Screening

It is important to note that only one third of people with AN seek medical care, which underscores the potential value of screening in order to reduce treatment disparities.[25]

Screening in high-risk individuals

The American Psychiatric Association (APA) recommends screening for the presence of an eating disorder as part of the initial psychiatric evaluation.[66]

All high-risk individuals (e.g., those with low BMI, amenorrhea, excessive concerns about body weight, or who have signs of semi-starvation) should be screened for AN during routine office visits, according to UK guidance.[65] The American Academy of Pediatrics recommends that pediatricians carefully inquire about eating and exercise patterns when weight loss is noted in any child or adolescent undergoing routine serial weight and height measurements.[70]

Screening in low-risk individuals

Screening for low-risk adolescent or adults with a normal or high BMI is not recommended, according to the US Preventive Services Task Force (USPSTF), citing a lack of evidence as to the efficacy of this approach.[81] However, the American Academy of Pediatrics advise that pediatricians should use the annual health supervision visit and preparticipation sports examination as an opportunity to screen for eating disorders in all adolescents, and recommend the use of questions on eating patterns and body image. They note that reported dieting, body image dissatisfaction, experiences of weight-based stigma or changes in eating or exercise patterns should prompt further inquiry.[70]

Screening tools

A number of structured rating scales may be used for screening, of which the 5-item Sick, Control, One, Fat, and Food (SCOFF) questionnaire is most frequently used in both adolescents and adults (although it should be noted that it is only validated in adults).[74]​ SCOFF has high sensitivity and specificity, particularly in young women, but its predictive value may be reduced for other patient groups, and for those with atypical presentations of AN.[74][75]​​[76][77]

Includes the following questions; the presence of two or more positive answers is suggestive of an eating disorder (e.g., AN or bulimia nervosa):[74]

"Do you ever make yourself sick because you feel uncomfortably full?"

"Do you worry that you have lost control over how much you eat?"

"Have you recently lost more than one stone in a 3-month period?"

"Do you believe yourself to be fat when others say you are too thin?"

"Would you say that food dominates your life?"

Alternative assessment tools include the Screen for Disordered Eating, and the Eating Disorder Screen for Primary care.[77][82]

UK guidance (from NICE) cautions against the use of screening tools (e.g., SCOFF) as the sole method to determine whether or not a person has an eating disorder; they note that if utilized, screening tools should act as an adjunct to a more comprehensive clinical assessment.[65]

In 2022, the National Center of Excellence for Eating Disorders (NCEED) developed the Screening, Brief Intervention, and Referral to Treatment for Eating Disorders (SBIRT-ED) tool, which is freely available to all primary care clinicians in the US. If a person screens positive for a possible eating disorder, clinicians can use conversation guides and resources from the tool to help guide the discussion regarding next steps for diagnosis and treatment. SBIRT for eating disorders Opens in new window

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