The scale: To weigh or not to weigh in recovery [Podcast]

Hello there, welcome to this week’s podcast. This week I had a chat with a lovely lady called Bridget Whitlow and Bridget is a psychologist and she’s really active in the eating disorder advocacy world as well. I met her, I think it was this year, there is this F.E.A.S.T symposium it’s wonderful. F.E.A.S.T  is the parent/carer non-profit that helps parents practice things like FBT with their children. So I had the pleasure of meeting Bridget there and we decided that we should do a podcast about the subject of the scale and this is just more like us having a chat, I have to admit I did forget that I was recording for a podcast, that happens more often than you’d think when I’m talking to people. So yeah, this is just having a chat about the scale.

I did actually for the beginning have enough about me to remember to ask Bridget to introduce herself so, here’s Bridget:

Bridget: So my name is Bridget Whitlow and I’m a private practice therapist in the San Francisco Bay area. I do a lot of Family Based Therapy work, I do a lot of Exposure work and also Compassion Focused Therapy. I love learning more about this field and I’m grateful to be talking with you.

Tabitha: Yes and I am with you as well. Today we’re going to talk about the subject of the scale. Which probably has a big emotional component for any people listening, even the world ‘scale’. Yes so where do we start with this one Bridget?

B: Well, this is a really really interesting one because on one hand, a lot of work that I do involves the scale, where I do weigh, in addition to perhaps a weight that the paediatrician or the medical team are doing in the Family Based Therapy. Sometimes we start out, in the manual you are definitely supposed to talk about it. That’s not always how it rolls out. That whole purpose behind that is to do exposures around it because it does bring up a lot of emotions. For some people, they just really don’t want to have anything to do with the scale really ever. That’s kind of OK too. Kind of depends on the person, just like anything. Not one thing is going to be a great fit, but it’s definitely an emotional equipment.

T: Yes and so tell me when you say, in the manual it says that, say if you’re working with an adult person and they are expressing that they know about themselves and whatever stage they are in recovery and that using a scale is not helpful to them, the manual would say that you would go ahead and make them know how much they weigh?

B: Well if you’re going by the letter of the law and that’s just how I was trained, but I wouldn’t since I’m in private practice and I’m not in a study situation or a clinic where I have to follow a certain protocol then I would certainly say, and I’d talk about it. What is that going to bring up? Because that’s always fruitful to figure out what comes up for people. Maybe we start off not using it and maybe we check it out later, it just kind of depends on what’s going on for that person. But no I would never, unless it was somebody who was on the edge of needing to be hospitalised, then I might really push it because we do have to make sure they are getting the level of care that’s needed.

T: But they could be blind weighed couldn’t they?

B: Yes. Absolutely and I have a scale where they output is separate from the actual scale so I can be holding it any which way and they can face me but it can be a very good planned weight.

T: Yes I think that listening to people, you think would go without saying but obviously it doesn’t go without saying. I just know from my own experience that it depend on where I was at mentally a lot of the time and also my own body weight had a huge impact on how I could process things mentally and so I know that there were certain stages in my recovery where it just would only of had a negative impact. I know that there are also certain stages in my recovery where actually I was able to use the scale as a motivational tool. Like, yes, this is going up and yes I’m doing this. So that’s just one person experiencing massively different dependant on my attitude and my physical state of malnutrition or not. I think that everybody is different and that also can come into it. I know that some peoples actual experiences of treatment can make them have a reaction to being weighed.

B: Yeah, yes absolutely and I’m really curious to hear from you, how you said at different points in your recovery it was a motivational piece, because I think that that would be really helpful for people to learn more about because that’s definitely a turning point.

T: Oh yeah, for sure but that’s really, I think that a lot of the time, you can be in recovery, in inverted commas. It’s like, yeah I’m in recovery but I’m not going to gain any weight. (laughs) Which is in my opinion, in that case, you’re not really in recovery because recovery if you are very underweight, requires weight gain. So if you can’t commit to the weight gain then good luck because you’re not going to be able to recover without it.

