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Screening for Eating Disorders

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Standardized screens for eating disorders in children and adolescents, screening guidance, and follow-up after a positive screen
Eating disorders are complex neurobiological and metabo-psychiatric illnesses with components of biological and temperamental vulnerability tempered by social and environmental factors. [Watson: 2019] Frequently overlooked and difficult to identify, body dysmorphia, maladaptive coping skills, and/or the need for control underlie many eating disorders.

Other Names

  • Anorexia nervosa (AN)
  • Avoidant restrictive food intake disorder (ARFID)
  • Binge-eating disorder (BED)
  • Bulimia nervosa (BN)

Key Points

Screen early for eating disorders
The American Academy of Pediatrics (AAP) recommend that primary care providers routinely screen for eating disorders during annual health supervision visits or sports physicals and ask surveillance questions about eating patterns and body image to all preteens and adolescents. [Hornberger: 2021] The American Academy of Child and Adolescent Psychiatry advise that mental health providers screen all child and adolescent patients for eating disorders. [Lock: 2015]
Importance of recognition
Early recognition can provide the opportunity to intervene before more severe consequences occur.
Malnutrition can occur in patients of any weight
Any concern expressed by a parent or caregiver about a child’s eating behaviors, weight, or shape should heighten concern for a possible eating disorder (current or future), regardless of their weight or BMI.
Increase screening for suicidality
While routine screening for depression and suicidality is recommended at all preventive care visits for youth ages 12-18 [Siu: 2016], suicide rates are increased in patients with eating disorders. [Hornberger: 2021] Consider more frequent screening and vigilance when an eating disorder is suspected or diagnosed.
Avoid weight stigma
Language, weight biases, and discrimination in society and healthcare settings can harm patients physically and psychologically, even when unintentional. Learn about how to recognize and reduce weight bias. See [Rubino: 2020] for an international practice guideline on this topic.

Practice Guidelines

In 2021, the American Academy of Pediatrics (AAP) updated the following guidance on recognizing, evaluating, and managing eating disorders for primary care clinicians.

Hornberger LL, Lane MA.
Identification and Management of Eating Disorders in Children and Adolescents.
Pediatrics. 2021;147(1). PubMed abstract

Prognosis

Eating disorders cause significant medical complications, including metabolic disturbances, nutritional deficiencies, hormone disruption, cardiac arrhythmias, and loss of bone mineral density. Eating disorders are also highly associated with comorbid neuropsychiatric conditions, self-harm, and suicidality. Eating disorders can be severe enough to cause significant morbidity and death. [Herpertz-Dahlmann: 2015]

Warning Signs of Eating Disorders

Teen girl looks unhappy in a bathroom mirror. Warning signs of eating disorders are numerous
Ivan Oboleninov
Preteens and adolescents may not be forthcoming when talking about eating disorders, but screening may help identify additional patients at risk for disordered eating. Some consider targeted use of eating disorder screens when concerns, including warning signs arise; yet, the number of warning signs is so extensive that it may be less complicated to perform routine screening on all patients.
Potential warning signs of eating disorders:
Growth
  • Excessive or rapid weight gain or loss
  • Failure to achieve or maintain appropriate increases in weight or height
  • Notable fluctuations in weight
Cardiovascular
  • Bradycardia or arrhythmia
  • Chest pain
  • Palpitations
  • Orthostatic tachycardia or hypotension
  • Shortness of breath
  • Edema in the extremities
  • Cardiac murmur
Gastrointestinal
Skin/Hair
  • Brittle or thinning hair or nails, or hair loss,
  • Dry, sallow skin
  • Lanugo
  • Carotenemia or carotenoderma (appearing orange),
  • Calloused knuckles
  • Poor wound healing
  • Bruising on the spine from excessive exercise
HEENT
  • Dental erosions or caries
  • Palatal abrasions
  • Aphthous ulcers
  • Angular stomatitis
  • Sialoadenitis or parotid gland enlargement
Neurological
Endocrine/ Genitourinary
  • Hypothermia/cold extremities or cold intolerance
  • Hot flashes or sweating episodes
  • Stress fractures or low bone mineral density
  • Primary or secondary amenorrhea or oligomenorrhea
Psychological

