F.E.A.S.T's Around The Dinner Table forum

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Please help me understand why our kids need to be shown their weight. I do not get it. Our D says it does not help her, in fact she wishes no one would tell her if she is gaining or losing. She says it all scares her and makes her ED worse. We are doing the FBT at  U of CHicago and she no longer wants to go, in fact she refuses because of the weight thing.
She IS eating, without much trouble now. We are on week 4. 
What does the FBT therapist say when you tell them that?  Ask them straight up - just like you did here.  There is nothing wrong with asking blunt questions about your childs health.  Tell them.  Expect an answer.
We have struggles with this as well. There are those on the forum who will tell you they did blind weights and it was fine. "pure" FBT would retire open weights. The reason is to expose the sufferer to her weight head on so that they deal with the anxiety of hearing it. In fact, one of the key things keeping our D in phase 1 is her inability to hear her weight if it has gone up without melting down.

It does work - over time she has gotten much better about hearing her weight, although it is still a source of anxiety for her.

Try to trust in the professionals on this one - I know it is tough...

Dad to 24 yr old D - recent relapse but relieved that she reached out for help.
It's an FBT thing. We didn't have strict Family Based Therapy so didn't share our daughter's weight with her. When she was in the hospital, in the beginning, her weight was shared, and it was traumatic, so when it was our choice, we chose not to.

However, she's two-years post weight restored now and still doesn't know her weight, and it's something that is hanging over our heads in a big, bad way. I think it might have been easier in the long run if we had shared her weight with her in the beginning.

I agree with the others. Ask them straight out.

Some families have worked things out so that the child could be told whether or not they they had gained or lost and whether they were within their range instead of having to know the exact weight.
Our D has always been told her weight and there has been varying amounts of anxiety and ED behaviour throughout. Now that she is almost WR and thinking things through better knowing her weight gives rise to questions such as "and why do you think you lost this week?" or "how do you feel that your weight has risen?" We can use this as a discussion starter in FBT and as a young adult (18.5) she is given a chance to buy in to goals we make. Some she buys into straight away and others we impose on her as necessary and then deal with the behaviours as she is exposed to the challenges.
A recent thread on this topic: Does your FBT use open weights?

Daughter age 28, restrictive anorexia (RAN) age 11-18, then alternating RAN with binge eating disorder and bulimia with laxatives, is in remission from EDs for 3 years after finally finding effective individual therapy. Treatment continues for comorbid disorders of anxiety, ADD and depression. "Perseverance, secret of all triumphs." Victor Hugo
If you're at U of Chicago--birthplace of FBT--they probably follow the treatment protocol and that includes open weighing.  UCSD also does open weighing.

While I agree that no number should be a source of anxiety and that desensitization to weight is a good idea, "weight as a number" is still a fairly abstract and unimportant idea.  We lived for 1000s of years without knowing our weight or the calorie content of foods and managed to survive.  Right now, during refeeding, seems like the time when this number causes the very most anxiety.  So why do we have to desensitize them right now?  If they are already climbing the walls with anxiety over eating?  Let's get some food into them, get them into a healthier mindset, and then start talking about unimportant things like weight.

That's my two cents.

But if they insist on open weights AND they are the University of Chicago, I would probably take a back seat...not because I agree with them but because I want everyone to sing from the same hymn sheet.  There may be other areas of disagreement ahead that I won't feel as able to compromise on (a proper target weight comes to mind).  I would hope that being flexible about some things would make them more amenable to compromising when it really matters to me.
Colleen in the great Pacific Northwest, USA

"What some call health, if purchased by perpetual anxiety about diet, isn't much better than tedious disease."
Alexander Pope, 1688-1744
When we participated in the week long family intensive program at UCSD Sept. 2010 and when d was in UCSD partial program for 2 months in 2012 she was always weighed blindly. I believe the parents and therapist make the decision together regarding how weights will be done. Most kids were weighed blindly. I understand completely why open weighing is done in manualized FBT . I also know how traumatized our d was when she was openly weighed while acutely ill during inpatient care 2 years ago. I also think being told her weight range was partially responsible for sending her back into Ed behaviors after discharged from residential last year. She has a compulsion to get on the scale but she can't handle the number yet ,it has backfired and back to treatment she goes. If she chooses to get on the scale again and we are made aware of it I am hoping she is well enough to handle it and continue to refrain from Ed behaviors . Our girl absolutely has not been able to see the number without falling into the Ed black hole. I wish this wasn't the case and we could open weight her ,expose her to the number and work through it. This is a difficult decision and everyone has to do what they think is best.
Thanks for that correction about UCSD, Roxy.
Colleen in the great Pacific Northwest, USA

"What some call health, if purchased by perpetual anxiety about diet, isn't much better than tedious disease."
Alexander Pope, 1688-1744
My D has been doing so much better after we stopped weighing her. Being weighed is a trigger for her. Have you talked to the therapists about how your daughter feels about this?
Perhaps if she has to be weighed, then ask if she can be blind-weighed (back to the scale).
I know that this is nearly always a sensitive and potentially contentious issue when it is brought up here; different folks have differing histories and experiences and one approach may seem to be more logical or work better than another for individual patients.  We did not have FBT but we did have a professional who believed that everyone should know the weight and that charting the weight was an important part of seeing how treatment was progressing.  My thoughts on this now are that the gaining of weight is a difficult concept for anyone with anorexia to be comfortable with and, ergo, pretty much no matter what you do, a weighing day is likely to bring on extremes of anxiety.

