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. Author manuscript; available in PMC: 2019 Aug 1.
Published in final edited form as: J Consult Clin Psychol. 2018 Aug;86(8):677–687. doi: 10.1037/ccp0000325

Relation of Self-Weighing to Future Weight Gain and Onset of Disordered Eating Symptoms

Paul Rohde 1, Danielle Arigo 2, Heather Shaw 3, Eric Stice 4
PMCID: PMC6061963  NIHMSID: NIHMS970163  PMID: 30035584

Abstract

Objective

Frequent self-weighing is recommended in weight loss interventions and may prevent weight gain. However, concerns regarding the associations between self-weighing and eating disorders have been expressed and the relations between self-weighing and weight gain/eating pathology have not been examined prospectively. We tested whether (1) frequency of baseline self-weighing in college students with weight concerns predicted weight change over 2-year follow-up, (2) this relation was moderated by eating disorder symptoms, and (3) self-weighing predicted future eating disorder symptoms.

Method

Data were merged from two trials evaluating obesity/eating disorder prevention programs in 762 students (M age = 18.7; 86% women). Participants reported how often they weighed themselves at baseline; BMI and eating disorder symptoms were assessed over 2-year follow-up.

Results

Baseline self-weighing predicted weight gain, with more frequent weighers experiencing greater gains over follow-up (0.8 BMI). This relation was moderated by the frequency of binge eating but not weight/shape concerns or compensatory behaviors; the combination of more frequent self-weighing and binge eating was associated with greatest weight gain (1.6 BMI). More frequent weighers also reported higher onset of compensatory behaviors, relative to non-self-weighers (OR = 3.90, 95% CI = 1.76, 8.75).

Conclusions

Young adults who weighed themselves more frequently had greater weight gain than those who self-weighed less frequently, especially those who engaged in binge eating, and were at risk for future unhealthy compensatory behaviors. Findings suggest that frequent self-weighing may have negative effects for some young adults, and that relations between self-weighing and weight control outcomes require further investigation.

Keywords: Self-Weighing, Obesity, Eating Disorder Symptoms, Prevention, Young Adults

Obesity is a prevalent condition with significant health and economic consequences (Ogden, Carroll, Fryar, & Flegal, 2015; Wang, McPherson, Marsh, Gortmaker, & Brown, 2011), prompting a need for effective, low-cost preventive efforts. Focusing such efforts on college students may be particularly fruitful, as young adulthood is a period of increased risk for weight gain (Anderson, Shapiro, & Lundgren, 2003; Lowe et al., 2006). Adolescence and young adulthood are also periods of increased risk for eating pathology (Kessler et al., 2005; Stice, Marti, & Rohde, 2013), which increases risk for excess weight gain (Stice, Cameron, Killen, Hayward, & Taylor, 1999; Stice, Presnell, & Spangler, 2002).

Self-weighing functions as a form of self-monitoring, increasing a person’s awareness of changes in weight (Linde, Jeffery, French, Pronk, & Boyle, 2005). Reviews of the impact of self-weighing during weight management interventions conclude that more (vs. less) frequent self-weighing is associated with greater weight loss, with no detected evidence of negative psychological effects (Shieh, Knisely, Clark, & Carpenter, 2016; VanWormer, French, Pereira, & Welsh, 2008; Zheng et al., 2015). Among individuals who had successfully lost excess weight, lower frequency of self-weighing was associated with significantly greater future weight gain (Butryn, Phelan, Hill, & Wing, 2007), and randomization to a weight loss maintenance program that included (vs. did not include) a self-weighing prescription resulted in significantly less weight gain following initial loss (Wing, Tate, Gorin, Raynor, & Fava, 2006).

In addition to its utility for weight loss and maintenance, frequent self-weighing may serve as a simple but effective weight gain prevention strategy for individuals at risk for weight gain. The evidence base regarding self-weighing for weight gain prevention is limited but encouraging. Among adults seeking weight gain prevention, daily self-weighing was associated with weight loss over two years, whereas less frequent self-weighing was associated with subsequent weight gain (Linde et al., 2005). A universal weight gain prevention intervention for freshman college students that recommended daily self-weighing (with graphical review of change) found that intervention participants lost an average of 0.5 kg over one year, whereas the control group (which received no intervention to change and was asked to weigh themselves as much as they wished) gained an average of 1.1 kg (Bertz, Pacanowski, & Levitsky, 2015).

However, there are concerns that frequent self-weighing could lead to depression, anxiety, body image concerns, disordered eating behaviors, or discouragement if weight loss efforts are not quickly evident (e.g., Dionne & Yeudall, 2005; Neumark-Sztainer, van den Berg, Hannan, & Story, 2006). Empirical support for these concerns has not been detected among adults in weight loss programs (Gokee-LaRose et al., 2014; O’Neil & Brown, 2005; Steinberg et al., 2014), adults who successfully maintained weight loss (Wing et al., 2007), or among adults (Wing et al., 2015) or college students in weight gain prevention programs (West et al., 2016). However, cross-sectional analysis of a large population-based sample of young adults found that more frequent self-weighing was associated with (1) more unhealthy weight control behaviors in the total sample, (2) more binge eating and depression, and lower self-esteem among women, and (3) more body dissatisfaction among men (Quick, Larson, Eisenberg, Hannan, & Neumark-Sztainer, 2012), prompting the authors to suggest that young adults be screened by health care providers before recommending self-weighing as a weight-monitoring tool. Similarly, more frequent self-weighing correlated with stronger attitudinal eating disorder symptoms for female (but not male) college students (Klos, Esser, & Kessler, 2012).