Incidence & Prevalence

Eating disorders are found in all ages, genders, sexual orientations, ethnicities, races, socio-economic statuses, and body types. Prevalence is difficult to derive due to under-recognition, changing definitions in the DSM-5, and the inclusion of those meeting criteria for atypical eating disorders. A 2011 cross-sectional survey of more than 10,000 nationally representative US adolescents ages 13-18 years had estimated prevalence rates of AN, BN, and BED at 0.3%, 0.9%, and 1.6%, respectively, with a mean age of onset = 12.5 years. [Hornberger: 2021] Another study demonstrated a higher prevalence of BED, 2-4%. The most common eating disorder in adolescents, BED, more equally affects boys and girls. [Hornberger: 2021] Although more common in older children and adolescents, eating disorders can be present in young children, with an incidence of 1-2.5% of children ages 5-12. Youth with underlying medical conditions requiring dietary control (such as diabetes, celiac disease, inflammatory bowel disease, and metabolic conditions) may be at increased risk of an eating disorder. [Hornberger: 2021] [Herpertz-Dahlmann: 2015] [Rosen: 2010]

Screens for Eating Disorders

Despite the AAP’s recommendation for routine screening of eating disorders in the primary care setting, pediatric eating disorder screens are limited. Studies continue to craft screens with higher sensitivity and specificity for use in different populations. This section includes eating disorder screens that are freely available for pediatric use.

Eating Disorders Screening Tool (NEDA)

An online, self-reported questionnaire created by the National Eating Disorders Association with approximately 20 questions, taking <5 minutes to complete. Upon completion, the site indicates level of risk and offers next steps.
  • Ages: 13 and older [Mairs: 2016]
  • Languages: English
  • Sensitivity/specificity: Likely high. 86% of NEDA’s self-selected online participants screened positive, among mostly adult respondents. NEDA’s tool is adapted from the Stanford-Washington University Eating Disorder Screen, supported by grant funding from the National Institute of Mental Health (R01 MH081125 and R01 MH100455). Question 19 is from the Primary Health Questionnaire (PHQ-9). The Stanford-Washington tool had >0.90 sensitivity and specificity for most eating disorders. [Wilfley: 2013]
  • Scoring: Automated
Freely accessible at Eating Disorders Screening Tool (NEDA).

Eating Attitudes Test (EAT-26)

Twenty-six self-reported questions using a 6-point Likert scale to assess the risk of disordered eating based on behaviors and thoughts. Initially developed in 1982, the EAT-26 has subsequently been evaluated in multiple different populations across the globe. Shorter and longer versions have also been studied, including a Children’s EAT (ChEAT or cEAT) that can be used down to age 7. One study of the cEAT showed that its sensitivity is lower than ideal for preteen girls with mild eating disorders. [Colton: 2007]
  • Ages: 13 and older [Mairs: 2016]
  • Languages: Many versions
  • Sensitivity/specificity: Unclear in pediatric population. An Irish study suggests using a shorter version, the EAT-18, for improved validity in adolescents. [McEnery: 2016]
  • Scoring: Referral is advised for a total score ≥20, any positive responses in Part C, or “extremely low” body weight compared to age-matched norms. The cutoff score of 20 for the 26-question ChEAT20 is also commonly used.
Free but requires permission to reproduce the link or download. Contact study authors to request access to the ChEAT. See Eating Attitudes Test (EAT-26, EAT-40).

Eating Disorder Screen for Primary Care (ESP)

A 5-question self-report screen derived from other eating disorder screens.
  1. Are you satisfied with your eating patterns? (A “no” to this question was classified as an abnormal response).
  2. Do you ever eat in secret? (A “yes” to this and all other questions was classified as an abnormal response).
  3. Does your weight affect the way you feel about yourself?
  4. Have any members of your family suffered from an eating disorder?
  5. Do you currently suffer with or have you ever suffered in the past with an eating disorder?
  • Ages: Normed in a broad range of ages, including a small number of adolescents
  • Languages: English
  • Sensitivity/specificity: 100%/71% from a validation study combining a primary care population with a somewhat higher-risk population of university students [Cotton: 2003]
  • Scoring: 3 or more abnormal responses are considered a positive screen for an eating disorder.
Free to use. Access questions and scoring instructions at Four Simple Questions Can Help Screen for Eating Disorders [Cotton: 2003]

