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Journal of Consulting and Clinical Psychology Copyright 2007 by the American Psychological Association
2007, Vol. 75, No. 4, 652– 656 0022-006X/07/$12.00 DOI: 10.1037/0022-006X.75.4.652

“STOP Regain”: Are There Negative Effects of Daily Weighing?

Rena R. Wing Deborah F. Tate

Brown University Medical School University of North Carolina, Chapel Hill
and The Miriam Hospital

Amy A. Gorin and Hollie A. Raynor Joseph L. Fava

Brown University Medical School University of Rhode Island
and The Miriam Hospital

This document is copyrighted by the American Psychological Association or one of its allied publishers. Jason Machan
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
The Rhode Island Hospital

Several recent studies suggest that daily weighing is important for long-term weight control, but concerns
have been raised about possible adverse psychological effects. The “STOP Regain” clinical trial provides
a unique opportunity to examine this issue both cross-sectionally and prospectively. Successful weight
losers (N ϭ 314) were randomly assigned to a control or to a face-to-face or Internet intervention
designed to help them maintain their weight loss and were then followed for 18 months. The intervention
groups reported increases in daily self-weighing, which were associated with successful weight loss
maintenance. We found no evidence that increases in frequency of weighing or daily weighing per se had
any adverse effects in this study population. Rather, increases in self-weighing were associated with
increases in dietary restraint ( p Ͻ .001), decreases in disinhibition ( p Ͻ .003), and decreases in
depressive symptoms ( p Ͻ .002). Moreover, those who weighed daily at 18 months were less likely to
report having Ն4 binge episodes per month ( p ϭ .03). Daily weighing appears to be an important aspect
of weight loss maintenance and was not associated with adverse psychological effects.

Keywords: self-regulation, obesity, weight loss maintenance, weighing, binge eating

The National Heart, Lung, and Blood Institute’s (2000) Practi- about possible adverse effects on mood and increased risk of
cal Guide for the Identification, Evaluation and Treatment of developing eating disorders (Dionne & Yeudall, 2005; Ogden &
Overweight and Obesity in Adults states that “regular self- Evans, 1996). There is little evidence to support these concerns
monitoring of weight is crucial for long-term maintenance.” This (National Task Force on the Prevention and Treatment of Obesity,
advice is supported by findings in the National Weight Control 2000; O’Neil & Brown, 2005), but few studies have examined this
Registry indicating that 44% of successful weight losers weigh prospectively.
themselves daily, and an additional 31% weigh themselves at least
weekly (Klem, Wing, McGuire, Seagle, & Hill, 1997) and by Recently, Wing, Tate, Gorin, Raynor, and Fava (2006) reported
evidence that individuals who weigh themselves frequently are results from a randomized clinical trial (STOP Regain) testing an
less overweight and more successful at preventing weight gain intervention to prevent weight regain in successful weight losers. The
(Linde, Jeffery, French, Pronk, & Boyle, 2005). intervention, which derived from self-regulation theory, was delivered
face-to-face or via the Internet. The intervention, delivered by either
Although these studies suggest that frequent weighing may be approach, was effective in reducing the proportion of patients who
important for long-term weight control, concerns have been raised regained Ն5 lb over 18 months, but only the face-to-face delivery
reduced the magnitude of weight regain. Moreover, in the intervention
Rena R. Wing, Amy A. Gorin, and Hollie A. Raynor, Department of groups, there was a significant increase in the proportion that weighed
Psychiatry and Human Behavior, Brown University Medical School and themselves daily, and daily weighing was associated with an 82%
The Miriam Hospital; Deborah F. Tate, Schools of Public Health and reduction in risk of weight regain.
Medicine, University of North Carolina, Chapel Hill; Joseph L. Fava,
Department of Psychiatry, University of Rhode Island; and Jason Machan, The “STOP Regain” trial provides an excellent opportunity to
The Rhode Island Hospital, Providence, Rhode Island. examine the association between frequency of self-weighing and
potential negative effects. We hypothesized that increased fre-
Trial Registration for the “STOP Regain” clinical trial is NCT00067145 quency of weighing would not be associated with increases in
in www.clinicaltrials.gov depression, binge eating episodes, or disinhibition (loss of control
over eating). However, because self-weighing may be part of a
Correspondence concerning this article should be addressed to Rena R. constellation of behaviors associated with dietary restraint, we
Wing, Brown University Medical School and The Miriam Hospital, 196 hypothesized that increases in frequency of self-weighing would
Richmond Street, Providence, RI 02903. E-mail: Rena_Wing_PhD@ be associated with increased dietary restraint.
Brown.EDU

