Clinician and patient characteristics and cognitions that influence weighing practice in cognitive‐behavioral therapy for eating disorders

Abstract

Objective Clinicians commonly fail to weigh patients appropriately in cognitive‐behavioral therapy for eating disorders (CBT‐ED), despite guidelines stressing the need to do so. This study considered the possible patient‐ and clinician‐based reasons why this element of treatment is omitted. Method Seventy‐four CBT‐ED clinicians were presented with vignettes that varied in patient diagnosis and distress levels, to determine whether those characteristics influenced different clinician weighing practices. Clinicians' own attitudes to weighing and their anxiety levels were also assessed to determine whether they were related to weighing intentions. Results Clinicians were more likely to weigh patients with anorexia nervosa than patients with bulimia nervosa, probably due to focusing on physical risk. However, they were less likely to weigh patients who were distressed at the prospect, despite that course of action being particularly clinically indicated. Clinicians were more likely to weigh patients if they had positive beliefs about the value of doing so, and if they were not prone to making unsupported exceptions in delivering this technique. Discussion This study provides evidence that clinicians use weighing differently according to the patient's presentation and their own beliefs, rather than working within guidelines. Education, training, and supervision are suggested to help clinicians address this failure to weigh patients in the most therapeutic way.

Management of eating disorders during pregnancy: A survey of Australian dietitians in clinical practice

“…The inconsistency in dietitian practice for weight tracking for women with an active or potential ED in pregnancy reported in this study may relate to uncertainty around the best practice for weighing during pregnancy as well as during ED treatment. In‐session weighing is a prominent feature of ED treatment and often a mandatory part of clinical assessment, required to monitor the physical safety of clients 29 . Additionally, in Australia, the National Health and Medical Research Council (NHMRC) has revised its pregnancy care clinical practice guidelines, recommending weighing be reintroduced as part of antenatal care, 30 conflicting with earlier NICE recommendations for this practice to be abandoned 26 .…”

“…In-session weighing is a prominent feature of ED treatment and often a mandatory part of clinical assessment, required to monitor the physical safety of clients. 29 Additionally, in Australia, the National Health and Medical Research Council (NHMRC) has revised its pregnancy care clinical practice guidelines, recommending weighing be reintroduced as part of antenatal care, 30 conflicting with earlier NICE recommendations for this practice to be abandoned. 26 In pregnancy, self-weighing is commonly seen by women as a method for preventing excessive weight gain, 31 and this could have negative consequences in people with EDs.…”

Impact of patient characteristics on clinicians' decisions to involve dietitians in eating disorder treatment

“…The present study used an online survey consisting of self‐report questionnaires and a series of clinical case vignettes similar to the survey design used by Daglish and Waller 17 . Ethical approval was received from the University of Sydney Ethics Committee (2020/131).…”

New developments in cognitive-behavioural therapy for eating disorders (CBT-ED)

“…Unfortunately, preliminary evidence that many clinicians do not deliver core tasks of CBT-ED [ 10 ] has been replicated very closely [ 33 ], confirming that clinicians’ emotions, beliefs and reactions to patients play a part in whether patients receive key elements, such as exposure therapy, weighing, etc. [ 34 ]. In particular, it appears that apparently inflated beliefs about the therapeutic power of the working alliance results in lower adherence to core CBT-ED methods [ 35 ].…”