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Introduction
Regular self-monitoring of dietary intake, physical activity, and/or body weight has been documented as a key strategy for weight loss Monitoring body weight has the advantage of being relatively easy compared to other weight control self-monitoring tasks such as energy intake or physical activity tracking, but can have disadvantages given that changes in weight status may be beyond the individual’s control, thus having the potential to lead to frustration when desired weight changes do not appear on the scale. Though weight may fluctuate from day to day, over a longer period of time a general trend may indicate patterns of positive or negative energy balance. It has been asserted that regular self-weighing has the potential to allow individuals early detection of excess energy intake relative to expenditure before these changes amount to substantial weight gain
While some studies have suggested that daily weighing is a feasible, well-accepted behavior with minimal psychological impact among young and middle-aged a self-weighing has not always been found to be beneficial for weight control [7, 8]. Furthermore, concerns about focusing on weight have been expressed [9], given its potentially harmful consequences for psychological outcomes and disordered eating behaviors [10–12]. This review examines self-weighing with regard to psychological and behavioral measures of potential relevance to disordered eating/eating disorders, with the aim of addressing the commonly asked question — Is frequent self-weighing associated with helpful or harmful psychological outcomes? If so, for whom? Under what circumstances? Answers will inform both the fields of obesity and eating disorders, the former of which tends to promote self-weighing as a weight control strategy, the latter of which tends to denounce frequent self-weighing given concerns about its impact on overall well-being
A comprehensive review of the self-weighing literature from 2008 suggested that weighing may be beneficial in preventing weight regain in previously overweight adults, and may prevent weight gain over time in adults [ Since this publication, data have been presented that support self-weighing in aiding weight loss in overweight adults and preventing weight gain in young adults not exerting high levels of dietary restraint [ However, a shortcoming of this body of work is that despite documented success of those who frequently self-weigh achieving better weight outcomes, many, if not all trials where self-weighing is used as an intervention exclude people with eating disorders or histories of eating disorders (e.g., This exclusion is problematic given concerns that have been raised about the potential harms of self-weighing with regard to disordered eating behaviors, excessive weight preoccupation, body image concerns, and overall psychological well-being Thus, while self-weighing is often promoted within the field of obesity to enhance self-monitoring and to assist with adherence, in contrast, within the field of eating disorders this behavior is a marker of over concern about shape and weight, making this type of review both timely and informative for progress in weight control.
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Methods
Though most of the research reviewed was published recently, data on the relationship between self-weighing and psychological factors were examined over the past two decades to include a frequently cited work arguing for self-weighing’s adverse psychological impact [10]. Articles were selected from peer-reviewed literature that reported a relationship between self-weighing and at least one psychological outcome. Search terms included “self-weighing” and “weighing”. Search engines used (Summon, Primo Central, Google Scholar) were selected because they covered multiple databases. Relevant articles were scanned for the reporting of self-weighing and psychological outcomes. From here, pertinent articles were forward and backward tracked until saturation was reached.
Psychological outcomes evaluated are grouped according to affect, self-esteem and body evaluation, and eating behaviors/cognitions (including disordered eating symptomology, dietary restraint, and disinhibition). Each section of this review is subdivided by psychological variables’ relationship with self-weighing — harmful, no relationship, or helpful. All relationships described are significant at p<0.05 unless otherwise noted; estimates and p-values are provided along with a summary of the results in Appendix 1. More attention is given to findings from studies with the strongest designs [16].
Results
Self-weighing and Affect: Anxiety, Depression, and the Mood States
Out of the 20 studies that were reviewed, ten studies evaluated self-weighing and mood state — either positive and negative affect, the mood in general, anxiety or depression, or some combination of these.
Negative Relationship
One randomized controlled trial (RCT), one cohort study, and two cross-sectional studies found inverse relationships between self-weighing and mood state. In the RCT, 30 college students were randomized to a daily weighing and charting or non-weighing condition for 2 weeks [Anxiety and depression (refer to the Appendix for instruments used) were measured at baseline and the end of the study. Both showed a group-by-time interaction such that anxiety and depression increased in the weighing group relative to the non-weighing group.