I think that there was a point when I realised that, that I could not recover from anorexia and suppress my body weight. It sounds, really, really, really obvious but I swear it wasn’t, because for years I was saying I really want to gain weight, I really want to recover but my heart wasn’t in it. I was saying those words and still restricting food. I was saying those words and still compulsively exercising and so they were just words. I’m sure that there was a part of me that wanted to recover but I didn’t want the weight gain associated I wasn’t committed to the weight gain and then finally, I sort of worked that out in my head and then I did commit to the weight gain and once I committed to the weight gain, weight gain became a trophy. It was like, this is me doing recovery every, every notch that the scale moved up, it was like, I’m actually doing this and because I had committed to doing it, it gave me this feeling of achievement.

So I was able to use the scales to motivate myself and actually, seeing them go up gave me more energy and was just like, yes, I’m going to challenge even more. That’s not going to work for everyone and I didn’t have any past experiences because I didn’t any treatment experiences. I didn’t have experiences of going and standing on the scale being this big kind of, I don’t know, moment of truth or other people watching or anything like that. So maybe my ability to do that would have been inhibited if the scales had taken on this other meaning to me, if my experience had been that somebody else had been watching as well and I’m going to get judge. Also not just judgement but implications, as in you’re going to be made to stay in treatment longer if something hadn’t happened and all of that additional anxieties.

B: Yes and when you say judged, do you mean judged by yourself? Or judged by whoever else in the room?

T: Well I think both, because if someone else is in the room then they are obviously having a judgement about that number that may have implications for your future. But definitely I think self judging as well. I just think there can be many many many things that go into that experience of getting on a scale and I never did experience getting on a scale in a treatment providers office. I don’t know what that would feel like because I didn’t go through that. I often wonder how that  would have influenced my relationship with the scale.

B: Yes and I wonder too, with the therapist from your point of view too.

T: Getting on a scale with a therapist?

B: Yes

T: Again, something I haven’t experienced it would really depend, say for example if I was someone who said look, I’ve been obsessively weighing myself for as long as I can remember, I don’t want to see this number any more, I don’t want to participate. Because knowing what mental impact seeing that number has on a lot of people I do think they just get to that point of, you know what? I don’t want to know! I just don’t want to see that, it’s just not helpful to me right now, it just does things to my brain that is very energetically consuming. So I think if I had a therapist that was like, no you need to do this because you need to desensitise yourself, or whatever. Then I’d probably have many feelings of anger about that sort of thing.

B: Yes.

T: But that’s just me, I tend to react to that sort of situation with anger.

B: Yes, well that’s understandable and I don’t think that there’s anyone in the field that would push it quite like, you need to do this. I know a lot of us do blind weights.

T: I definitely have clients that have been told that and been made to do various things. It’s often a discussion that I do have with clients because they may be being pushed one way or another and I always say to people, well what do you know about yourself? And your history and your experience? And how you feel about this right now, if this is something sensible right now. If this is something that’s helpful right now. Ultimately the information that is on that scale is only so useful anyway. I sometimes do often wonder, how important is this actually? If this moves a nanojolt either way, what have we actually achieved? Sometimes I really do wish we could move towards understanding that mental state markers indicate full recovery or not.

B: Yes I mean it’s a tough one because I know that in the work that I do in the family based work, the little incremental numbers but it’s one of the only objective things that we have to go on. So it’s not perfect at all.

T: No it’s not, it’s so difficult though because as you said, especially if you’re trying to help someone to recover who is relatively resistant to recovery. Then it’s very difficult to have any other measure to anything actually happening. But even then I think that some times using that as a measure can almost build this false sense of security because I did go through a phase when I was being weighed by a parent and I could manipulate that scale. I think sometimes we’ve got to understand that people are intelligent. If somebody wants to manipulate a scale, it’s going to happen.

B: Yes. I think that’s probably something really unnerving for other people, you know family members and loved ones to hear.

T: Absolutely but that doesn’t make it any less true, and so once that problem is understood then that can be understood, that sometimes even seeing a weight go up is you know, somebody has to be invested in recovery really to make a full recovery. You can get them so far, but the more that we can make people feel like they can be honest and they don’t have to be manipulating something the better and that requires listening to people because why would somebody be honest if they are just being shut down and not listened to.

B: Yes absolutely. You know one thing that I’m thinking about is that sometimes when there is a lot of emotions around the scale, I have this other scale, that I got. That when you step on it, it says  things like, creative or sexy, it just different adjectives you know? And stuff like that can bring in a playful element.