Collectively, existing data support the benefit of self-weighing for weight control among adults engaged in weight management efforts, but raise the possibility that benefits may not be universal. Few studies have tested whether young adults’ elective use of self-weighing predicts future change in weight or disordered eating symptoms over long-term follow-up; this information could be useful for informing weight gain prevention programs designed for this population. Accordingly, the first aim of this study was to test whether frequency of baseline non-prescribed self-weighing predicted future weight change over 2-year follow-up in a sample of young adults at elevated risk for weight gain. The second aim was to test whether the association between baseline self-weighing and weight trajectories were moderated by disordered eating cognitions (defined as excessive weight/shape concerns) or symptoms (defined as number of binge episodes and number of compensatory behaviors in the year prior to baseline). Previous research has suggested that each of these three facets of disordered eating predicted weight gain in community samples of girls and young women (e.g., Krahnstoever Davison, Markely, & Birch, 2003; Stice et al., 1999, 2002; Tanofsky-Kraff et al., 2009). We hypothesized that (1) for the total sample, more frequent self-weighing would be associated with less future weight gain, but that (2) more frequent self-weighing would not be associated with weight loss for individuals reporting eating disorder symptoms. Given the evidence suggesting associations between frequent self-weighing and indices of disordered eating attitudes and behaviors (e.g., Klos et al., 2012; Quick et al., 2012), the third aim was to test whether the frequency of self-weighing at baseline predicted future onset of binge eating and unhealthy compensatory weight control behaviors over 2-year follow-up.

Method

To increase sample representativeness and power to detect meaningful effects, analyses were conducted using a merged data set from two large trials evaluating selective prevention programs; each aimed to reduce both obesity and eating disorders in at-risk college samples. Both trials included assessment of the frequency of self-weighing at baseline and measured weight gain and disordered eating symptoms for 2-years post-intervention. Institutional Review Boards at Oregon Research Institute and participating universities approved study protocols and written informed consent was obtained from all individuals prior to data collection. We summarize characteristics of participants and procedures for each of the two studies separately, followed by a description of the assessments procedures common to both studies.

Study 1: Participants and Procedure

Participants were 398 women (M age = 18.40, SD = .58) with a mean baseline BMI of 23.7 kg/m2 (SD = 4.3). From 2007 to 2010, participants were recruited from a large state university inviting freshmen women with body image concerns to participate in a study evaluating body acceptance interventions (ClinicalTrial.gov #NCT00433680). Participants had to verbally affirm that they had body image concerns, which was defined as scoring above the median on a 9-item body dissatisfaction screener. The sole exclusion criterion was a current diagnosis of DSM-IV eating disorder. Participants provided interview and survey data at pre, post (intervention termination), and at 6-, 12-, and 24-month follow-ups.

Participants were randomized to either (1) the Healthy Weight intervention or (2) educational brochure control. Healthy Weight consisted of 4 weekly 1-hour group sessions, facilitated by pairs of advanced clinical graduate students. Session content focused on making small, lasting changes to dietary intake and physical activity to maintain a healthier body weight (the intervention made no mention of self-weighing). Participants in the control condition received a 2-page brochure that described negative and positive body image, and offered steps for achieving body acceptance. There were significant condition effects for eating disorder symptoms but not BMI change over 2-year follow-up. Additional study details were provided previously (Stice, Rohde, Shaw, & Marti, 2012).

Study 2: Participants and Procedure

Participants (N = 364) were 261 young women (M age = 19.1, SD = 1.2) with a mean BMI of 23.2 kg/m2 (SD = 2.7) and 103 young men (M age = 19.2, SD = 1.2) with a mean BMI of 24.2 kg/m2 (SD = 2.4) (ClinicalTrial.gov #NCT01680224). From 2012 to 2014, participants were recruited from three large public universities in two states; recruitment materials invited college students ages 17-23 with weight concerns to participate in programs designed to promote healthy lifestyle choices and prevent weight gain. Participants had to verbally affirm that they had weight concerns. Exclusion criteria included a current diagnosis of DSM-IV eating disorder or BMI <18 or >30. Participants provided interview and survey data at pre, post (intervention termination), and at 6-, 12-, and 24-month follow-ups.

Eligible participants were randomized to (1) a 6-hour version of Healthy Weight, (2) a 6-session Project Health intervention, that paralleled the format of Healthy Weight but added exercises designed to create cognitive dissonance about engaging in behaviors that contribute to weight gain, or (3) a 1-hour educational video control; neither intervention recommended or discouraged self-weighing. Participants in both active interventions attended 6 1-hour weekly group sessions. Both active interventions showed significantly greater reductions in eating disorder symptoms compared to video controls over follow-up and Project Health participants showed significantly smaller increases in BMI at 2-year follow-up than both Healthy Weight participants and controls. Additional study details are provided elsewhere (Stice, Rohde, Shaw, & Gau, in press).

Measures Administered in Both Studies

Self-weighing habits

At each assessment, participants reported how often they weighed themselves (“Over the past two weeks, how many times have you weighed yourself?”) with eight response options: Never, 1-3 days, 4-6 days, 7-9 days, 10-12 days, 12-14 days, Everyday, and More than once per day. To normalize the initially skewed distribution of scores for this variable, responses were collapsed to form three categories, which were used for all analyses: (1) None (no self-weighing reported), (2) Occasional (1-3 days), and (3) More Frequent (4-6 days to More than once per day). Descriptive information for responses to this item, as well as additional baseline data regarding the merged sample, can be found in Table 1.

