Weighing in: Clinician and Patient Perspectives on Discussions of Expected Body Weights in Eating Disorder Treatment

Abstract

Objective

Clinicians often determine an “expected body weight” (EBW) for patients who have lost weight due to an eating disorder (ED). However, there is inconsistent guidance and limited empirical research on when, how, and why to discuss EBWs with patients. This study explores clinician and patient perspectives on discussions of EBWs.

Method

Semi-structured interviews were conducted with 24 multidisciplinary ED clinicians and 16 individuals with outpatient ED treatment experience in the past 6 months. Clinicians shared their experiences with and rationales for sharing EBWs with patients and patients' family members. Patients shared their experiences of being informed about their EBWs, factors influencing their comfort level discussing EBWs with clinicians, and perceived impact of these discussions on their recovery. Interviews were analyzed using reflexive thematic analysis with a critical realist lens.

Results

Clinician and patient perspectives aligned regarding when, how, and why to hold these discussions. Both groups emphasized that these discussions should occur after patients have demonstrated engagement with recovery and underscored the importance of framing the EBW as one aspect of a holistic recovery. Additionally, clinicians and patients highlighted the potential therapeutic benefits of these discussions, while also acknowledging challenges relating to parental involvement and weight bias.

Discussion

Findings suggest that when discussions of EBWs are approached intentionally—accounting for timing, framing, and individual patient needs—clinicians and patients see potential therapeutic benefit. Future research can focus on developing evidence-based guidelines for sharing EBWs, addressing patient willingness to be informed of their EBW, weight bias, and parental involvement.