T: Absolutely and sense of humour, I hadn’t seen or heard of that before but that’s wonderful because I think anything that can make us laugh can really defuse that stressful and anxiety situation. That’s cool.

B:  And then I’ll have the parents get on, so everyone’s got their little adjective and sometimes that can be helpful.

T: Yes, yes. I think that the other thing that always tickles me a little bit when I hear this happen with adults is that somebody might say to me, I’m being blind weighed because my therapist says I shouldn’t know my weight or whatever it is, I think it’s like, wait a minute, so this person is a free ranging adult person and the therapist thinks that blind weighing them is going to stop them knowing their weight, if they want to know their weight. Can we give people some credit? (laughter) It just kind of makes me giggle because I’ll be like, you know your weight don’t you??

B: Yes (laughs)

T: So I just think the more that we can work with people and just say, well what’s actually going to happen? Especially if they’re an adult. It’s like lets brainstorm this and see what’s going to work right now because then you will have their buy in and they will be more likely to do it or not. I guess it’s harder with children though.

B: In terms of buy in?

T: Yes

B: Yeah and interestingly depending on their age and development some kids don’t really have a grasp on what weight is. So often I’ll say how much do you think you weigh and it’s just these numbers that wouldn’t make sense at all. So even talking about their weight or even them know their weight doesn’t make sense. Then it would train them to think in that way does that make sense?

T: Yes for sure. I think that sometimes it’s one of the stereotypes of say anorexia, is that somebody is obsessed with their weight and wanting to be thin and things like that. Some kids are actually oblivious of their weight and so then the idea gets planted though and they start paying attention and they are like, well obviously this is important because people keep talking about this to me!

B: Right.

T: Have you ever come across any guidelines for treatment providers around that sort of situation, how to take the focus off of weight?

B: Meaning like with kids or just in general?

T: With kids I think specifically.

B: I haven’t seen any guidelines per say but I just really follow the lead of the parents and what they know of their kid and what I know of the kid as well. So if it just doesn’t make sense to share it then we might just do a quick weigh in and no big deal, just move on quickly and then the parents know they can keep track. So far that hasn’t been problematic.

T: So you talk to parents quite often in that situation then?

B: Yes so often the way my meeting is structured is that I will meet with the individual for 10-15 minutes and check in on a variety of different things, you know how they are doing, get their weight just get an overall check in, see if there is anything we need to talk about, maybe share some skills. Then the parents will come in and if it’s blind weigh in then I will just show them the weight when I get them in the waiting room. So they know where things are headed and then we come in the room and we talk about what’s working and what isn’t working and so forth. If it’s a child or adolescent or you know a young adult that’s having loved ones involved.

T: Have you ever been in a sort of situation where the information that you’ve got from the parents has surprised you and really helped you form, or take a different path? Or anything like that?

B: In terms of weight? Or the scale?

T: In terms of weighing yes.

B: Only if they shared that there’s not a good sense what weight is or anything of that. I guess that would make me take a different path. That’s the only thing that’s coming to my mind Tabitha.

T: Yes. I really like it that you are actually listening to the parents.

B: It’s key, everyone needs to be listened to. For sure.

T: Have you sort of experienced the opposite sometimes, where you think maybe the parent is really too focused on weight and could be, you need to maybe try and help them back of a little bit so that the child doesn’t become over focused on it?

B: Yes I think that can definitely come up and I’d say that is a lot more common and of course there’s a lot of anxiety and in how their kid is doing. So I might talk to them separately or I might talk to them together. Just depending on how things are going and just say lets just pay attention to how the mood is and how things are going around the meal. Like it’s great that there was some spontaneous eating, that’s awesome, that’s a good sign of recovery. So I’ll just emphasis other areas that we should put our attention too and typically that helps.

T: I admire you working with children, I one of those people that’s really not very good with children.

(laughter)

I just don’t know what to say, I just talk to children as if they’re adults a lot of the time and I’m just like this child is not responding in the way that…

B: I don’t know they might like that!

T: Maybe I don’t know! Yeah, it must be very, very different. I can’t imagine actually just talking to a really innocent kid that doesn’t even understand what weight means. Just how can we protect that innocence for as long as possible?