Table 1.

Descriptive statistics at baseline for key study variables.

Original Responses
None 1-3 Days 4-6 Days 7-9 Days 10-12 Days 12-14 Days More than 1x/Day
Self-Weighing Frequency (n) 356 259 57 18 10 14 16
Percent of Sample 49% 36% 8% 3% 1% 2% 2%
Recoded Responses Full Sample Self-Weigh at Baseline: Three Categories
No Self-Weighing (n = 354) Occasional (1-3 Days) (n = 259) More Frequent (4+ Days) (n = 115)
M (SD) M (SD) M (SD) M (SD)
Age (years) 18.71 (1.00) 18.63 (1.07) 18.74 (.94) 18.90 (.99)
Baseline BMI (kg/m2) 23.61 (3.62) 23.69 (3.78) 23.24 (3.03) 23.87 (3.66)
Weight/Shape Concerns 3.60 (1.11) 3.46 (1.09) 3.60 (1.11) 3.98 (1.08)
Binge Episodes (prior 12 months) 4.90 (18.74) 4.51 (20.44) 5.71 (19.27) 4.46 (12.96)
Compensatory Behaviors (prior 12 months) 14.74 (44.16) 14.30 (56.22) 13.93 (28.27) 16.74 (33.45)
Study
 Study 1 398 (52%) 221 (30%) 114 (16%) 31 (4%)
 Study 2 364 (48%) 135 (18%) 145 (20%) 84 (12%)
Ethnicity
 Caucasian/European American 629 (83%) 292 (40%) 209 (29%) 91 (13%)
 Asian/Pacific Islander 83 (10.5%) 39 (5%) 31 (4.5%) 12 (1.5%)
 American Indian/Alaskan Native 15 (2%) 10 (1.5%) 1 (.5%) 0 (0%)
 Hispanic 14 (2%) 6 (1%) 8 (1%) 0 (0%)
 Black/African American 16 (2%) 6 (1%) 5 (.5%) 5 (.5%)
 Mixed/Other 3 (.5%) 2 (.5%) 0 (0%) 1 (.5%)
Sex
 Women 659 (86%) 319 (44%) 213 (29%) 95 (13%)
 Men (Study 2 Only) 103 (14%) 37 (5%) 46 (6%) 20 (3%)
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Body mass

BMI scores were used to reflect height-adjusted weight. At each assessment, after removing shoes and coats, height was measured to the nearest millimeter using stadiometers and weight was assessed to the nearest 0.1 kg using digital scales. Two measures of each were obtained and averaged. BMI correlates with direct measures of body fat (r = 0.80 – 0.90) and health measures (Pietrobelli et al., 1998).

Eating pathology

The Eating Disorder Diagnostic Interview (EDDI; Stice, Shaw, Burton, & Wade, 2006) was administered by trained and supervised assessors masked to intervention condition to assess DSM-IV eating disorder symptoms over the past 12 months at baseline and on a month-by-month basis (since the last interview) over the 2-year follow-up. The symptom composite has shown internal consistency (α = 0.74-0.92), inter-rater agreement (r = 0.84), 1-week test-retest reliability (r = 0.90-0.95), sensitivity to intervention effects, and predictive validity (Stice, Butryn, Rohde, Shaw, & Marti, 2013; Stice, Marti, Spoor, Presnell, & Shaw, 2008). Lifetime retrospective diagnostic interviews are known to underestimate the occurrence of mental disorders compared to repeated waves of assessment (e.g., Takayanagi, Spira, Roth, Gallo, Eaton, & Majtabai, 2014), which were used in the present study; interviews in the current study covered retrospective periods of 2-12 months. In addition, short-term test-retest reliability is typically higher for objective binge episodes than for less severe events (i.e., subjective binge episode and objective overeating; Reas, Grilo, & Masheb, 2006).

Three indices of baseline disordered eating were examined: (1) weight/shape concerns, defined as the degree to which weight/shape influences self-evaluation (item: “Over the past four weeks has your weight and/or shape been important in influencing how you feel about yourself as a person?; response options ranged from “no importance” [1] to “supreme importance/nothing is more important in terms of self-evaluation [7]”); (2) frequency of binge eating (i.e., eating an amount of food that most people would consider very large and feeling a loss of control over eating) in the prior 12 months (at baseline; the timeframe at subsequent assessments was “since the last interview”); and (3) frequency of compensatory weight control behaviors (self-induced vomiting, laxatives/diuretic use, fasted [skipped at least 2 meals in a row] or excessive exercise (more than 1 hour of intense exercise or more than 2 hours of moderate exercise expressly done ‘to compensate for “overconsumption” of eating or drinking’). These indices were chosen to represent one cognitive and two behavioral symptoms of disordered eating.