Patient Health Questionnaires (PHQ)

The full version of the PHQ (e.g., not the PHQ-2 or PHQ-9) is a 3-page self-report questionnaire to screen for eating problems, depression, anxiety, alcohol use, and somatoform disorders. Questions 6 a, b, c, and question 8 pertain to bulimia nervosa and binge eating disorder.
  • Ages: Adults (extrapolated for use in children and adolescents)
  • Languages: More than 20
  • Sensitivity/specificity: 89%/96% [Striegel-Moore: 2010]
  • Scoring: Bulimia nervosa is suspected with a positive response to questions 6A, 6B, 6C, and 8; binge eating disorder if positive response to questions 6A, 6B, 6C, but negative or blank question 8.
The PHQ screens and scoring instructions can be freely accessed and downloaded at Patient Health Questionnaire (PHQ) Screeners.

The Sick, Control, One, Fat & Food (SCOFF) Questionnaire

A 5-question screen for eating disorders:
  1. Do you make yourself Sick because you feel uncomfortably full?
  2. Do you worry you have lost Control over how much you eat?
  3. Have you recently lost more than 14 lb (6.3 kg or One stone) in a 3-month period?
  4. Do you believe yourself to be Fat when others say you are too thin?
  5. Would you say that Food dominates your life?
It is validated in adults and tested widely in different populations internationally, including some adolescents. [Rosen: 2010]
  • Ages: Adults (extrapolated for use in adolescents)
  • Languages: Translated into many languages for different studies
  • Sensitivity/specificity: A 2017 multi-ethnic study in London found 54%/94%, suboptimal for a general population screen. [Solmi: 2015] Prior to that, the SCOFF was found to have 85%/90% relatively in a relatively homogeneous primary care setting in London (not pediatric-specific). [Hill: 2010]
  • Scoring: One point should be given for every “yes” answer; a score of 2 or higher indicates a likelihood of an eating disorder. A cutoff point of 2 is advised.
The SCOFF is freely accessible at The SCOFF: A Quick Assessment for Eating Concerns (PDF Document 234 KB).

Children’s Eating Disorder Examination-Questionnaire (ChEDE-Q8)

An 8-item self-report to screen for anorexia nervosa, bulimia nervosa, and binge‐eating disorder. [Kliem: 2017] A related version, the Youth Eating Disorder Examination-Questionnaire (YEDE-Q), was studied in 2007. [Goldschmidt: 2007]
  • Ages: Best for 8-14 yrs, but studied in ages 7-18
  • Language: German, English (the versions vary slightly)
  • Sensitivity/specificity: N/A. strong initial validation study.
  • Scoring: Scoring is 0-6 for each question. The article provides a table by age and sex to determine cutoff percentiles. >=90%ile considered a critical result.
The author granted permission for the screen to be reproduced freely for research purposes. See Children’s Eating Disorder Examination-Questionnaire (ChEDE-Q8) (Word Document 17 KB).

Adolescent Binge Eating Questionnaire (ADO-BED)

A 10-item questionnaire (Adolescent Binge Eating Scale) developed for the prediction of a binge eating disorder (BED) diagnosis in adolescents seen for obesity.
  • Ages: 12-18 years
  • Languages: English
  • Sensitivity/specificity: 83%/96%
  • Scoring: A positive response to questions 1 or 2 plus more than 6 positive responses to questions 3-10 identifies those at high risk for BED; a score of 3 or fewer indicates a low likelihood of BED.
Free to download at Adolescent Binge Eating Scale (ADO-BED) Questionnaire (PDF Document 268 KB).