B: Yes, it’s tough. It is tough especially when everyone around them is so worried and organising to help them.

T: So what do you overall, do you see any patterns, say with adults, do you think people find it more helpful to know what they weigh, do you think to not?

B: Again that kind of depends, like what you were saying about where you are at in recovery. So I think a big pattern, when you first asked the question that immediately came to mind was a sense of guilt. So it’s like there’s no winning. Guilt if there wasn’t weight restoration or guilt if there was and working through that. That seems to be a big big theme.

T: I think that sometimes, one thing I get from talking to people is that other peoples reactions to their weight gain can affect them more than the number does. So if their reaction might be, oh wow, you gained a load of weight, will actually affect them more than the number going up. I think that sometimes it could be especially if you’re a clinician that really cares about the client and has been really worried about their weight and is just genuinely happy that that’s happened I think that it can be a natural reaction for that to happen, congratulations and maybe making a bigger deal about it than really should be.

B: I was wondering if that comes up more in a medical office versus a therapist office. It’s just me, I don’t hear what other people are doing, but you know, I try and keep it as neutral as possible like, oh OK things are steady, do you want feedback, not want feedback? If we are doing a blind weigh in, then I’ll say OK it’s trending in the right direction or it seems a little lower is there anything different? Just trying to use it as a jumping point to talk about how things are going and what might be really challenging and where we could set some goals around.

T: Do you know what I have actually had come up quite a lot, more so in the NHS than anywhere else is that somebody may be requesting, I don’t want to know my weight and they will say that to the nurse and they will say that to the doctor and then just, I can’t tell you how many different routes to just clumsiness that leads to that person being shown their weight. Or something, I had some person who got lab results and she’d not been show her weight at the doctor but then it was plastered at the top of the lab results. I had another one who had to go back out to the nurse to book another appointment and the nurse was just kind of writing down the weight and saying the numbers out loud, mumbling to herself, it’s just like, oh people can we not just get this together!

B: It is surprising and I think it’s just so hard when it’s a bigger system to keep it, not that it’s an excuse, I see that too and it’s really frustrating. I don’t know what the fix is.

T: I think that a lot of the problem is just people not understanding the significance of that for some people and that that’s really important. Just because it might not be significant to them and their brains, so just they might say, oh yes that person doesn’t want to know their weight and then they forget 5 minutes later and they’re writing it down on the top of the next appointment sheet or whatever. I do sometimes try and politely when I hear that and I’m in communication with someone’s doctor just try and politely remind them, like you know there was a reason that that person requested you not to tell them their weight could you maybe tell that to the rest of your staff.

I’ve had that happen really bad situations, situations where someone was really not in a good place to hear that number and it had a massive negative effect. So I just think that I really wish that doctors could understand that, especially in the NHS, I think it’s pretty much the same in the USA as well. Where if you go to a doctors appointment, I could go to a doctors appointment about something hurting in my foot and the first thing they will do is put me on the scales.

B: Right, and can you refuse to?

T: You can, yeah and I do and I don’t give a damn what the scales say. I really don’t care. I just do it for the point of it because sometimes it might spark a conversation with the nurse when I say no I’d rather not be weighed, they might think oh that’s interesting and I can say do you know for certain people with an eating disorder history and this that and the other that being weighed can actually be very negative for their health. Just using it as an opportunity to educate. It actually annoys me when the nurse doesn’t say anything. I’m going to tell her anyway.

(laughter)

B: That’s great though, using that to educate, that’s wonderful.

T: Yeah and I think that the other thing that is really helpful for people to understand is that I can genuinely, 100% say that I can get on the scales and I have zero emotional reaction to whatever it says and that was not true for many years of my life. So it’s just that recovery can get to the point where something that has felt like it’s been an obsession in your head and really help you hostage to it, can have absolutely no emotional reaction.

B: Which I think is great to hear you say that because I think people can feel that that’s impossible and I’m curious what are the factors do you think that went into that? Do you think it was partially exposure? What do you identify?

T: I think that there has to be, even a certain stage in recovery it’s not helpful to see the scales. There will become a point in recovery, I know that for some people there just becomes a point where they think, actually I can handle this now. Then just exposing themselves to it. Then exposing themselves somewhat but for me the bigger thing was actually then not weighing myself. Like, I knew my weight but not weighing myself maybe once a year or something and that’s sort of way.