Our experience was that weighing in a GP's surgery was way too uncontrolled - different scales in different offices for different doctors at different times of day meant there was no consistency or surety in the results.  We tried weighing at home and this was a disaster too - the fall out could last for days - and we tried without my daughter knowing the numbers and her anxiety escalated further; she imagined that she was now completely out of control - in her mind her weight might have sky rocketed or it might have stood still but either way it meant that she was anxious -  that she was gaining weight even if she ate fresh air, that she had lost weight and more calories would be added - her imagination of the horrors on the scale gave her a harder time than doing the maths, which she did, based on the actual numbers, to work out how easily her body might gain weight in an uncontrolled fashion way into the future (and her ability to do that maths with irrefutable logic was impressive!).  There was absolutely no peace in her mind whatever way we played it.

Ultimately, we opted for open weight, in the doctor's office, at a regular time of the day and the week and poker faces and zipped lips were the order of the day.  If we talked in the car on the way home it had to be about anything other than food or weight or numbers; I was not to seem pleased or unhappy about anything to do with our appointment, and I had to learn not to engage in any weight/calorie/food related talk. 

Weighing days were always uniquely and consistently hideous and stressful but we weathered them; we no longer own a weighing scale or have any idea about what any of us weighs, but it doesn't matter anymore because it is just a number on a scale, suitable for working out doses of medication when absolutely necessary, and holds no further magical powers over any of us. 

Our doctor emphasised that this was no more than a dot on a chart, worth nothing on any given day and valuable only to indicate trends over time.  Treatment protocols would never be worked out to zig zag about in an uncontrolled manner because of the snapshot that the weighing scale would give, they would be consistent and controlled and nuanced as a result of the curve on the graph over a period of time and our doc was in charge of directing them and this, ultimately, gave some sense of comfort to all of us.  It didn't help my daughter if the number unhinged me too and we only settled into a pattern that worked for us when everyone else (apart from my daughter) was not frightened by it.

Erica, UK
My D having ED for so long and being fixated on numbers, had blind weights with the FBT we worked with.  This continued for a long time and when we began working with another FBT my D asked that we continue blind weights.  At some point she accidentally saw her weight on a Dr report and she didn't have much problem adjusting to the number.

I believe for her it was imperative that she had blind weights for a long time until her brain healed and she could accept the number as just a number.

If she had seen her weights each week for Phase I and even into Phase 2, it would have just added fuel to the fire, since most of her ED thoughts were so ingrained.  Numbers of any kind were something she ruminated about.  And very hard for her to stop those ruminating thoughts.
WenWinning (formerly wenlow) - a Mom who has learned patience, determination, empathy, and inner strength to help her young adult daughter gain full remission after over a decade of illness and clinician set inaccurate weights
I didn't read this entire thread but I wanted to also add that UCSD weighed our daughter blind and some of the other girls open (no boys our trip) - they did whatever the girls were used to already. 

We have done blind weights until this summer and I am very happy with the results - I would not change anything just because the book says you should do open weights.

We had no plan of when exactly to introduce open weights.   One morning out of the clear blue sky when my daughter was ready to step on the scale she asked if she could see the number.    It felt right so she did and that was that.  Zero stress.

The blind weight vs. open weight debate is in the same category of "do we rip the band-aid off or not?" and "3 meals and 3 snacks or 3 meals and 2 snacks?" category.    

Some parents don't push fear foods and do open weights.   I pushed fear foods and we did blind weights - whatever works.
A dad.
Our FBT does blind weights with our daughter.