Statistical Analysis

Data were available for 762 participants at baseline, 733 participants at post-intervention, 705 participants at 6 months, 688 participants at 12 months, and 650 participants at 24 months, with missing data due to attrition. The total sample had a M age = 18.7 (SD = 0.9) and M BMI = 23.6 kg/m2 (SD = 3.6) (18 participants [2%] had a baseline BMI lower than 18.5; 30 Study 1 participants [4%] had baseline BMI values greater than 30); 86% were women and race/ethnicity composition was 74% non-Hispanic White, 11% Asian/Asian-American, 10% Hispanic/Latina, 2% Black/African-American, 1% American Indian/Native American, 0.3% Pacific Islander/Native Hawaiian, and 2% ‘other’. Participants who withdrew from the studies (M = 23.96 kg/m2, SD = 3.57) did not differ from those who completed (M = 23.55 kg/m2, SD = 3.63; t[153] = 1.12, p = 0.27) in initial BMI, but were significantly older (M = 19.0 [SD = 1.3] vs. 18.76 [SD = 0.94] years; t[132] = 2.71, p = 0.01). Attrition over two years was more common in Study 2 than in Study 1 (χ2[1] = 30.04, p < 0.01), but did not differ by intervention condition (within study; ps > 0.38), racial/ethnic identification (χ2[1] = .39, p = 0.53), sex (Study 2 only; χ2[1] = 1.93, p = 0.16), or frequency of baseline self-weighing (χ2[1] = 1.70, p = 0.43). Four BMI values were deemed impossible (e.g., 10 kg/m2) and were removed from the data set; these data were treated as missing at random.

Descriptive statistics include the frequency of self-weighing at baseline; differences in self-weighing (based on study, sex, race/ethnicity) were examined with chi-square tests. Relation between baseline self-weighing and BMI change over 2 years was tested with multilevel models (MLM). MLM is appropriate for nested longitudinal data (e.g., assessment points within participants) and flexibly addresses both attrition and unequally spaced assessments (as in the present study; Singer & Willett, 2003). Models employed SAS PROC MIXED with restricted maximum likelihood estimation (Version 4) to examine the effects of time (assessment point; level 1), baseline self-weighing (category; level 2), and the interaction of time and baseline self-weighing (level 1*level 2) to predict BMI over 2-year follow-up.

Moderator effects were tested using the 3-way interaction of time (level 1), baseline self-weighing (level 2), and the proposed moderator (level 2), following recommendations by Hox (2010). Both binge eating and compensatory behaviors were used as continuous variables in these moderator analyses. Covariates included in all models were age (mean centered), race/ethnicity (recoded as white/nonwhite), study, and intervention condition; we also examined whether either study or intervention condition moderated any of the outcomes and found that all interactions were nonsignificant. Effect sizes for these models are expressed as semi-partial correlation coefficients (sr), in which r = .1 = small; r = .3 = medium; r = .5 = large magnitude effects (e.g., Cohen, 1992). Sex was examined in an exploratory manner and did not moderate any of the effects reported (ps > 0.40). Models predicting onset of binge and compensatory behaviors as a function of baseline self-weighing categorized binge and compensatory behaviors as present/not present at baseline and follow-up points; these models used PROC LOGISTIC to determine the odds of reporting symptom onset during follow-up among participants who were initially asymptomatic. Regarding the magnitude of effects, odds ratios of 1.5, 2.5, and 4.3 are generally considered small, medium, and large magnitude effects (Cohen, 1992).

Results

Frequency of Self-Weighing at Baseline

Approximately half the sample (49%) reported no recent self-weighing and 8% of the sample reported weighing themselves at least half of the days. Using the three categories previously identified (i.e., none, occasional, more frequent), frequency of self-weighing at baseline was associated with study (χ2[2] = 48.91, p < 0.001), such that Study 2 showed a greater proportion of more frequent self-weighers than Study 1 (23% vs. 8%). Self-weighing category was not associated with race/ethnicity (χ2[1] = .61, p = 0.74), sex (Study 2 only; χ2[1] = 1.73, p = 0.42), baseline BMI (F[2,727] = 1.76, p = 0.17), baseline frequency of binge episodes in the past 12 months (F[2,721] = 0.34, p = 0.72), or baseline frequency of compensatory behaviors in the past 12 months (F[2,729] = 0.17, p = 0.85). Self-weighing category was, however, associated with age (omnibus F[2,724] = 3.23, p = 0.04); More frequent self-weighing participants were older than participants in the other two groups (contrast t[1] = 2.12, p = 0.03). Self-weighing category also was associated with baseline weight/shape concerns (omnibus F[2,729] = 9.79, p < 0.0001), with more frequent self-weighing participants reporting higher weight/shape concerns than those in the other two groups (contrast t[1] = 16.30, p < 0.0001). As the majority of participants remained in their baseline self-weighing category at each of the 4 follow-up assessments (60% of participants were in the same self-weighing category from pretest to posttest, which was more than 1-month later), we considered self-weighing frequency fairly stable over the 2-year follow-up period.

Degree to which Baseline Self-Weighing Predicts BMI Change

Controlling for age, race/ethnicity, study, and intervention condition, the linear effect of time was significant for change in BMI over 2 years, and indicated a significant increase (F[1,2635] = 10.62, p = 0.001). The three baseline self-weighing categories significantly differed on BMI change over 2 years (F[8,2625] = 15.53, p < 0.001, sr = 0.14; see Table 2), but differences were not in the predicted direction. Figure 1 shows the pattern of BMI change for the three self-weighing groups from baseline to the end of 2-year follow-up. The no self-weighing (slope B = 0.06, SE = 0.02) and occasional self-weighing (slope B = 0.11, SE = .02) groups showed less BMI change over two years compared to the more frequent self-weighing group (slope B = 0.21, SE = 0.03). The relation between self-weighing and BMI change was not moderated by baseline BMI (F[8,2632] = 2.39, p = 0.12). Given that the more frequent self-weighing group varied quite widely (i.e., from 4 times over a 2 week period to more than daily), we re-ran this analysis removing the highest frequency group (i.e., more than daily self-weighers, n = 16); the relation between baseline self-weighing and BMI change did not show meaningful change when the most frequent self-weighers were removed (F[8,2577] = 13.31, p = 0.003, sr = 0.13).