Until I got to the point where I suddenly realised the scales had been in the bathroom but I hadn’t even thought about them for months, I’d even forgotten they were there because there was a stage where I had to take the scales out of the house. Not have any and that was really helpful and then there was a stage where it was really motivating for me to get on them and see them go up and that was very good for my relationship with the scale but I do think I’m a bit strange there, I think that that’s less common for most people in recovery that they go through that, maybe not. And then there was a stage where it was like, you know I don’t even, I’d feel a bit like I’d walk into the bathroom and I’d see the scales there and I’d be a bit like, oh I could just pop on and check and then a part of me would be like, why? What difference is that number going to make? And I’d just be like, so lets not.

After weeks I’d suddenly realised that I was completely desensitised to even seeing them in the bathroom, they didn’t even make me think to get on those and so I do  think that it’s relatively unsustainable for most people to walk through their life without completely not knowing their weight you have to work quite hard to do that, with doctors and things like that. But it probably is possible. But I do think that the final step is being able to know that and being able to have scales in the house and just not giving a shit.

B: Yeah and I really like what you’re saying Tabitha about pausing and going, why? What is that going to do? And it reminds me on my little quote board that I have for the past few weeks is, Is that useful? Because it’s good to take a pause and think is that a useful thought or a useful behaviour? Just taking time to check in.

T: Absolutely I think that also that our brains, our actions inform our brain as to what’s important or not and I think at some point I began to understand that constantly getting on the scales was informing my brain that that information was important, because why else would I be getting on the scales if that information wasn’t important? So if we want our brains to start acting as if that number on the scale is not important, we have to teach ourselves that the number on the scales isn’t important and you do that by not getting on the scales, because why would you do that if it wasn’t important? We only do things that are important to us or relevant.

B: Yeah, I love that and it also brings up something that I think can be really challenging to some people who are athletes perhaps, the scale is part of what they need to do to make a certain weight range, either wrestlers or lightweight rowers or things like that. I don’t know if that’s come up at all in the clients that you’ve worked with because that can be really challenging.

T: Well, I’m kind of one of those, who are like it’s recovery or sport, which one are you going to choose right now?

B: (laughs) OK

T: So usually I think that by the time someone, if they’ve chosen recovery then that shouldn’t necessarily come up too much. I think that there maybe some circumstances especially for different sorts of eating disorders, because we’ve got to remember, I think we’ve mainly focused our discussion or mostly I have been thinking about anorexia but binge eating disorder that might not result in a lower weight representation but can there be just as much obsession with the scale so the same things need to be taken through as to, or considered as to what’s healthy for this person. I think that this is something that’s even less understood by treatment providers, that’s somebody that is in a larger body can have a restrictive eating disorder and that the scale can cause a much greater restriction and worsen things.

B: Yes, absolutely.

T: Well I think that we covered alot there.

B: (laughs) Yes this was great.

T: Yeah and I think the scale is an interesting topic because it’s not one where there can really be this guideline for do or don’t, I think it’s completely dependent on the individual and not just on that individual but on that individual in that present moment. As in where they are in recovery in that present moment. Sounds like you see the same sort of thing?

B: Yes absolutely. I think when it’s a younger person or a child or a teenager and they are doing FBT it’s little a bit different, it’s usually more, OK are we doing this blind or are we all talking about it? But yes it is very specific to developmental level, developmental level of the recovery of the person and where that person is at.

T: And that was that conversation. Big thanks to Bridget for chatting to me about that. She actually suggested the topic so kudos to her because I think that is an important one, it’s rather complicated and there is no straightforward answer as you probably gathered from all the talking that we did about it. I like that sort of question. I like that sort of discussion and I like opening our minds to think that there is no one single right answer for every single person who has an eating disorder about anything actually in particular. Apart from the concepts of food and rest. I’m pretty convinced that those are, oh and not restricting. Not restricting I’m convinced that applies to every single person who is recovering disorder and not just people who are recovering from an eating disorder, people in general. Anyway if you have any questions you can always email me info@tabithafarrar.com you can get contact through my website if that’s easier as well. Thanks for listening, until next time. Cheerio.