This is an update to a post originally shared on November 30, 2010.
When we discharge a patient from Kartini Clinic back to their primary care provider, it is usually with the instructions for weekly blind weights for about a month, then, if stable, every two weeks, then monthly for about half a year. But I am frequently asked by those primary care providers, “How do you weigh an eating disordered child?”
So here is my advice for weighing an eating disordered child for any providers who ask:
Remember that weights are a source of extreme anxiety for children/youth with eating disorders and, to the extent that weight gain/stabilization is seen by families as the only “real” benchmark of progress, pressure on the patient to falsify it in order to please others will be strong. Nonetheless, weight restoration is critical, critical, critical in recovery —even though it’s not everything.
Any patient who has web access will be aware of multiple ways to falsify their weight; you need to safeguard them against this overwhelming temptation by weighing them in a predictable, unvarying way (see below).
I would encourage you not to share a patient’s weight with them, but rather to carry their anxiety about weight numbers for them (with their parents, of course). Don’t make a big state secret out of it, just say something general like, “You’re doing a good job, we’re pretty stable,” or “We’re headed in the safe direction.”
Taking a weight is just like taking any other vital sign, which is what it is. Do it professionally, privately and kindly.
- Always weigh the patient on the same scale. If you have multiple scales in your office, mark one discreetly (fingernail polish works, just a dot).
- Always weigh them in a gown with no underwear and with their back to the scale.
- Please do not weigh them in the hall.
- Educate your nurse or medical assistant to say nothing while taking a weight or afterward, and to write it down away from the patient; do not leave the chart in the room.
- Weigh the patient after a void. Check the specific gravity of the urine in order to assess for any degree of water-loading; if the urine specific gravity is 1.005 or less, ask them to void again before weighing them. If it remains that dilute, abort the weighing and have a talk with them and their parents about over-drinking prior to a weight being taken. Let the parents help them prevent this.
- We have seen weights worn everywhere, even taped to the body. Be alert but non-judgmental about this possibility.
- If you have concerns about your patient wearing weights, ask them not to bring any bags, purses, etc into the exam room while they change into a gown. Once they leave, discreetly check the wastebasket for discarded heavy items.
- Teach your staff that you are not doing these things to “bust” your patients but to safeguard them.
So: weigh them in a room on the same scale each time, in a gown, after a void, with their back to the scale, and never allow your staff to comment on or reveal the results.