A cohort of 118 women with anorexia nervosa was followed for two weeks and using ecological momentary assessment, the effect was assessed [Comparing negative affect ratings using the assessment before and after self-weighing indicated that negative affect increased after weighing, whereas there was no significant difference in positive affect before and after weighing. In addition to the pre-post comparison, trends in effect were evaluated using multiple assessments before and after self-weighing; negative affect increased over time before weighing but did not significantly decrease afterward. A significant increase in positive affect overtime was found after weighing
In a cross-sectional study of young adults (N=2287) participating in Project EAT-III, frequent self-weighing was related to higher levels of depressive symptoms in women, but not in men Similarly, a cross-sectional survey was administered to a population-based sample of 2778 adolescents in the EAT 2010 study; self-weighing frequency was associated with higher levels of depressive symptoms in overweight boys, non-overweight boys, and overweight girls, but not non-overweight Findings from these two studies provide important information about the relationship between depressive symptoms and self-weighing within large population-based samples of young people. However, the cross-sectional study designs do not allow for the determination of temporality of relationships or causality.
No Relationship
Three RCTs found no relationship between self-weighing and mood state. In one study, 30 overweight adults were randomized to a daily weighing or weekly weighing condition. Anxiety and depression were not clinically elevated at baseline and remained stable on average over 6 months — no interactions were found for depression or anxiety by weighing condition or over time. A study that randomized 40 overweight young adults to daily self-weighing or weekly group weigh-ins found no significant group by time interaction for depression; depression decreased to the same extent in both groups [3]. Similarly, in another 6 month RCT of 91 overweight adults allocated to a daily weighing condition or delayed control group, no group by time interaction was found for depressive symptoms at 6 months
A larger scale (n=4665), a population-based survey of middle-aged women examined depression, self-weighing, and body mass index (BMI) . The interaction between self-weighing and depression was not significant, meaning that BMI did not systematically differ depending on the frequency of self-weighing and depression status. Lower BMI was independently and significantly associated with more frequent self-weighing and absence of depressive symptoms. Thus in this age group of women, self-weighing was not associated with detrimental effects.
In a survey of 157 college-aged women, 53.8 % responded that they did not find it harmful to self-weigh and 65.3 % found it helpful to self-weight At the same time, 63.1 % agreed that the number on the scale affected their mood. It is not clear why the percentages for harm versus helpfulness of weighing are inconsistent; reconciling and investigating feelings about weighing and the role that weight change may play will be important in future research. For example, is self-weighing viewed as helpful/not harmful only when weight change is in a favorable direction?
Positive Relationship
One intervention study found that frequent self-weighing was associated with a better mood state. In 314 adults who had lost weight and signed up to participate in weight regain prevention intervention, regardless of intervention group assignment, increased weighing frequency over 18 months was related to decreased depressive symptoms. At baseline, a weak and borderline significant (p=0.07) cross-sectional inverse relationship was found between depressive symptomology and self-weighing, indicating that more frequent self-weighing was associated with less depressive symptomology.
Summary
Out of ten studies that examined the relationship between self-weighing and mood-related variables, four studies found evidence of a negative relationship, five studies did not find a relationship, and one study found evidence of a positive relationship. It seems as though BMI and participation in weight-loss treatment may be factors that help to explain different relationships between self-weighing and mood. In the reviewed studies that found a negative relationship between self-weighing and mood, samples were not treatment-seeking whereas those not finding a relationship or finding a beneficial relationship between self-weighing and mood, the majority of samples were composed of overweight individuals participating in a weight loss or regain prevention program. This brings into question the role of weight change in the relationship between self-weighing and mood.
Self-weighing
elf-esteem and Body EvaluationThe relationship between self-weighing and self-esteem was assessed in four studies, and the relationship between self-weighing and measures of body evaluation (e.g., body image, body dissatisfaction, or body satisfaction) was assessed in ten studies.
