Expanding the Scope of Open Weighing to Target Anxiety About the Consequences of Weight Gain in Cognitive-Behavioral Therapy for Eating Disorders - Abstract

Sep 29, 2026

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Anxiety about weight gain is a central feature of eating disorders and sustains core symptomatology. Cognitive-behavioral therapy has used collaborative and open weighing to help patients form realistic views of eating-weight relationships, yet many patients also fear downstream consequences such as social rejection, self-hatred, and enduring body dissatisfaction. This paper argues that open weighing, combined with real-time processing of weight increases and emotions, offers underused opportunities to address consequence-related beliefs. It outlines three clinical enhancements: guided inquiry for catastrophic beliefs, cognitive restructuring via behavioral experimentation, and in vivo weighing paired with imaginal exposure to feared outcomes.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages7

Reading Time18 min

AccessFree to download

ABSTRACT

Objective

Method

Results

Discussion

1 | Introduction

2 | Translating Anxious Beliefs to Treatment Development

International Journal of Eating Disorders Expanding the Scope of Open Weighing to Target Anxiety About the Consequences of Weight Gain in Cognitive-Behavioral Therapy for Eating Disorders Jamal H. Essayli1 | Kaitlin A. Hill2 | Hana F. Zickgraf3 | Lauren N. Forrest4 | Cheri A. Levinson5 1Penn State College of Medicine, Department of Pediatrics, Department of Psychiatry & Behavioral Health, Hershey, Pennsylvania, USA | 2Clinical Psychologist, OCD Institute of Texas, Houston, Texas, USA | 3Research Psychologist, Rogers Behavioral Health, Oconomowoc, Wisconsin, USA | 4University of Oregon, Department of Psychology, Eugene, Oregon, USA | 5University of Louisville, Department of Psychological and Brain Sciences, Department of Pediatrics, Division of Child and Adolescent Psychiatry and Psychology, Louisville, Kentucky, USA Correspondence: Jamal H. Essayli ([jessayli@pennstatehealth.psu.edu](jessayli@pennstatehealth.psu.edu)) Received: 14 April 2025 | Revised: 1 October 2025 | Accepted: 2 October 2025 Action Editor: Anja Hilbert Funding: This work was supported by Penn State College of Medicine (KL2 TR002015, UL1 TR002014) . Keywords: anorexia nervosa | anxiety | bulimia nervosa | cognitive-behavioral therapy (CBT) | eating disorders | open weighing | weight | weight gain ABSTRACT Objective: Anxiety about weight gain is a central feature of eating disorders (EDs) and plays a key role in maintaining ED symptomatology. Cognitive-behavioral therapy (CBT) experts have observed that patients with EDs often believe regular eating will lead to immediate, dramatic, and/or uncontrollable weight gain, prompting interventions like “collaborative weighing” and“open weighing” that help patients develop a realistic understanding of eating-weight relationships. However, patients also report anxiety about the consequences of weight gain (e.g., social rejection, self-hatred, permanent body dissatisfaction) . While various CBT interventions address concerns about the consequences of weight gain, we propose that open weighing sessions—when patients confront weight increases and process accompanying emotional responses—provide underutilized therapeutic opportunities to work with these beliefs in real-time. Method: This paper outlines three clinical enhancements that systematically leverage open weighing sessions to address consequence-related beliefs: (1) identifying catastrophic beliefs about weight gain consequences through guided inquiry,(2) integrating cognitive restructuring by framing weight restoration as a behavioral experiment, and (3) combining in vivo weighing with imaginal exposure to feared weight gain consequences. Results: These enhancements may provide complementary techniques for capitalizing on patients' real-time emotional activation during weighing, potentially enhancing existing CBT protocols' effectiveness in addressing a key mechanism underlying restrictive EDs. Discussion: Future research might include randomized controlled trials comparing various weighing approaches, mixedmethods evaluations exploring weight-related fears across ED diagnoses and weight status, and mechanistic studies examining how addressing consequence-related beliefs improves treatment outcomes. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. © 2025 The Author(s). International Journal of Eating Disorders published by Wiley Periodicals LLC. International Journal of Eating Disorders, 2026; 59:47–53 47 [https://doi.org/10.1002/eat.24571](https://doi.org/10.1002/eat.24571) Summary • People with eating disorders experience anxiety about the consequences of weight gain, such as social rejection, self-hatred, and permanent body dissatisfaction. • While existing cognitive-behavioral therapy protocols address these concerns throughout treatment, open weighing sessions may

FAQs

Why is anxiety about weight gain important in eating disorders?

Anxiety about weight gain is described as central to maintaining eating disorder symptomatology and sustaining relevant beliefs about eating and weight.

What therapeutic opportunity do open weighing sessions provide?

Open weighing is proposed to help patients confront weight increases and process accompanying emotional responses in real time, specifically working with consequence-related beliefs.

What three enhancements are proposed to improve open weighing within CBT?

The paper proposes: guided inquiry to identify catastrophic consequence beliefs, cognitive restructuring that frames weight restoration as a behavioral experiment, and combining in vivo weighing with imaginal exposure to feared consequences.

Sep 29, 2026

Uploaded by Fans