of health, such as oral intake, energy levels, mental health, digestive health, immune system, signs of starvation syndrome, etc.
- Arguably the most important one - asking people with body image difficulties to step on a scale in front of you is not without iatrogenic harm. Our clients routinely report that being weighed is highly distressing for them. And for many, weighing is a ritual closely associated with their eating disorder. We have heard from a number of our clients and lived experience advocates that not only did weighing exposure not reduce their distress, but instead increased their body hypervigilance and weight preoccupation - some even reporting that it resulted in a preoccupation that was not there prior
- As psychologists and dietitians, we don’t monitor blood sugar levels, we don’t take bloods, we don’t measure blood pressure, and we don’t perform ECGs. So we’re definitely not going to perform the one health measurement that is the most unreliable indicator of health, causes the most distress to the individual, and is the most likely to perpetuate fatphobia
This decision has not been without criticism, but we have chosen to prioritise individualised care based on lived experience perspectives over manualised approaches that have been reported to result in iatrogenic harm.
*Flament et al. (2015). Weight Status and DSM-5 Diagnoses of Eating Disorders in Adolescents from the Community. Child & Adolescent Psychiatry. 54(5). p403-411.