Negative Relationship
In an RCT that randomized 30 young adult women to a daily weighing and charting condition or a non-weighing condition, daily weighing over a 2-week period significantly decreased self-esteem in those in the weighing condition as compared to those in the non-weighing condition [. In Project EAT-III (N=2287 young adults), more frequent self-weighing was cross-sectionally associated with lower self-esteem in women, but not in men [ In EAT 2010 (N=2778 adolescents), more frequent weighing was associated with lower self-esteem in overweight girls, non-overweight girls, and non-overweight boys [The trend was in the same direction (inverse relationship between self-weighing and self-esteem) for overweight boys but did not reach statistical significance. Given the cross-sectional nature of the surveys, it is unclear whether self-weighing is more frequent among adolescents and young adults who have low self-esteem or if self-esteem is lowered as a function of frequent self-weighing. However, the RCT provides causal evidence suggesting self-weighing decreases self-esteem in young females.
Four cross-sectional studies found inverse associations between self-weighing and body satisfaction. In Project EAT-III (N=2287 young adults), the frequency of self-weighing was inversely associated with body satisfaction in men, and inversely associated but not statistically significant in women In EAT-2010 (N=2778 adolescents), the frequency of self-weighing was inversely associated with body satisfaction in girls ]. In boys, this relationship was not statistically significant. In a study of 268 college undergraduates, self-weighing directly correlated with many subscales evaluating facets of body image; however, after controlling for BMI, only the direct relationship between self-weighing and health orientation, fitness evaluation, and overweight preoccupation remained significant ]. In another sample of 145 college undergraduates, a direct correlation was found between frequency of weighing and body dissatisfaction. Based on these findings, there appears to be a relationship between self-weighing and poorer body satisfaction; however, one study indicated that BMI might explain some of this relationship. The designs of these studies do not allow for inference into whether self-weighing promotes poorer body satisfaction or if poorer body satisfaction promotes self-weighing.
No Relationship
Regarding self-esteem, in one cross-sectional survey of 157 college women, 48 % indicated that the number on the scale affects their feelings of self-worth. As the article did not indicate the exact nature of the effect on self-worth, this article is best characterized as neutral with regard to the impact of weighing on self-esteem.
Three RCTs found no change in body satisfaction for those prescribed daily or weekly weighing. Thirty women randomized to daily weighing or no weighing for 2 weeks did not experience differential changes in body image score based on group assignment over the study period [. Two out of four conditions in an RCT examining weight gain prevention in first-year college students allowed for comparison between weekly weighing and feedback and no treatment [ Over a 6-week period, there was no difference in pre and post weighing scores on body dissatisfaction comparing the weekly weighing group with the control group in 79 participants. Finally, 30 overweight adults randomized to a daily or weekly weighing condition showed no significant change in body image or differences between conditions over 6 months
In a cohort of 63 overweight adults participating in a weight loss RCT, body satisfaction, assessed in multiple ways (see Appendix for instruments used), was not associated with self-weighing at baseline, 6 months or with change in self-weighing over the intervention period, suggesting that in this population, self-weighing or change in weighing was not related to body satisfaction.
Positive Relationship
No studies found a positive relationship between self-weighing and self-esteem.
With regard to body satisfaction, two RCTs suggest a positive relationship with self-weighing. In 91 overweight adults, those randomized to a 6-month daily weighing condition had improved body satisfaction while those randomized to the delayed treatment control group had worsened body satisfaction — yielding a condition by time interaction. In a trial that randomized 40 young adults to a daily or weekly weighing condition over a 10-week period, both groups showed improvements in body satisfaction . Of note, both groups lost weight, and there was not a significant group by time interaction, suggesting that weight loss may mediate the relationship between weighing and body satisfaction, or the improvement in body satisfaction may be due to other factors such as participating in a study or attending group classes.