Table 2.

Estimates for prospective multilevel models predicting BMI over two years (five time points).

Variable B (SE)
Fixed Effects
 Intercept   22.88 (.61)***
 Age     0.45 (.14)**
 Ethnicity (White/Nonwhite)     0.11 (.09)
 Study     −0.59 (.56)
 Intervention Condition     0.11 (.19)
 Time     0.06 (.02)**
 Baseline Self-Weighing     −0.15 (.19)
 Baseline Self-Weighing* Time     0.07 (.02)***
Random Effects
 Intercept 11.69
 Residual  1.10
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Note:

*

p < 0.05;

**

p < 0.01;

***

p < 0.001; BMI = Body Mass Index; SW = self-weighing (frequency in the two weeks prior to baseline assessment; three categories).

Figure 1.

Figure 1

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BMI over two years for the three baseline self-weighing groups.

Note. SW = self-weighing at baseline (past two weeks). 1.5 months represents BMI at post-intervention.

Moderation of Disordered Eating on the Predictive Impact of Self-Weighing on BMI Change

We next examined whether the presence of baseline disordered eating symptoms moderated the association between baseline self-weighing and BMI change (i.e., whether the effect of baseline self-weighing on BMI change differed by the extent of eating pathology at baseline). Moderators were (1) weight/shape concerns, (2) number of binge episodes in the past 12 months, and (3) number of compensatory behaviors in the past 12 months. Descriptive statistics for these symptoms are presented in Table 1 and model results are shown in Table 3.

Table 3.

Estimates for moderated prospective multilevel models predicting BMI over two years (five time points).

Moderator Variable
Weight/Shape Concerns Binge Eating Episodes Compensatory Behaviors
B (SE) B (SE) B (SE)
Fixed Effects
 Intercept 21.28*** 0.88 22.91*** 0.61 22.82*** 0.62
 Age 0.42** 0.14 0.43** 0.14 0.43** 0.14
 Ethnicity (White/Nonwhite) 0.13 0.09 0.11 0.09 0.13 0.09
 Study −0.59 0.56 −0.54 0.56 −0.55 0.57
 Intervention Condition 0.15 0.17 0.10 0.19 0.09 0.19
 Time −0.002 0.06 0.06* 0.02 0.05** 0.02
 Baseline Self-Weighing (SW) −0.61 0.65 −0.22 0.20 −0.02 0.20
 Baseline moderator 0.27** 0.17 −0.005* 0.02 0.001 0.005
 SW × Time 0.05 0.06 0.07*** 0.02 0.07** 0.02
 Moderator × Time 0.02 0.02 −0.00004** 0.002 −0.0001 0.0004
 SW × Moderator 0.10 0.17 0.01 0.01 −0.009 0.005
 SW × Moderator × Time 0.004 0.02 0.004* 0.001 0.0001 0.0005
Random Effects
 Intercept 11.51 11.68 11.01
 Residual 1.09 1.09 1.01
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Note:

*

p < 0.05;

**

p < 0.01;

***

p < 0.001; BMI = Body Mass Index; SW = self-weighing (frequency in the two weeks prior to baseline assessment; three categories)

Participants who reported greater baseline weight/shape concerns had higher BMIs (across all time points) than participants who reported lower weight/shape concerns (F[1,2614] = 10.26, p = 0.001), but baseline weight/shape concerns did not predict change in BMI over 2 years. Contrary to prediction in the present study, weight/shape concerns did not moderate the association between baseline self-weighing and change in BMI over time (i.e., the degree of baseline weight/shape concerns did not change the pattern of baseline self-weighing predicting change in BMI over 2 years; F[8,2614] = 0.22, p = 0.99).

The baseline number of binge episodes showed three significant relations with BMI. First, participants who binged more frequently at baseline had higher BMIs (across all time points) than those who binged less frequently (F[1,2613] = 4.41, p = 0.04). Second, binge episodes showed a two-way interaction with time (F[4,2613] = 4.79, p = 0.0007), such that participants who binged more frequently at baseline showed greater increases in BMI over time than those who binged less frequently. Third, and most relevant to this study, as predicted, the number of baseline binge episodes moderated the relation of baseline self-weighing and BMI change over time (F[8,2613] = 1.80, p = 0.04, sr = 0.05). To illustrate the moderation effect of this continuous variable, we estimated the effect of self-weighing on BMI for participants at +/-1 standard deviation from the mean of binge eating frequency. As can be seen in Figure 2, regardless of baseline binge frequency, participants in the no and occasional self-weighing groups showed little change in BMI over 2 years (all slope ps > 0.12). However, the group who endorsed both more frequent self-weighing and more frequent binge episodes at baseline showed greater BMI increases relative to other participants; model estimates indicate these participants gained 1.6 BMI units over two years (slope p = 0.04).

Figure 2.

Figure 2

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BMI over two years for the three self-weighing groups by binge eating frequency at baseline.

