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

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 conceptualized these discussions as therapeutic exposures targeting fear of weight gain, but clinician and patient perceptions of these conversations and the factors shaping them remain uncharacterized. This preregistered study examined ED clinician (N=158) and patient (N=46) perceptions of anxiety, difficulty, benefit, and willingness regarding EBW discussions, as well as factors associated with these perceptions and current clinician practices around sharing EBWs with patients. Most patients reported that EBW discussions would be anxiety-provoking (80.4%) and difficult (67.4%) yet were still willing to engage (76.1%) with these discussions. 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 both 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 typically 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. Overall, findings suggest that EBW discussions hold promise as individualized therapeutic exposures, but evidence-based guidelines are needed to realize this potential.