What to Do With a Positive Screen

Carefully assess each situation for the possibility of an eating disorder and closely monitor at intervals as frequent as every 1 to 2 weeks until the situation is clarified.
Suspected eating disorders: [Medical: 2016]
  • Check CBC, CMP, and electrocardiogram (ECG) in all. See Eating Disorders: A Guide to Medical Care (PDF Document 364 KB).
  • Selective use of the following tests: leptin level, TSH and T4, amylase and lipase, gonadotropins (LH, FSH) and sex steroids (estradiol, testosterone), Dual Energy X-ray Absorptiometry (DEXA).
  • Consider performing a longer diagnostic evaluation using the Eating Disorders: Diagnostic Measures (E-CBT), which is validated in adults and children down to age 9 (considered the gold standard for diagnosis), or a modified version, the children’s EDE (also see Eating Disorders: Diagnostic Measures (E-CBT)), which can be used for younger children down to age 8.
  • Consider symptom-based referrals to a pediatric cardiologist, endocrinologist, psychiatrist, behavioral health specialist, and/or pediatric gynecologist.
  • Consider hospitalization and/or referral to a multidisciplinary eating disorders program. These usually include some or all of the following: psychiatrist, family therapist, psychologist, pediatrician, nurse, dietician, and other therapists.
  • Evaluate for comorbid conditions, such as Depression , Anxiety Disorders, or Obsessive-Compulsive Disorder (OCD).
  • Consider symptom-based referrals to a pediatric cardiologist, endocrinologist, psychiatrist, behavioral health specialist, and/or pediatric gynecologist.
  • For adolescents with anorexia nervosa, consider referral for family-based treatment; these patients may be less responsive to antidepressants. [Harrington: 2015]
  • For adolescents with bulimia nervosa, refer for short-term psychotherapy (e.g., cognitive-behavior therapy) and consider antidepressant medications. [Harrington: 2015]
For extended guidance about diagnosis and treatment, see Resources below.

Services & Referrals

A multidisciplinary team, coordinated by the primary care clinician or a psychiatric provider, is generally advised for outpatient treatment of eating disorders. The team ideally includes a primary care clinician, a psychiatrist, a dietician with experience in eating disorders, and a therapist. Members of the team should initially plan to see the individual 1-4 times per month, depending on severity. Additional consultants may be advised; guidance for referrals follows:
Psychiatry > … (see RI providers [89])
Refer for difficult-to-manage behavioral problems or consultation on pharmacological management.
Nutrition Assessment Services (see RI providers [2])
Refer to a registered dietician or nutritionist experienced in eating disorders to implement a nutritional treatment plan, guide a healthy diet and exercise, and discuss behaviors related to food and eating. Look for registered dieticians and other providers specialized in eating disorders who have obtained certification as a Certified Eating Disorder Specialist (CEDS) through the International Association of Eating Disorders Professionals Foundation (iaedp).
Eating Disorders Counseling (see RI providers [1])
Refer for ongoing monitoring and treatment of mental health issues, cognitive behavioral therapy, family therapy, and support.
Pediatric Gastroenterology (see RI providers [19])
Refer for digestive system consequences of disordered eating behaviors.
Obstetrics & Gynecology (see RI providers [6])
Refer for menstrual dysfunction (delayed menarche, oligomenorrhea, and amenorrhea).
Pediatric Sports Medicine (see RI providers [7])
Refer for evaluation and management of the athletes with low energy availability, bone mineral loss, and (when relevant) menstrual dysfunction.
Pediatric Orthopedics (see RI providers [16])
Refer for bone health issues (e.g., stress fractures).
Pediatric Endocrinology (see RI providers [13])
Refer for growth, menstrual disturbance, and concurrent conditions (e.g., thyroid disease or osteopenia/osteoporosis Osteoporosis and Pathologic Fractures).
Adolescent Medicine (see RI providers [8])
Refer for medical care and emotional issues of teens.
Developmental - Behavioral Pediatrics (see RI providers [12])
Refer for medical and emotional issues of children, adolescents, and their families, and for assistance in diagnosing suspected neurodevelopmental disorders like autism spectrum disorder.