Summary
Out of four studies examining self-weighing and self-esteem, three found a negative relationship and one found no relationship. Out of ten studies examining self-weighing and body evaluation, four found a negative relationship, four found no relationship, and two found a positive relationship. Therefore, a concerning number of studies examining self-weighing and self-esteem or body evaluation found that more frequent self-weighing was associated with poorer self-esteem/body evaluation. Though few studies examined self-weighing and self-esteem, evidence supported a harmful relationship, warranting focus on this aspect of well-being in future self-weighing research. For body evaluation, similar to the previously discussed findings on mood, it appears that improvement on this psychological measure is found in treatment-seeking, overweight samples, again bringing into question the role of weight change. Survey data provides cross-sectional relationships between more frequent self-weighing and poorer body evaluation; however, experimental trials in non-treatment-seeking individuals would be necessary to assess the directionality of this relationship.
Self-weighing, Disordered Eating Symptomatology, and Eating-related Behaviors and Cognitions
Disordered eating symptoms, eating-related behaviors (e.g., weight control behaviors ranging from healthy to extreme), and beliefs about one’s relationship with food (e.g., dietary restraint, disinhibition) were assessed in 13 of the 20 reviewed studies.
Negative Relationship
One longitudinal study and five cross-sectional studies found that higher levels of self-weighing were associated with higher levels of disordered eating. A large cohort of boys and girls, about 1/3 of whom were younger adolescents (approximate mean age of 13), and 2/3 of whom were older adolescents (approximate mean age of 16) participated in Project EAT-I Self-weighing was examined at baseline in relation to weight control behaviors 5 years later in the 2516 participants. In both younger and older girls, more frequent self-weighing at baseline was associated with higher levels of select unhealthy and extreme weight control behaviors and binge eating 5 years later. Controlling for body satisfaction reduced the observed significance of the relationships. In boys, the self-weighing frequency at baseline directly predicted the percentage of the younger cohort engaging in unhealthy weight control practices; when controlling for body satisfaction, this relationship was no longer statistically significant.
In a sample of 106 undergraduate psychology students recruited through dieting-related social media sites and assessed for high or low eating attitude scores, a correlation was found between higher frequency of weighing and higher eating attitude score ], indicating more symptoms and characteristics of eating disorders. In another sample of 268 undergraduates, a direct correlation between self-weighing and shape concern remained in women after controlling for BMI; however, this correlation became nonsignificant for weight concern in women after controlling for BMI and was nonsignificant for both subscales in men after controlling for BMI [. In EAT 2010 (N=2778) adolescent boys and girls who reported more frequent self-weighing were more likely to report dieting, unhealthy, and extreme weight control behaviors than adolescents who did not frequently weigh themselves. Self-weighing was also directly associated with binge eating in non-overweight girls and non-overweight boys ]. In Project EAT-III (N=2287), young adult men and women engaging in frequent self-weighing were more likely to diet and use healthy, unhealthy, and extreme weight control behaviors as compared to young adults not engaging in frequent self-weighing []. Again, more frequent self-weighing was associated with a greater probability of binge eating in women. In a sample of 55 women with clinically diagnosed eating disorders and 55 women without eating disorders, a direct relationship was found between weighing frequency and body checking behaviors in both samples; this relationship was stronger and more significant in the clinical group but was also statistically significant in the nonclinical group [24].
Response to self-weighing was evaluated in a group of 64 women with clinically diagnosed eating disorders, some of whom were included in the previously described group of 55 with eating disorders. In addition to avoiding self-weighing more than any other checking behavior, a high proportion of women responded to self-weighing by increasing dietary restraint regardless of weight change (increase, decrease, or stable), which is not considered healthy in this population. This research provides evidence for concern regarding the relationship between self-weighing and disordered eating behaviors; however, experimentally designed studies focusing on body weight status are necessary to better understand this complex relationship.
No Relationship
Two RCTs and one intervention cohort study found no evidence of an effect of self-weighing on disordered eating. In an RCT examining daily weighing versus no weighing over a 2-week period in 30 college women, no changes in preoccupation with dieting, food, or eating behaviors were observed in either group [. In 79 first-year college students, randomization to a weekly weighing condition did not produce different changes in binge eating, drive for thinness, dietary restraint, or disinhibition (propensity to eat due to external or emotional reasons rather than physiological hunger) over 6-weeks as compared to a control group [15]. These studies suggest that directing some individuals to weigh themselves does not create or worsen eating disorder symptoms.