Note. SW = self-weighing at baseline (past two weeks). 1.5 months represents BMI at post-intervention. The frequency of binge episodes in 12 months prior to baseline dichotomized into +/-1 SD for illustrative purposes only.

To better understand these associations, we conducted two post-hoc analyses. First, given that baseline self-weighing correlated with baseline weight/shape concerns, we explored whether the moderating effect of binge eating on the relation of self-weighing to BMI change would remain significant after controlling for baseline weight/shape concerns, and it did (F[9,2608] = 4.37, p = 0.04, sr = 0.08). Second, given that the more frequent self-weighing group ranged widely in the frequency of their self-weighing, we re-ran this analysis removing the highest frequency group (i.e., more than daily self-weighers, n = 16) to test whether results were due solely to the most extreme group. After applying these adjustments, the moderating effect of binge eating on the association between baseline self-weighing and change in BMI over time was reduced to a trend, though the effect size was similar (F[8,2250] = 3.61, p = 0.06, sr = 0.07).

The number of prior compensatory behaviors at baseline did not moderate the relation between baseline self-weighing and time on BMI; F[4,2623] = 0.09, p = 0.99) and showed no other relations with BMI (e.g., did not predict change in BMI over 2 years; see Table 3).

Degree to which Baseline Self-Weighing Predicts Future Binge and Compensatory Behaviors

Of the participants who reported no binge eating at baseline (n = 628), 58 reported one or more binge eating episodes at one of the follow-up points over 2 years (9%). Of the 58 participants who endorsed binge eating at follow-up, 44 reported more than 1 episode of binge eating (76%). Logistic regression models showed that baseline self-weighing was not significantly associated with the onset of binge eating (Wald χ2 = 1.73, p = 0.42).

Of those who reported no prior compensatory behaviors at baseline (n = 416), 67 reported engaging in these behaviors at one of the follow-up points (16%). All of these participants reported more than 1 episode of compensatory behaviors during follow-up; 4 reported vomiting, 2 laxatives/diuretic use, 16 fasting, and 49 excessive exercise [some participants reported onset of more than one behavior type]). Self-weighing significantly predicted future onset of compensatory behaviors (Wald χ2 = 11.29, p = 0.004). The odds of developing compensatory behaviors during follow-up were almost 4 times greater for more frequent self-weighers than for non-weighers (OR = 3.90, 95% CI = 1.76 – 8.65) and were 2.5 times greater for more frequent than for occasional self-weighers (OR = 2.48, 95% CI = 1.12 – 5.53). The odds of developing compensatory behaviors did not significantly differ for occasional self-weighers versus non-weighers (OR = 1.57, 95% CI = 0.56 – 2.89).

We conducted two post-hoc analyses. First, given that (a) baseline self-weighing was correlated with weight-shape concerns and (b) baseline self-weighing and binge eating interacted to predict increases in BMI, we explored whether the frequency of baseline self-weighing would predict onset of compensatory behaviors controlling for both baseline weight/shape concerns and binge eating. This exploratory analysis found that the frequency of baseline self-weighing failed to significantly predict increased risk for the onset of future compensatory behaviors with these additional covariates (Wald χ2 = 3.52, p = 0.06, OR = 1.48, 95% CI = 0.98 – 2.23). Second, to control for additional potential confounds, we re-ran this analysis also controlling for baseline BMI and deselecting the potential outliers who reported more than daily self-weighing at baseline; association between baseline self-weighing and onset of compensatory behaviors remained significant (Wald χ2 = 10.29, p = 0.001, OR = 1.92, 95% CI = 1.29 – 2.86).

Discussion

This study had three aims, testing whether: (1) frequency of elective self-weighing in a sample of college students at risk for weight gain predicted future weight gain over 2-year follow-up; (2) presence of disordered eating cognitions (i.e., weight/shape concerns) or behaviors (i.e., binge episodes and compensatory behaviors) moderated the association between self-weighing and BMI change; and (3) frequency of self-weighing predicted future onset of compensatory weight control behaviors. Half of the sample (49%) reported no self-weighing in the prior two weeks, one-third (35%) reported occasional self-weighing, and one-sixth (16%) reported more frequent self-weighing, which was defined as approximately twice a week or more frequently at baseline. Only 2% reported daily (or more frequent) self-weighing, which has been recommended by some (Bertz et al., 2015; Gokee-LaRose et al., 2014) as a weight control strategy for adults interested in either weight loss or weight gain prevention.

Frequency of baseline self-weighing significantly predicted future weight gain. Participants who were occasional self-weighers entered the study with slightly lower BMI values than either the no self-weighing or the more frequent weighers, and the occasional weighers showed relatively little change in BMI over the 2-year follow-up period, gaining approximately 0.5 BMI points. Of the two other groups, the more frequent weighers showed the greatest BMI gains (approximately 0.8 BMI points compared to 0.4 BMI points for the no self-weighers). This effect was small in magnitude, which is the norm in weight gain prevention effects (e.g., Bertz et al., 2015; Linde et al., 2005; Stice et al., in press; West et al., 2016). It is worth reiterating that the interventions examined in both studies neither encouraged nor discouraged self-weighing as an obesity prevention intervention, so we did not expect participants to change their self-weighing behaviors over follow-up as a result of the interventions.