652

BRIEF REPORTS 653

This document is copyrighted by the American Psychological Association or one of its allied publishers. Method sick (vomit), as a means of controlling their shape or weight or to
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly. counteract the effects of eating.
Subjects
Eating Inventory. All participants completed the Eating Inven-
To be eligible for STOP Regain, participants had to have lost at tory (Stunkard & Messick, 1988) to assess restraint and disinhibi-
least 10% of their body weight within the past 2 years using any tion. The Restraint factor assesses the degree of conscious control
method. The study population (N ϭ 314) was 81% women; their one is exerting over eating behaviors; possible scores range from
mean age was 51.3 years (SD ϭ 10.1) and their mean body mass 0 to 21. The Disinhibition factor measures susceptibility to loss of
index (BMI) at entry was 28.6 kg/m2 (SD ϭ 4.8). On average, control over eating; scores range from 0 to 16. This factor has been
participants had lost 19 kg (or 19% of their body weight). A figure shown to correlate positively with frequency and severity of binge
of participant flow into the study is available in Wing et al. (2006). eating (Marcus, Wing, & Lamparski, 1985). Both scales have good
The protocol was approved by the Institutional Review Board at internal consistency; the alpha coefficients among a sample of
The Miriam Hospital, Rhode Island, and written consent was dieters were reported as .79 for Restraint and .84 for Disinhibition
obtained from all participants. (Stunkard & Messick, 1988). In the present study, the alpha values
were .73 and .80, respectively.
Intervention
Frequency of weighing. Participants were asked to indicate
Participants were randomly assigned to one of three groups: how frequently they had weighed themselves during the past
control, Internet, or face-to-face. The control group was sent month using a 7-point scale ranging from (several times a day) to
quarterly newsletters regarding healthy eating, activity, and weight (never). These ratings were recoded so that higher numbers rep-
control. The Internet and face-to-face groups attended weekly resented more frequent self-weighing. In addition, scores on the
meetings (via chat rooms or face-to-face group meetings) for 4 scale were used to form a dichotomous variable indicating whether
weeks and then monthly meetings through 18 months and received or not the participants weighed themselves daily (including several
the same intervention content. The intervention was based on and 1 time a day) or less often.
self-regulation theory (Kanfer & Goldstein, 1975) and encouraged
participants to weigh themselves daily and use the information Statistical Analysis
from the scale to know when adjustments in intake and exercise
were needed. Weight and physical activity data were submitted Baseline comparisons between groups were conducted in SPSS,
weekly via an Internet diary or an automated phone system. On a using analysis of variance, and the association between frequency of
monthly basis, participants whose weight remained within 2 lb of self-weighing and other continuous variables was analyzed with Pear-