In a cohort of 178 overweight individuals participating in an intervention trial, those that adopted daily weighing were compared with those who did not over 18 months; no change in disordered eating symptoms between the two groups was found. In this study, however, eating disorder score was significantly lower in those that reported daily weighing at 12-and 18- months compared to those weighing less than daily [ Thus, individuals that choose to weigh themselves more frequently did not experience adverse eating disorder symptoms in making this change.
Positive Relationship
Two RCTs and analyses in two cohorts provided evidence of a relationship between more frequent self-weighing and improvements in eating behaviors/cognitions. In an RCT of 91 overweight adults, participants assigned to weigh daily over 6 months showed reductions in disinhibition score and number of binge eating episodes compared to a delayed-treatment control group [. A group-by-time interaction was found for dietary restraint, such that the daily weighing group’s restraint score increased relative to the control group’s restraint score over the 6-month trial. However, no significant group by time interaction was found for anorectic cognitions, nor was there a main effect for either group
Another RCT examining daily versus weekly self-weighing in 40 overweight young adults found that dietary restraint, eating concerns, weight concerns, and shape concerns along with binge eating all improved over 10-weeks in both groups Though there was no group by time interactions, meaning that the aforementioned outcomes did not change differently over time depending on weighing frequency, scores remained lower 10 weeks after the intervention, and the majority of individuals randomized to the daily weighing group continued to self-weight; however, this was not the case in the weekly weighing group. Thus, two studies with experimental designs found evidence of a beneficial impact of weighing on eating behaviors; however, these studies examined overweight individuals seeking weight loss treatment, and weight loss could be a confounding variable.
In a cohort of 314 adults who had lost weight and participated in weight regain prevention intervention trial, increasing weighing frequency over 18 months corresponded with increased dietary restraint, decreased disinhibition, and decreased likelihood of reporting at least one weekly binge eating episode [. However, in this sample, baseline weighing frequency was not able to differentiate between those reporting binge eating at least weekly versus reporting less frequent binge eating and the baseline cross-sectional association between weighing frequency and disinhibition was not significant. Baseline self-weighing frequency was, however, directly related to dietary restraint [ Increasing frequency of self-weighing over time appears to be associated with changes in eating-related behaviors/cognitions, while self-weighing frequency at a sole time point may not be robust enough of an effect to evince significant relationships with these behaviors.
Over one year, in 2462 National Weight Control Registry (NWCR) participants, those who increased their self-weighing frequency had a significant increase in dietary restraint compared to those who decreased their weighing frequency [ However, no relationship was found between self-weighing and disinhibition in this study.
Summary
Out of 13 studies assessing self-weighing and disordered eating cognitions and behaviors, six found evidence of a negative relationship, three found no relationship, and four found evidence of a positive relationship. Cross-sectional or longitudinal cohort studies provided evidence of a harmful relationship between self-weighing and disordered eating behaviors. These studies included more heterogeneous populations compared to those finding no evidence of a relationship or a positive relationship between self-weighing and eating behaviors/cognitions. Studies finding no evidence of a relationship between self-weighing and eating behaviors/cognitions included samples of young adults and a cohort within a treatment intervention study. Again, studies finding a positive relationship between self-weighing and eating behaviors/cognitions tended to be in overweight, treatment-seeking samples.
Conclusions
The aim of this review was to evaluate recently published peer-reviewed literature documenting the relationship between self-weighing and psychological outcomes. With regard to affect, self-esteem and body evaluation, and eating-related behaviors and cognitions, in total, most studies provided evidence of a harmful impact of self-weighing on these outcomes; fewer studies found a positive impact.
For the studies that found evidence of self-weighing being helpful, weight change may be a confounding factor. For example, studies finding a positive relationship between self-weighing and body image tended to also produce weight loss [3, ], making it unclear whether the weight loss, imposition of self-weighing, or combination of the two impacted body satisfaction. One study that examined response to weighing by weight change status found that out of 16 women randomized to a daily weighing group, those who lost weight showed a corresponding decrease in body dissatisfaction while those that maintained or gained weight showed no change [10]. In the same vein, reductions in symptoms of depression [3, 20] or eating disorder scores may be confounded by weight change.