Resources

Information & Support

Related Portal content: ICD-10-CM codes
  • Z13.21, Encounter for screening for nutritional disorder
  • F50.9, Eating disorder, unspecified
CPT codes
  • 96160, Instrument-based health risk assessment (e.g., mini-nutritional assessment, HEADDSSS questionnaires)
  • 96127, Instrument-based assessment of potential emotional or behavioral conditions (e.g., depression screen)

For Professionals

National Eating Disorders Association (NEDA)
A nonprofit organization dedicated to supporting individuals and families affected by eating disorders. Serves as a catalyst for prevention, cures, and access to quality care.

Eating Disorders: A Guide to Medical Care (PDF Document 364 KB)
Promotes recognition and prevention of medical morbidity and mortality associated with eating disorders using current research and best practices. 2016/3rd Edition; Academy for Eating Disorders Medical Care Standards Committee.

NICE Guideline: Recognition and Treatment of Eating Disorders
Assessment, treatment, monitoring, and inpatient care for those with eating disorders. Details the most effective treatments for anorexia nervosa, binge eating disorder, and bulimia nervosa; National Institute for Health and Care Excellence (United Kingdom).

International Association of Eating Disorders Professionals Foundation (iaedp)
Provides education and high-level training standards to an international multidisciplinary group of various healthcare treatment providers and helps professionals who treat the full spectrum of eating disorder problems.

Disordered Eating Didactic Presentation Slides (MAPP-Net) (PDF Document 280 KB)
A 26-minute Project Echo presentation including medical evaluation, binge eating/purging signs, physical findings, laboratory abnormalities, admission criteria (SAHM), refeeding syndrome, goal weight, outpatient medical care; Montana Access to Pediatric Psychiatry Network.

Disordered Eating Didactic Presentation Recording (MAPP-Net)
A Project Echo presentation about the medical evaluation; signs of disordered eating, binge eating, and purging; physical findings, laboratory abnormalities, admission criteria (SAHM), refeeding syndrome, goal weight, and outpatient medical care. Recorded December 11, 2019. Presenter Adrienne Coopey, DO; Montana Access to Pediatric Psychiatry Network.

Research Roundup with Dr. Lewis First, Clinical Report on Eating Disorders (AAP)
This 33-minute podcast from the Pediatrics On Call series discusses highlights of the American Academy of Pediatrics (AAP)'s Committee on Adolescence 2021 clinical report on Eating Disorders. Aired on Feb. 2, 2021.

For Parents and Patients

National Eating Disorders Association (NEDA)
A nonprofit organization dedicated to supporting individuals and families affected by eating disorders. Serves as a catalyst for prevention, cures, and access to quality care.

Energy In: Recommended Food & Drink Amounts for Children (HealthyChildren.org)
A pediatrician-approved resource with caloric needs, recommended food group servings, and portion sizes.

Practice Guidelines

Hornberger LL, Lane MA.
Identification and Management of Eating Disorders in Children and Adolescents.
Pediatrics. 2021;147(1). PubMed abstract
This clinical report includes a review of common eating disorders diagnosed in children and adolescents, outlines the medical evaluation of patients suspected of having an eating disorder, presents an overview of treatment strategies, and highlights opportunities for advocacy; Committee on Adolescence, American Academy of Pediatrics.

Lock J, La Via MC.
Practice parameter for the assessment and treatment of children and adolescents with eating disorders.
J Am Acad Child Adolesc Psychiatry. 2015;54(5):412-25. PubMed abstract
This practice parameter from the American Academy of Child and Adolescent Psychiatry reviews evidence-based practices for the evaluation and treatment of eating disorders in children and adolescents.

Rubino F, Puhl RM, Cummings DE, Eckel RH, Ryan DH, Mechanick JI, Nadglowski J, Ramos Salas X, Schauer PR, Twenefour D, Apovian CM, Aronne LJ, Batterham RL, Berthoud HR, Boza C, Busetto L, Dicker D, De Groot M, Eisenberg D, Flint SW, Huang TT, Kaplan LM, Kirwan JP, Korner J, Kyle TK, Laferrère B, le Roux CW, McIver L, Mingrone G, Nece P, Reid TJ, Rogers AM, Rosenbaum M, Seeley RJ, Torres AJ, Dixon JB.
Joint international consensus statement for ending stigma of obesity.
Nat Med. 2020;26(4):485-497. PubMed abstract / Full Text
To inform healthcare professionals, policymakers, and the public about this issue, a multidisciplinary group of international experts, including representatives of scientific organizations, reviewed available evidence on the causes and harms of weight stigma and developed a joint consensus statement with recommendations to eliminate weight bias.