starting weight were sent token gifts; those who gained 2.1 to 4.9 son correlations. Hierarchical linear modeling (HLM) analyses, con-
lbs were instructed to use problem solving, and those who regained ducted with Proc MIXED procedure in SAS Version 9.1, were used
5 lb or more were instructed to restart weight loss efforts and to compare the trajectory of the three groups on restraint, disinhibi-
received counseling to assist them. tion, and depressive symptoms at baseline, 6, 12, and 18 months, after
adjusting for baseline body mass index (BMI) and gender. Baseline
Measures BMI, gender, and group were treated as fixed effects with a random
intercept. The model was fit with residual estimation of maximum
All participants were assessed at baseline, 6, 12, and 18 months likelihood and an unstructured variance– covariance structure. When a
by staff members who were unaware of their treatment assignment. statistically significant linear effect of the ordinal representation of
Weight was measured in light street clothes with a calibrated scale. time was observed, the model was revised to treat months from
All participants completed the self-report questionnaires described baseline as a continuous random effect. A statistically significant
below. interaction of Group ϫ Months was followed by comparing the group
slope parameters through orthogonal contrasts. HLM with time-
Depressive symptomatology. Symptoms of depression were varying covariates was also used to assess the effect of changes in
assessed with the Beck Depression Inventory (BDI; Beck & Steer, frequency of self-weighing on changes in psychological variables
1987). over the baseline, 6-, 12-, and 18-month time frame. Generalized
estimating equations, conducted with the Proc GENMOD procedure
Binge-eating behavior. Following questions used in the Eating in SAS Version 9.1, was used to examine longitudinal changes in
Disorder Examination Questionnaire (EDE-Q; Fairburn & Beglin, binge eating coded as a binary variable.
1994), participants were asked whether “there have been times
when you have eaten what other people would regard as an Results
unusually large amount of food.” If they answered yes, participants
were asked, “How many such episodes have you had over the past Association Between Frequency of Self-Weighing and
4 weeks?” and “During how many of these episodes of overeating Psychological Variables at Baseline
did you have a sense of having lost control?” Because Յ5% of
participants endorsed having 2 or more binge episodes per week at Levels of depressive symptoms were low at baseline indicating
any point in the study (the clinical criteria for binge eating), we “no depression” (M ϭ 4.0, SD ϭ 4.1). Scores on the dietary
used a lower level of such episodes (Ն4 episodes per month with restraint (M ϭ 15.1, SD ϭ 3.2) and disinhibition (M ϭ 8.3, SD ϭ
large intake and loss of control) to examine whether there was any 3.5) factors of the Eating Inventory were similar to scores typically
evidence of even minimally increased risk. Participants were also observed at the end of the intensive phase of a weight loss program
asked whether over the past 4 weeks they had made themselves

