diff --git a/homeassistant/components/withings/binary_sensor.py b/homeassistant/components/withings/binary_sensor.py
index 69af68e988b..1317befcf3f 100644
--- a/homeassistant/components/withings/binary_sensor.py
+++ b/homeassistant/components/withings/binary_sensor.py
@@ -1,13 +1,17 @@
 """Sensors flow for Withings."""
 from __future__ import annotations
 
+from collections.abc import Callable
+
 from homeassistant.components.binary_sensor import (
     BinarySensorDeviceClass,
     BinarySensorEntity,
 )
 from homeassistant.config_entries import ConfigEntry
+from homeassistant.const import Platform
 from homeassistant.core import HomeAssistant
 from homeassistant.helpers.entity_platform import AddEntitiesCallback
+import homeassistant.helpers.entity_registry as er
 
 from .const import DOMAIN
 from .coordinator import WithingsBedPresenceDataUpdateCoordinator
@@ -22,9 +26,22 @@ async def async_setup_entry(
     """Set up the sensor config entry."""
     coordinator = hass.data[DOMAIN][entry.entry_id].bed_presence_coordinator
 
-    entities = [WithingsBinarySensor(coordinator)]
+    ent_reg = er.async_get(hass)
 
-    async_add_entities(entities)
+    callback: Callable[[], None] | None = None
+
+    def _async_add_bed_presence_entity() -> None:
+        """Add bed presence entity."""
+        async_add_entities([WithingsBinarySensor(coordinator)])
+        if callback:
+            callback()
+
+    if ent_reg.async_get_entity_id(
+        Platform.BINARY_SENSOR, DOMAIN, f"withings_{entry.unique_id}_in_bed"
+    ):
+        _async_add_bed_presence_entity()
+    else:
+        callback = coordinator.async_add_listener(_async_add_bed_presence_entity)
 
 
 class WithingsBinarySensor(WithingsEntity, BinarySensorEntity):
diff --git a/tests/components/withings/test_binary_sensor.py b/tests/components/withings/test_binary_sensor.py
index 5054bf46daa..c56b14ae893 100644
--- a/tests/components/withings/test_binary_sensor.py
+++ b/tests/components/withings/test_binary_sensor.py
@@ -22,6 +22,7 @@ async def test_binary_sensor(
     webhook_config_entry: MockConfigEntry,
     hass_client_no_auth: ClientSessionGenerator,
     freezer: FrozenDateTimeFactory,
+    caplog: pytest.LogCaptureFixture,
 ) -> None:
     """Test binary sensor."""
     await setup_integration(hass, webhook_config_entry)
@@ -31,7 +32,7 @@ async def test_binary_sensor(
 
     entity_id = "binary_sensor.henk_in_bed"
 
-    assert hass.states.get(entity_id).state == STATE_UNKNOWN
+    assert hass.states.get(entity_id) is None
 
     resp = await call_webhook(
         hass,
@@ -53,6 +54,15 @@ async def test_binary_sensor(
     await hass.async_block_till_done()
     assert hass.states.get(entity_id).state == STATE_OFF
 
+    await hass.config_entries.async_reload(webhook_config_entry.entry_id)
+    await hass.async_block_till_done()
+
+    assert hass.states.get(entity_id).state == STATE_UNKNOWN
+    assert (
+        "Platform withings does not generate unique IDs. ID withings_12345_in_bed already exists - ignoring binary_sensor.henk_in_bed"
+        not in caplog.text
+    )
+
 
 async def test_polling_binary_sensor(
     hass: HomeAssistant,
@@ -67,7 +77,7 @@ async def test_polling_binary_sensor(
 
     entity_id = "binary_sensor.henk_in_bed"
 
-    assert hass.states.get(entity_id).state == STATE_UNKNOWN
+    assert hass.states.get(entity_id) is None
 
     with pytest.raises(ClientResponseError):
         await call_webhook(