The way findings were summarized in this review has several limitations. It does not account for the strength of design; a cross-sectional study and a randomized controlled trial are both tallied equally. An additional limitation of this method is that some of the outcomes are clearly helpful or harmful (e.g., self-esteem — more is better), while others are not quite as clear. For example, subscales of body image instruments, like overweight preoccupation or fitness evaluation do not cleanly fit into a category of ‘helpful’ or ‘harmful’ for psychological well-being and disordered eating behaviors. In some instances, some degree of body dissatisfaction may motivate weight change in a healthful direction [ A final limitation is that in studies finding no effect of weighing on psychological outcomes, an effect may be too subtle for the sample size studied or may require a certain frequency of self-weighing. The dose of weighing paired with the time frame studied may not have been sufficient to show an effect (e.g., weekly self-weighing for 6 weeks in.
Variety in sample characteristics may be one reason for differential findings. Samples ranged from overweight adults seeking weight loss (e.g., [ to adults who had previously lost weight college-aged individuals [8, 10, 11, 15, 21, 23), individuals with clinical eating disorders [24], and adolescents [ Despite this variety in sample characteristics, themes were observed. First, it seemed as though self-weighing was more often found to be harmful to women, though it is not clear if this is due to most studies involving a large percentage of women. Second, relationships between self-weighing and detrimental psychological outcomes consistently emerged for younger individuals and those interested in dieting ]. The importance of body image to the development of self-identity during adolescence has been documented It is not clear whether self-weighing is a proxy for dieting behavior and precedes other more troubling outcomes or vice versa. Finally, positive relationships between self-weighing and psychological outcomes tended to occur in overweight, treatment-seeking samples, suggesting that weight change is an important variable to investigate in the relationship between self-weighing and psychological outcomes.
It is also important that future research examines the impact of self-weighing on psychological outcomes across the developmental stages. Investigating these relationships could be insightful in differentiating when individuals may be more likely/able to interpret weight information as ‘data’ as compared to a value connected to their self-worth. If interventions with adolescents, or any individuals, include self-weighing, the impact on these psychological outcomes and disordered eating must be addressed upfront and carefully monitored throughout the trial. It is recommended that any interventions involving self-weighing measure psychological outcomes at multiple time points, and are especially wary of adverse effects.
Finally, though not included in the Appendix because the outcome of this trial was weight, intriguing advances have provided clues as to potential moderating variables (dietary restraint) in the relationship between self-weighing and weight control [8]. Replication and future work examining restraint and other moderating variables — personality facets, temperament, attachment style might be of interest — may help to investigate who benefits from self-weighing, making this a fertile area for future research.
In Moving Forward, a More Nuanced Perspective is Necessary to Understand How Self-Weighing Can Help and for Whom As discussed, some of the outcomes evaluated do not fit into a ‘helpful’ or ‘harmful’ category and the same may be true of self-weighing, which is why recommending encouragement or discouragement of weighing at a population level is not sensible. Ultimately, there are likely to be individuals for whom weighing has benefits and individuals who are adversely affected. Age, developmental stage, gender, and individual personality and temperament factors need to be considered in how self-weighing affects the individual psychologically. This paper is a call to further study self-weighing as a behavioral strategy for weight control, at the same time considering pertinent psychological outcomes, amidst an environment of increasing dietary diversity, high levels of overweight and obesity, and also those troubled by obsessive and intrusive thoughts about body weight and shape. Self-weighing is one behavioral strategy that can unite fields concerned with bodyweight control. The proposition that self-monitoring is beneficial is a broad claim, and though there is evidence to support benefit in specific contexts (e.g., weight loss [1]), self-monitoring outside of this context may have a differential impact. Further refinement of who benefits from the specific self-monitoring behavior, self-weighing, and in what contexts will help researchers and practitioners to use self-weighing in a way that improves the quality of life in a broader range of individuals.