654 BRIEF REPORTS

This document is copyrighted by the American Psychological Association or one of its allied publishers. (Klem, Wing, McGuire, Seagle, & Hill, 1998). No significant met the weekly criterion no longer met this criterion at 18 months,
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly. between-groups differences were observed at baseline. with no differences among the three treatment groups.

More frequent self-weighing at baseline was associated with Changes in Frequency of Self-Weighing and
higher levels of dietary restraint (r ϭ .12, p ϭ .03) and weakly Psychological Outcomes
associated with lower scores on the BDI (r ϭ Ϫ.10, p ϭ .07) but
was not related to disinhibition (r ϭ Ϫ.01, p ϭ .82). Among those Group slope parameters were analyzed to determine whether
who weighed daily at baseline, 13.6% reported 4 or more binge increases in the frequency of self-weighing from 0 to 6, 12, or 18
episodes per month compared with 10.4% of those who weighed months were related to adverse outcomes. Increases in the fre-
less often, ␹2(1, N ϭ 314) ϭ 0.75, p ϭ .39. Only 1 participant quency of self-weighing were associated with increases in restraint
reported any episodes of vomiting. (M ϭ 0.79, SD ϭ 0.15; CIs ϭ 0.49, 1.08, p Ͻ .001) but with
decreases in disinhibition (M ϭ Ϫ0.37, SD ϭ 0.12; CI ϭ Ϫ.61,
Changes Over Time by Treatment Group Ϫ.13, p ϭ .003) and decreases on the BDI (M ϭ Ϫ.70, SD ϭ .22;
CI ϭ Ϫ1.13, Ϫ0.27; p ϭ .002). Increases in frequency of weighing
Table 1 presents the adjusted means for the three treatment were also associated with decreases in the probability of reporting
groups on the psychological variables over time. There were no Ն4 binge episodes/month (M ϭ Ϫ.24, SD ϭ .07; CI ϭ Ϫ.39,
significant differences between groups for measures of disinhibi- Ϫ.09; p ϭ .01). Those who weighed daily at 18 months (N ϭ 145)
tion or depressive symptoms. For dietary restraint, there was a were less likely to report 4 or more binge episodes per month
significant linear effect of time; thus time was used as a continuous compared with those who weighed less often (8.3% vs 16.8%),
measure. The Time (in months) ϫ Group interaction was signifi- ␹2(1, N ϭ 264) ϭ 4.47, p ϭ .03.
cant, F(2, 516) ϭ 3.89, p ϭ .02. As shown in Figure 1, the
face-to-face group reported increasing levels of restraint over time, Of particular interest are the 58 participants who self-weighed
which differed significantly from the changes in the control group less than daily at baseline but then self-weighed at least daily at 18
(comparisons of slopes of the lines: face-to-face vs. control, months. As shown in Table 2, these participants reported signifi-
t(516) ϭ 2.70, p ϭ .02, after Bonferonni adjustment). There were cant decreases in disinhibition ( p ϭ .04; partial eta squared ϭ.07).
no differences between groups in the percentage of participants Changes in restraint, depression, and percentage of participants
who met the Ն4 times per month binge-eating criterion (Table 1). reporting Ն4 binge episodes per month were not significant.
Only 1 participant reported any episodes of vomiting (1 time per
month) at 6, 12, or 18 months. Moreover, only 1 participant (in the Participants Who Weighed Several Times a Day
newsletter group) who did not report 4 or more binge episodes per
month at baseline subsequently met this criterion at 6, 12, and 18 A small number of participants reported weighing themselves
months. In contrast, 24 of the 37 (63%) participants who initially several times a day at baseline (n ϭ 27) or at 18 months (n ϭ 22).

Table 1
Least Squares Means Estimates and Standard Errors Across Time (T) by Group (G) Adjusted for Gender and Baseline Body Mass
Index (BMI)

Newsletter Internet Face-to-Face p value

Variable/month M SE M SE M SE Group Time G ϫ T

Disinhibition .27 .25 .20

0 7.5 0.4 8.2 0.4 8.2 0.4

6 7.8 0.4 8.5 0.4 7.8 0.4

12 7.7 0.4 8.4 0.4 7.9 0.4

18 7.6 0.4 8.2 0.4 7.4 0.4

Restraint .78 .01 .02

0 14.8 0.4 14.8 0.4 14.6 0.4

6 14.3 0.4 14.3 0.4 14.4 0.4

12 13.9 0.4 14.1 0.4 14.6 0.4

18 13.6 0.4 14.0 0.4 14.9 0.4

BDI .19 .19 .47

0 3.3 0.5 4.1 0.5 4.7 0.5

6 3.5 0.5 4.5 0.5 4.7 0.5

12 3.9 0.5 5.1 0.5 4.9 0.5

18 4.2 0.5 4.5 0.5 4.3 0.5

% with Ն4 binges per month .11 .05 .68

0 10.5 14.5 10.5

6 10.9 19.4 9.5

12 7.1 12.0 4.6

18 10.0 14.6 11.8

Note. BDI ϭ Beck Depression Inventory.

