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Evidence for Eating Disorder Screening in Asymptomatic Individuals “Insufficient,” Says USPSTF
The US Preventative Services Task Force (USPSTF) deemed existing evidence for screening for eating disorders in asymptomatic adolescents and adults "insufficient" based on a 57-study evidence report. The USPSTF recommendation applies to adolescents and adults with normal or high body mass index (BMI) who do not display symptoms of an eating disorder.
Cynthia Feltner, MD, MPH, of the University of North Carolina at Chapel Hill, and colleagues conducted the evidence to inform a recommendation by the USPSTF. Researchers evaluated 57 studies with 10,773 participants investigating screening adolescents and adults for eating disorders for populations and settings relevant to primary care in the US.
Eating disorders "are characterized by a persistent disturbance of eating or eating-related behavior that results in the altered consumption or absorption of food that significantly impairs physical health or psychosocial functioning," according to the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition.
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Of the included studies, 17 evaluated screening test accuracy, 11 assessed the 5-item SCOFF questionnaire, and 40 randomized clinical trials (RCTs) evaluated eating disorder interventions. The SCOFF questionnaire had a pooled specificity of 80% in adults and 73% in adolescents. Based on these data and data that found the Eating Disorder Screen for Primary Care had a sensitivity of 97%, the USPSTF determined there is inadequate evidence for adolescents, men, and other populations.
"It is important to note that the insufficient evidence statement is not a recommendation for or against screening, but rather that there is not enough evidence to make a recommendation either way," wrote Jason M. Nagata, MD, MSc, and co-author Neville H. Golden, MD, of Stanford University in California in their JAMA Internal Medicine editorial.
The USPSTF recommends that clinicians assess eating disorders based on signs or symptoms, including preoccupation with weight, food, eating, appearance, and calories, and engaging in weight-control behaviors, such as fasting, skipping meals, and vomiting to lose weight.
"Research on benefits and harms of screen-detected populations from primary care settings is needed because no studies assessing this question were identified. In particular, studies of screening and treatment in adolescents, men, racial and ethnic minority groups, and sexual and gender minority groups are needed to move beyond the insufficient evidence recommendation," Nagata and Golden concluded.
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