Analyses for our second aim indicated that the association between baseline self-weighing and future weight change was moderated by baseline binge episodes, though not by weight/shape concerns or frequency of unhealthy compensatory weight control behaviors. The subgroup of participants who reported both more frequent self-weighing and binge episodes experienced greater future weight gain (approximately 1.6 BMI-point increase), whereas the other groups – which included more frequent self-weighers who did not binge and those who binged but did not frequently self-weigh – showed no significant BMI change. To our knowledge, this is the first study to show this negative association prospectively. Important potential directions for future research include replicating this effect and exploring potential associated mechanisms. For instance, it is possible that frequent self-weighing leads to increased body dissatisfaction, psychological distress, negative affect, or discouragement about weight control efforts, which might increase risk for overeating (e.g., Dionne & Yeudall, 2005; Neumark-Sztainer et al., 2006), though the frequency of self-weighing in the present study did not predict onset of binge eating. Consistent with the pattern of findings in the present study, cognitive-behavioral therapies for the treatments of eating disorders discourage self-weighing between sessions (e.g., Fairburn, 2008; Waller et al., 2007). A descriptive examination of the association of elective self-weighing in individuals with an eating disorder (Pacanowski et al., 2016) also concluded that a greater frequency of self-weighing was associated with greater eating disorder attitudinal pathology, especially among individuals with anorexia nervosa. The present findings suggest that even among individuals without clinically significant eating disorder pathology, the combination of more frequent self-weighing and binge eating was associated with future weight gain.

Although not a specific aim of the present report, another novel contribution of this study was the finding that binge eating at baseline significantly predicted greater future BMI gains. To date only a few studies have provided evidence that eating disorder symptoms increase risk for excessive weight gain with prospective data (Stice et al., 1999, 2002), including loss-of-control eating significantly predicting BMI increases over 4-5 year follow-up in children who were at elevated risk for obesity due to their own or parental overweight status (Tanofsky-Kraff et al., 2009). As such, this finding helps to further establish the adverse effects of eating pathology, in that obesity has been estimated to be the third leading cause of preventable death in USA, after tobacco smoking and high blood pressure (Goodarz et al., 2005). Although baseline binge eating predicted BMI gain over follow-up, neither weight/shape concerns nor compensatory behaviors at baseline were significantly associated with BMI gain, which have previously been found in community samples of girls (Krahnstoever Davison et al., 2003) and younger women (Stice et al., 1999). It is possible that the method of selecting participants for inclusion in these studies resulted in a restricted range of scores on weight and shape concerns (i.e., fewer individuals with low or non-existent concerns).

Our third aim examined whether baseline self-weighing was associated with significantly greater onset of binge eating and compensatory behavioral symptoms over the 2-year follow-up period. Nine percent of the sample reported new emergence of binge eating episodes and 16% reported new occurrences of compensatory behavior episodes; these were not subthreshold diagnoses although almost all participants in these onset groups reported engaging in recurrent episodes of either binge eating or compensatory behaviors over follow-up. We found that more frequent self-weighing was significantly more likely to predict future onset of compensatory behaviors (though not binge eating), with rates 2.5 to nearly 4 times greater than the other self-weighing groups, which reflect medium-to-large magnitude effects, although the association failed to remain statistically significant after controlling for related baseline factors of weight/shape concerns and binge eating. Almost all of the incident compensatory behaviors consisted of excessive exercise that was specifically done to compensate for perceived overeating/excessive drinking (73% of participants with onset), followed by fasting (i.e., skipping of 2+ concurrent meals, 24%); the onset of vomiting and laxative/diuretic abuse in our sample was infrequent (6% and 3%, respectively). Frequent elective self-weighing (defined in that trial as more than weekly) correlated with higher rates of unhealthy (e.g., meal skipping) or even extreme (e.g., self-induced vomiting) weight control behaviors in both men and women in a community sample of young adults (Quick et al., 2012). Previous research on the occurrence of disordered eating in weight gain prevention has either examined cross-sectional associations (Wing et al., 2015) or involved small samples that may not have adequate power to detect small effects (West et al., 2016). In a prospective study of overweight/obese treatment-seeking adults (M BMI = 35.0), daily self-weighing at baseline was not associated with changes in a disordered eating composite score or with rates of engagement in compensatory behaviors over an 18-month follow-up (Gokee-LaRose et al., 2014). The present study is the first, to our knowledge, to find that self-weighing prospectively appears to predict future engagement in unhealthy compensatory weight control behaviors in a non-obese sample of young adults.

The finding that self-weighing was associated with future compensatory behaviors but not binge eating warrants consideration. These compensatory behaviors, which consisted almost exclusively of excessive exercise and meal skipping, may have been completed with the broader goal of weight loss rather than to directly compensate for binge eating episodes. Further, self-weighing might provide the information necessary to motivate either healthy or unhealthy compensatory behaviors but would not as directly motivate someone to binge eat. That is, if the scale indicates your weight is going up or is not going down (assuming that is your goal), compensatory behaviors could potentially address this perceived problem of not losing weight, whereas binge eating would only exacerbate it, or potentially lead to weight gain. Lastly, people often engage in unhealthy weight control behaviors more often than they engage in binge eating (Stice et al., 2006), and the recently introduced diagnosis of purging disorders describes unhealthy weight control behaviors that occur in the absence of binge eating. Important directions for future research include replicating the association between self-weighing and compensatory behaviors and, if replicated, examining potential mechanisms for this effect.

