Weighing in Eating Disorder Treatment: Why We Do It (and When We Don’t)

If you’ve ever been in eating disorder treatment, chances are the idea of being weighed brings up a lot. Fear. Resistance. Anger. Shame. Or a very strong urge to avoid the conversation altogether.

I want to talk openly about weighing in therapy: why it’s included in many evidence-based treatments, why I used to feel uncomfortable about it, and how my approach has evolved over time.

My own journey as a clinician

When I first began working in eating disorder treatment, I was avoidant of weighing clients. Not because I didn’t know the evidence, but because I was anxious. I worried about causing distress. I worried clients would feel exposed or judged. And if I’m honest, I worried about my own discomfort sitting with their emotional reactions.

Over time, as my confidence grew and I leaned more heavily into evidence-based practice, I swung the other way. I became quite rigid: weighing was part of treatment, full stop. If the research supported it, then that was the framework I followed.

These days, my approach is more nuanced.

I still believe weighing can be a very important - and often helpful - part of treatment. But rather than taking a one-size-fits-all stance, I now assess this case by case, clearly explaining the rationale, exploring the pros and cons with clients, and making collaborative decisions wherever possible.

Why weighing is used in eating disorder treatment

There are three key reasons weighing is commonly included in therapy.

1. Safety

First and foremost, weighing can be about safety.

As a clinician, it’s important for me to have an accurate understanding of what is happening with a client’s weight so I can assess medical risk and advise when a medical review is needed. There are some situations (particularly where there is significant restriction, purging, rapid weight change, or medical instability) where I would insist on weighing as part of safe practice.

In these cases, weighing isn’t about control or judgement. It’s about ensuring I’m practising ethically and responsibly, and that the client is adequately medically supported.

2. Exposure

Avoidance keeps eating disorders going.

For many people, the number on the scale holds enormous power; it can dictate mood, self-worth, behaviour, and even whether a day is deemed “good” or “bad”. Avoiding that number can feel protective, but it often reinforces the idea that weight is something too dangerous to face.

Weighing in therapy can function as a form of exposure: gradually learning to see the number without attaching meaning, moral judgement, or panic to it.

I’ve had some incredibly powerful experiences with clients who, over time, reach a point where they can step on the scale, read the number, and notice… nothing much at all. No spiral. No urge to compensate. No shift in their recovery goals. Those moments matter; they represent a real loosening of the eating disorder’s grip.

3. Fact checking the eating disorder voice

Eating disorders are excellent liars. The ED voice is very good at exaggerating the impact of nutritional or behavioural changes:
“I’ve eaten more, so I must have gained a huge amount of weight.”
“I stopped exercising for a week; everything will have changed.”

If we’re working towards specific treatment goals, it can be helpful for both therapist and client to be able to check the facts. Weighing allows us to reality-test the eating disorder’s predictions and gently challenge distorted beliefs with evidence, rather than reassurance alone.

When clients choose not to be weighed

Around 90% of my clients ultimately agree that weighing makes sense in therapy and are willing to include it in some form.

For those who choose not to, the most common reason is trauma related to weight stigma; particularly experiences of being shamed, dismissed, or harmed by health professionals. I take this very seriously.

I’m also mindful that therapy already involves a power imbalance, and that my own genetically slender body may amplify this for some clients. For a small number of people, introducing weighing too early - or without enough trust - risks reinforcing harm rather than supporting recovery.

In these situations, we talk openly about it. We review the decision regularly. And I hold hope that, over time, clients may feel safe enough to reconsider; not because they’re being forced, but because they want the opportunity to have a different experience: one where they are not judged, shamed, or reduced to a number.

So… is weighing necessary?

Weighing is an integral part of many evidence-based treatments for eating disorders, and it’s important people understand why it’s used. And yes, there are exceptions.

Good eating disorder treatment isn’t about rigid rules or avoiding discomfort at all costs. It’s about balancing evidence, ethics, safety, and compassion, and making thoughtful, collaborative decisions in the service of recovery.

If weighing is part of your treatment, my hope is that you understand the rationale and feel supported through it. And if it isn’t (yet), my hope is that the conversation remains open, because healing often happens in the places we once felt most afraid.