Screening for eating disorders: Latest recommendations
M3 Global Newsdesk Jun 18, 2022
This article talks about a systematic review commissioned by the USPSTF to evaluate screening for eating disorders in adolescents and adults. The screening tools, clinical considerations and prevalence of eating disorders are also penned down in the article.
- The US Preventive Services Task Force (USPSTF) has published its first recommendations on screening for eating disorders in adolescents and adults.
- In individuals who are not showing any symptoms of eating disorders, there’s insufficient evidence to recommend for or against screening for eating disorders.
- Clinicians can decide to screen patients based on individual risk factors and circumstances.
For the first time, the USPSTF has issued a recommendation statement on the potential benefits and harms of screening for eating disorders in adolescents and adults 10 years and older.
The USPSTF commissioned a systematic review to evaluate screening for eating disorders in adolescents and adults who show no signs of eating disorders and have a normal or high body mass index (BMI).
Signs of eating disorders include:
- Rapid weight loss
- Weight gain
- Departure from growth trajectory
- Delayed puberty
The review concluded there was insufficient evidence to determine if the advantages of screening outweigh potential drawbacks in this patient population. The insufficient evidence statement is not a recommendation supporting or discouraging screening. Instead, it indicates that the evidence is too limited to allow the USPSTF to make a recommendation either way.
Prevalence of eating disorders
Eating disorders (including binge eating, bulimia nervosa, and anorexia nervosa) are psychiatric conditions characterized by eating behaviour disturbances. They can severely affect a person’s physical and mental health and are associated with both short- and long-term adverse health outcomes.
The estimated prevalence of anorexia nervosa, bulimia nervosa, and binge eating disorder in adult women is 1.42%, 0.46%, and 1.25%, respectively. In adult men, the prevalence is lower, at 0.12%, 0.08%, and 0.42%, respectively. In adolescent females, the prevalence of eating disorders can be up to 2.3% (range, 0.3% to 2.3%) and in adolescent males, the range is from 0.3% to 1.3%.
Weight, height, and BMI are routinely assessed in primary care settings. Changes in growth or weight may allow clinicians to detect some eating disorders. However, it’s important to acknowledge there are limitations to using BMI as a metric, such as an inability to distinguish body composition (fat mass vs lean mass, for example).
For individuals with no signs of eating disorders, there are screening questionnaires that can be used in the primary care setting, such as the Eating Disorder Screen for Primary Care (EDS-PC), Screen for Disordered Eating, and SCOFF questionnaire. These questionnaires inform clinicians about a patient’s eating habits, and also their feelings about eating and weight.
Both the SCOFF and EDS-PC screening tools were included in the USPSTF review, which found that SCOFF had an 84% pooled sensitivity and an 80% specificity from 10 studies, while EDS-PC had a sensitivity of 97% and 100%, and a specificity of 40% and 71%, from two studies, respectively.
The USPSTF determined there was sufficient evidence to support SCOFF’s accuracy for screening of eating disorders in adult women. However, there was insufficient evidence for other populations, including adolescents and men.
Considerations for clinicians
More research is needed to determine if all adolescents and adults should be screened for eating disorders. In the meantime, clinicians can base decisions to screen patients on individual risk factors and circumstances.
The USPSTF statement encourages clinicians to consider the following factors when making decisions to screen patients for eating disorders:
- Potential preventable burden: Eating disorders can negatively affect many organ systems (such as musculoskeletal and cardiovascular) and may lead to disturbances in cognitive and emotional functioning. Individuals diagnosed with eating disorders also have higher death rates compared with the general population.
- Potential harms: False positives can lead to unnecessary referrals and cause anxiety. Treatments can have negative side effects such as headache, dry mouth, nausea, insomnia, and tremor.
- Current practice: Deviations from routine height, weight, and BMI measurements can be used to identify some eating disorders.
- Assessment of risk: Athletes, women, young adults aged 18 to 29 years, and transgender individuals are more likely to have eating disorders. Certain factors such as trauma, childhood issues, perfectionism, social pressures, other mental health conditions, and genetics are associated with higher risk.
What this means for you
The recent USPSTF recommendation statement regarding screening for eating disorders acknowledged there’s insufficient evidence to recommend routine screening in individuals with no signs or symptoms of eating disorders. However, clinicians should be aware of risk factors and symptoms of eating disorders and should elicit, and listen to, patient concerns about eating. By these means, they can ensure that those who need help can access it. Decisions to screen for eating disorders should be made on an individual basis.
Disclaimer: This story is contributed by Samar Mahmoud and is a part of our Global Content Initiative, where we feature selected stories from our Global network which we believe would be most useful and informative to our doctor members.
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