"Hope is a wonderful thing ... but hope by itself is not enough. Hope is the reason to take action, to make a plan and then to change the plan when it isn’t working - over and over and over again if necessary." Hannah Joseph (Let's Feast Friday Reflection, "Just Keep Going," Friday, March 3rd, 2015)
Our team does blind weights every 2 weeks. I just say "your'e safe" when he's weighed. Since he's male he will need to continue to grow. I think he gets that concept now - but early on he didn't. He compared himself to female models. He aims to play soccer at the college level and the experience of playing in a competitive league I think has helped him with the reality of needing fuel and serious muscle mass. Males grow different so my comments may not be helpful for female sufferers.
Son diagnosed @ 12.5 yrs old with Severe RAN 2/11. Co-morbids - anxiety, Active restriction for 3 months. He stopped eating completely 2x. He needed immediate, aggressive treatment from a provider who specialized in eating disorders, adolescents and males. We got that at Kartini Clinic. WR since 5/11. 2017 getting ready to graduate slipping lost 8lbs. Fighting our way back.
We did open weight starting from the first day of the treatment. Right now D is about 90% recovered after her weight has restored for more than 6 months. Now I looked back to the decision we made, this was one of the right decisions we made. At the beginning, she was anxious about her weight. With the time going, she got used to the open weight. To her, that was one of EXRP. Of course, this is just our experience. Each individual is different.
19 yr old d Dx Feb 2012. WR June 2012. Now she is in Phase III and enjoy her study and activities. Try to give the control back to her but still keep vigilant. 
"The darkest night is often the bridge to the brightest tomorrow."
 I am with Colleen on this one. Yes, there are very good reasons FOR open weighing, and very good reasons AGAINST it, but it isn't a deal breaker in treatment to my mind.

I believe you are not only with a team at the University of Chicago, you are actually in a trial. Is that correct? If so I think it highly unlikely that the team will deviate from the manual as they can't, they are testing it in a controlled trial.

It seems that so far you are doing very very well indeed with the method. In week 4 she is eating, without too much resistance. That is HUGE. Well done!

You will all, family, patient and treatment team face challenges along the way but you have cleared the first hurdle with flying colours. I hope you will also be able to take this one. I'm not suggesting that you meekly accept that the weighing is going to be that way and that you force your daughter to go along. Your daughter needs to be heard and her pain at the challenge that open weighing involves acknowledged. The team need to know that this is an ordeal for her and for you and that you wonder whether it is really necessary. I hope that it is something that you can discuss at the next session.
Fiona Marcella UK
The rationale is exposure response. ED is scared of a weight. So it is exposed at regular increments to de sensetize. The patient is given support to process, and parents are.

Are there valid reasons for deviating from this requirement of the manual? Yes I do believe so. If the age of the patient precludes their cognitive ability to understand what a weight is. That was our reason, age 10. If they have so much weight to gain over the course of growth and treatment that they could not possibly desensetize the way an adolescent or adult would that would be a valid reason. (my young D had to gain 40 pounds). If the sufferer self harms because of the exposure and you cannot keep her safe. That is a valid reason. (hand waving).

Is it a deal breaker to stop going to FBT? For ED it is. I am sure ED would want it to be.

You have many examples of fine parents on here who have done blind weights (waving hand) and shifted later to open without incident. You also have many examples of fine parents who with support, have pushed through exposure and done open weights during treatment with success. 

Am I relieved now that weights are open now? (happened by accident the nurse forgot to turn the display off and voila!). Yes... I am relieved that it is open now. It was hard to call parents on a play date and ask them to remove scales from their bath rooms. It was hard to ask relatives to do this on visits. That being said I am glad that we had the support to deviate with (good reason I think) from the manual because my D was so young, but not just because it caused her anxiety. Everything caused her anxiety.....
We have always done open weights.  Yes, every weigh-in day has been stressful, for D and us.  No win situation.  If D gains ED gives her a hard time, if she loses she feels a failure.  Lots of times I have felt we should blind weigh, probably to alleviate my own anxiety as much as anything!

But in time weigh day has not been such a big deal.  Ultimately I would like D to weigh herself independently to check she is in her target range.  Long way off this but at least the exposure of regularly being weighed and knowing her weight will not be such a big deal.

Also there are situations in life when you will be weighed, such as preparing for an anaesthetic, routine doctors appointments, some sports.  D loves skiing and of course you are weighed when getting skies fitted.  I would imagine if you don't know your weight all of these normal things in life could be extra stressful and perhaps avoided.

So I guess in hindsight I am glad we open weigh but I can completely understand individuals decisions to do blind weighing.
UPDATE: We went back to U of Chicago yesterday, for session 4. We had talked in great detail with her FBT the night before, saying that our D was so scared about getting weighed because she feared it would set her back, and at this point she is somewhat pro-recovery minded. The FBT told us they do allow adjustments to be made on an individualized basis according to what is best for each patient. She was weighed blindly yesterday. We are now using some sort of code words that let her dad and I understand where our D is at in each session without weight numbers being said. Example: " She is right on target." means that she gained 2 pounds that week.  "She is making progress." means that she gained about 1 pound a week. 
Our D handled this well.
I do hear all that you parents are saying and I see reasons for doing the weight both ways. I see great wisdom in both sides of the coin. I have had to deal with my own OCD by doing Exposure Therapy, so I do see great value in that. I also see that at critical stages, where weight gain is to restore health, AND because our D has suicidal tendencies as well as self-harm, for us we are going to do it blindly for a while and are pleased that U of C research study is fine with that.