Patient Education

Eating Disorders: About More Than Food (NIMH)
Patient education about eating disorders that can be printed as a PDF; National Institute of Mental Health.

What Is an Eating Disorder? (NEDA brochure)
2-page colorful, printable brochure (8.5 x 14') explaining eating disorders and how to seek help; National Eating Disorders Association.

Eating Disorders: Conversation Tips for Friends & Family (PDF Document 129 KB)
Two-page handout explaining how and how not to talk about suspected eating disorders; Intermountain Healthcare.

Tools

Eating Disorders Screening Tool (NEDA)
Online, self-reported questionnaire for those 13 years and older with approximately 20 questions, taking <5 minutes to complete. Upon completion, the site indicates level of risk and offers next steps; National Eating Disorders Association.

Eating Attitudes Test (EAT-26, EAT-40)
Screens (26 or 40 questions) to assess risk of disordered eating based on behaviors and thoughts. Uses the EAT score in combination with BMI and patterns of recent weight loss to recommend need for further evaluation. Free, but requires permission to reproduce link or download.

Patient Health Questionnaire (PHQ) Screeners
Free screening tools in many languages with scoring instructions to be used by clinicians to help detect mental health disorders. Select from right menu: PHQ, PHQ-9, GAD-7, PHQ-15, PHQ-SADS, Brief PHQ, PHQ-4, PHQ-8.

Adolescent Binge Eating Scale (ADO-BED) Questionnaire (PDF Document 268 KB)
10-question screen developed to identify obese adolescents at risk for binge eating disorder (BED)

The SCOFF: A Quick Assessment for Eating Concerns (PDF Document 234 KB)
A 5-question screen developed for primary care clinicians to screen for eating problems.

Children’s Eating Disorder Examination-Questionnaire (ChEDE-Q8) (Word Document 17 KB)
An 8-item self-report to screen for anorexia nervosa, bulimia nervosa, and binge‐eating disorder in children ages 12-18.

Adolescent Binge Eating Scale (ADO-BED) Questionnaire (PDF Document 268 KB)
10-question screen developed to identify obese adolescents at risk for binge eating disorder (BED)

Management of Eating Disorders Care Process Model (Intermountain) (PDF Document)
This care process model (CPM) and accompanying patient education were developed by a multidisciplinary team including primary care physicians (PCPs), mental health specialists, registered dietitians, and eating disorder specialists, under the leadership of Intermountain Healthcare’s Behavioral Health Clinical Program. Based on national guidelines and emerging evidence and shaped by local expert opinion, this CPM provides practical strategies for early recognition, diagnosis, and effective treatment of anorexia nervosa, bulimia nervosa, binge-eating disorder, and other eating disorders.

Dietary Reference Intake Calculator for Healthcare Professionals (USDA)
Calculates daily nutrient recommendations established by the Health and Medicine Division of the National Academies of Sciences, Engineering and Medicine. Represents current scientific knowledge; however, individual requirements may be higher or lower than recommendations. Entering height, weight, age, and activity level generates BMI, estimated daily calorie needs, and recommended intakes of macronutrients, vitamins, and minerals based on DRI data. For use with ages 3 and older; US Dept. of Agriculture.

Services for Patients & Families in Rhode Island (RI)

For services not listed above, browse our Services categories or search our database.

* number of provider listings may vary by how states categorize services, whether providers are listed by organization or individual, how services are organized in the state, and other factors; Nationwide (NW) providers are generally limited to web-based services, provider locator services, and organizations that serve children from across the nation.

Helpful Articles

Harrington BC, Jimerson M, Haxton C, Jimerson DC.
Initial evaluation, diagnosis, and treatment of anorexia nervosa and bulimia nervosa.
Am Fam Physician. 2015;91(1):46-52. PubMed abstract
Recommendations for primary care clinicians on anorexia and bulimia, based on DSM-5 diagnostic criteria. Includes information relevant for adolescents and adults.