BRIEF REPORTS 655

This document is copyrighted by the American Psychological Association or one of its allied publishers. Figure 1. Mean restraint as a function of intervention and time (black or binge eating at baseline. These participant characteristics should
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly. markers) with model predictions (solid). Markers indicate raw means for be kept in mind when interpreting the results.
participants who completed the assessment visit; the lines are based on
predictions from the model. The present study suggests that frequent self-weighing is part of
a constellation of behaviors associated with dietary restraint. As
These individuals did not differ significantly from those who shown previously (Wing et al, 2006), changes in frequency of
weighed daily on any of the outcome measures described above. self-weighing over time were associated with improved weight
Moreover, there was no evidence that the intervention increased loss maintenance. These changes also appear to be associated with
the prevalence of weighing several times a day. increases in restraint and decreases in disinhibition. Prior studies
have suggested that high levels of dietary restraint and low levels
Discussion of disinhibition are associated with successful weight loss and
maintenance (Bjorvell, Aly, Langius, & Nordstrom, 1994; Clark,
This is the first prospective study testing whether frequency of Niaura, King, & Pera, 1996; Foster, Wadden, Swain, & Vogt,
self-weighing, and particularly daily self-weighing, is associated 1998; Pekkarinen, Takala, & Mustajoki, 1996; Wing & Phelan,
with negative psychological consequences. We found no evidence 2003). National Weight Control Registry members, who have lost
supporting this concern among a sample seeking to maintain an average of 33 kg and kept it off over 5.8 years, report average
weight loss. On the contrary, increases in frequency of self- restraint scores of 15.1 and disinhibition levels of 7.1 (Klem et al.,
weighing were associated with decreases in depressive symptoms, 1998), which are extremely similar to the levels reported here. The
decreases in disinhibition, and increases in restraint. Likewise, association we observed between increased frequency of self-
disinhibition decreased in those who initiated daily weighing. weighing and lower levels of depressive symptoms may be due to
the positive emotional effects of successful maintenance of weight
Strengths of this study include the fact that participants were loss.
randomly assigned to treatment groups and that those in the active
maintenance interventions who were taught to weigh themselves The present study adds to the growing literature suggesting that
daily, significantly increased their frequency of self-weighing. A behavioral weight control programs emphasizing self-weighing do
limitation is that all participants in the study were successful not result in increases in binge eating. Our conclusions are limited
weight losers, and none reported significant depressive symptoms by the use of only a few items from the EDE-Q rather than the full
questionnaire or the EDE interview (Fairburn & Cooper, 1993),
which is the gold standard for assessing eating disorders, as well as
the failure to assess other compensatory behaviors besides vomit-
ing. However, we focused on the most common compensatory
behavior and examined the prevalence of very low levels of binge
eating (4 episodes per month) to assess even minimal levels of
binge eating. We found no differences among the treatment groups
or between daily self-weighers and other participants in the prev-
alence of binge eating. Moreover, vomiting was extremely rare in
this sample. Perhaps most notable was the fact that those who
self-weighed daily at 18 months were less (rather than more) likely
to report binge eating 4 or more times per month. Similarly, a
recent study conducted with the EDE interview found no evidence
that behavioral weight loss programs involving weight assess-
ments at treatment sessions, recommendations to self-weigh at
home, or different degrees of caloric restriction produced higher
rates of binge eating or other disordered eating than did a nondi-
eting approach that discouraged self-weighing (Wadden et al.,
2004).

Table 2
Comparison of Baseline and 18-Month Scores for Those Individuals Who Did Not Self-Weigh
Daily at Baseline but Did Self-Weigh Daily at 18 Months

Baseline 18 months

Variable M SD % M SD % p

Disinhibition 8.0 3.9 7.2 3.6 .04

Restraint 15.1 2.8 15.8 3.0 .10

BDI 3.4 4.1 4.0 4.6 .42

Ն4 binge episodes per month 10.0 8.6 .74

Note. N ϭ 58. BDI ϭ Beck Depression Inventory.

656 BRIEF REPORTS

This document is copyrighted by the American Psychological Association or one of its allied publishers. In summary, the present study found no evidence that frequent (1998). Psychological symptoms in individuals successful at long-term
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Rather, frequent self-weighing, including daily weighing, appears (2005). Self-weighing in weight gain prevention and weight loss trials.
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Klem, M. L., Wing, R. R., McGuire, M. T., Seagle, H. M., & Hill, J. O.