Given that our findings did not detect any positive effects of frequent self-weighing among non-obese young adults, further research could examine whether current self-weighing recommendations for weight control should extend to this population. It should be reiterated that self-weighing is recommended as a weight control strategy that is done in combination with education and specific weight loss strategies to reduce caloric intake or increase expenditure. It is possible that self-weighing among young people without instruction about healthy steps to induce modest weight loss may be problematic. Thus, it may be prudent for health care providers working with young adults to ask their clients about the frequency with which they self-weigh, and consider the possibility that frequent self-weighing (i.e., more than weekly) may be associated with problematic attitudes and negative health outcomes (including weight gain and unhealthy compensatory weight control behaviors such as meal skipping, excessive exercise completed in response to real or perceived overconsumption, laxative/diuretic abuse, or self- induced vomiting). Consistent with this distinction in recommendations, a qualitative analysis of adults who had successfully maintained a weight loss of at least 10% for more than one year found that approximately half weighed themselves more than weekly as a monitoring tool, whereas the majority of the comparison group who had maintained a normal stable weight weighed themselves less than once a month, relying instead on other information (e.g., fit of clothes, reflection in mirror) (Carrard & Kruseman, 2016).

It is important to consider study limitations. First, we focused solely on the self-reported frequency of weighing during a two-week period prior to baseline. However, many prospective studies have examined risk factors that occurred over a 1-4 week period of baseline and the baseline self-weighing classification in the present report was fairly stable across future assessments. Future research could examine the impact of changes in self-weighing behavior on BMI change and eating disorder symptoms in more time-sensitive analyses. Our intention in this report was to examine whether a simple measure of self-weighing collected before entry into a prevention trial had any detectable effects on either weight gain or the onset of behaviors indicative of disorder eating pathology.

Second, very few participants reported daily (or more frequent) self-weighing, which limited our ability to examine high self-weighing rates separately. However, these rates are consistent with the frequency of self-weighing in young adults (e.g., 15% of young adults reported self-weighing more than weekly; Quick et al., 2012). Based on the present results, there does not appear to be an “epidemic” of daily or more frequent weighing on college campuses, although the results indicate that such weighing (particularly when combined with binge eating) is associated with negative outcomes in the small number of students affected. Third, participants came from two studies that differed in some baseline characteristics, although both samples were selected with the intention of being at elevated risk for either eating disorder or overweight/obesity onset; the participants were not intended to be representative of the general college population but we do not definitively know the degree to which they varied from the general community.

Fourth, the relatively low number of male participants reduced our ability to detect sex effects, which have been found in other studies involving young people (e.g., Quick et al., 2012; Klos et al., 2012). Fifth, although over 60% of young adults in the United States attend college (US Department of Education, 2008) and entry into college may be a risk period for weight gain (Lloyd-Richardson, Bailey, Fava, & Wing, 2009), findings may not generalize to young adults who do not attend college or to older adults. On a related note, the sample was predominantly European-American. Self-weighing and other weight control behaviors may vary by race/ethnicity and education level (e.g., Kong et al., 2012). Sixth, we conducted a large number of tests and did not correct for study-wide error. The findings need to be conceptualized as hypothesis-generating rather than hypothesis-confirming. We do note, however, that 60% of tested a priori effects were significant, compared to the 5% that might be expected due to chance. Finally, despite the evidence of temporal precedence between self-weighing and future increases in BMI and onset of compensatory behaviors, prospective data do not permit causal inferences. It is possible that some third variable explains the relation between self-weighing and these two adverse outcomes.

In sum, results suggest that weighing oneself more frequently was associated with greater future BMI gains relative to less frequent self-weighing in a sample of young adults who were at elevated risk for weight gain due to both their age and either body image or weight concerns. Thus, contrary to previous findings with other populations, more frequent self-weighing was associated with an increase rather than decrease in future weight gain. In addition, we found that the relation of frequent self-weighing to future weight gain predicted even greater BMI gains for the subset of participants who also engaged in binge eating at baseline. Collectively these findings suggest that further work is needed before recommendations regarding self-weighing as a weight control technique for non-obese young adults can be offered – particularly if they report binge eating, as this combination is associated with elevated risk for weight gain. Further, we found that more frequent self-weighing may be associated with increased risk for onset of unhealthy compensatory weight control behaviors, which has not been previously documented with prospective data. This finding also suggests that self-weighing should not yet be recommended as a means of weight management in non-obese young adults, as it is associated with later emergence of eating pathology, and that additional research is needed in this area.

Public Health Significance Statement.

In a large sample of college students with body image or weight concerns more frequent self-weighing was associated with greater weight gain, and this effect was even stronger among those reporting binge eating; baseline weight did not moderate relations. More frequent self-weighing also predicted onset of unhealthy compensatory weight control behaviors. Collectively, finding suggests that there is need for increased attention to the potential effects of self-weighing in non-obese young adults with weight concerns.

Acknowledgments

This work was supported by the National Institute of Diabetes and Digestive and Kidney Diseases (DK072932) and the National Institute of Child Health & Human Development (HD071900). We wish to thank project research assistants Juliana Bednarski, Shelley Durant, Julie Pope, and Victoria Perko, as well as the undergraduates who volunteered to participate in these trials.

Footnotes

The authors do not have any financial conflicts of interest to disclose.

Contributor Information

Paul Rohde, Oregon Research Institute.

Danielle Arigo, The University of Scranton.

Heather Shaw, Oregon Research Institute.

Eric Stice, Oregon Research Institute.

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