The Weight of the Number: Perceptions and Practices Surrounding Expected Body Weight Disclosure in Eating Disorder Treatment

Abstract

ABSTRACT Objective Expected body weight (EBW) determination is common in eating disorder (ED) treatment, yet no evidence‐based guidelines exist for how to discuss EBWs with patients. Clinicians have previously conceptualized these discussions as therapeutic exposures targeting fear of weight gain. This study examined clinician and patient perceptions of EBW discussions, factors associated with these perceptions, and clinician practices regarding disclosure of EBWs. Method ED clinicians ( N = 158) and patients ( N = 46) rated their perceptions (anxiety, difficulty, benefit, and willingness) on Likert scales. Predictors of clinician and patient perceptions were examined using linear mixed effects models and Spearman correlations, respectively. Predictors of clinician EBW sharing practices were examined using logistic regression. Results Most patients reported that EBW discussions would be anxiety‐provoking and difficult yet remained willing to engage. Positive body image was associated with lower anxiety and difficulty and greater willingness to discuss EBWs among patients. Additionally, stronger therapeutic alliance and lower fear of weight gain were associated with lower anxiety about EBW discussions, and prior experience discussing EBWs was associated with greater willingness to engage in these discussions. Clinicians reported low personal anxiety and difficulty around communicating EBWs, though they rated these conversations as anxiety‐provoking and difficult for patients. Working in a context in which patients are informed of their EBWs predicted greater clinician willingness and perceived benefit of these discussions. Additionally, doctoral‐level psychologists shared EBW information more frequently than other providers. Discussion Overall, findings suggest that EBW discussions hold promise as individualized therapeutic exposures, but evidence‐based guidelines are needed to realize this potential.