Herpertz-Dahlmann B.
Adolescent eating disorders: update on definitions, symptomatology, epidemiology, and comorbidity.
Child Adolesc Psychiatr Clin N Am. 2015;24(1):177-96. PubMed abstract
Conveys the basic knowledge of these frequent and disabling disorders and reviews new classification issues resulting from the transition to DSM-5.

Brigham KS, Manzo LD, Eddy KT, Thomas JJ.
Evaluation and Treatment of Avoidant/Restrictive Food Intake Disorder (ARFID) in Adolescents.
Curr Pediatr Rep. 2018;6(2):107-113. PubMed abstract / Full Text
Information for pediatricians should be aware of the diagnostic criteria and management of adolescent patients with ARFID.

Watson HJ et al.
Genome-wide association study identifies eight risk loci and implicates metabo-psychiatric origins for anorexia nervosa.
Nat Genet. 2019;51(8):1207-1214. PubMed abstract / Full Text
The results of this study encourage a reconceptualization of anorexia nervosa as a metabo-psychiatric disorder. Elucidating the metabolic component is a critical direction for future research, and paying attention to both psychiatric and metabolic components may be key to improving outcomes.

Authors & Reviewers

Initial publication: February 2021; last update/revision: August 2022
Current Authors and Reviewers:
Authors: Jennifer Goldman, MD, MRP, FAAP
Reviewer: Maryrose Bauschka, MD, CEDS

Page Bibliography

Colton PA, Olmsted MP, Rodin GM.
Eating disturbances in a school population of preteen girls: assessment and screening.
Int J Eat Disord. 2007;40(5):435-40. PubMed abstract
Study assessed the utility of the Children's Eating Attitudes Test (cEAT) questionnaire in screening for interview-ascertained eating disturbances but found that t cEAT was not an efficient screening tool for interview-ascertained mild eating disturbances in preteen girls.

Cotton MA, Ball C, Robinson P.
Four simple questions can help screen for eating disorders.
J Gen Intern Med. 2003;18(1):53-6. PubMed abstract / Full Text
A study comparing the performance characteristics of 2 eating disorder screening tools, the SCOFF clinical prediction guide, and a new set of questions, the Eating disorder Screen for Primary care (ESP).

Goldschmidt AB, Doyle AC, Wilfley DE.
Assessment of binge eating in overweight youth using a questionnaire version of the Child Eating Disorder Examination with Instructions.
Int J Eat Disord. 2007;40(5):460-7. PubMed abstract / Full Text
A study validating the Youth Eating Disorder Examination-Questionnaire (YEDE-Q), a self-report version of the Child Eating Disorder Examination (ChEDE), to assess the spectrum of ED psychopathology in youth.

Harrington BC, Jimerson M, Haxton C, Jimerson DC.
Initial evaluation, diagnosis, and treatment of anorexia nervosa and bulimia nervosa.
Am Fam Physician. 2015;91(1):46-52. PubMed abstract
Recommendations for primary care clinicians on anorexia and bulimia, based on DSM-5 diagnostic criteria. Includes information relevant for adolescents and adults.

Herpertz-Dahlmann B.
Adolescent eating disorders: update on definitions, symptomatology, epidemiology, and comorbidity.
Child Adolesc Psychiatr Clin N Am. 2015;24(1):177-96. PubMed abstract
Conveys the basic knowledge of these frequent and disabling disorders and reviews new classification issues resulting from the transition to DSM-5.

Hill LS, Reid F, Morgan JF, Lacey JH.
SCOFF, the development of an eating disorder screening questionnaire.
Int J Eat Disord. 2010;43(4):344-51. PubMed abstract
This article describes the three-stage development of the SCOFF, a screening tool for eating disorders.

Hornberger LL, Lane MA.
Identification and Management of Eating Disorders in Children and Adolescents.
Pediatrics. 2021;147(1). PubMed abstract
This clinical report includes a review of common eating disorders diagnosed in children and adolescents, outlines the medical evaluation of patients suspected of having an eating disorder, presents an overview of treatment strategies, and highlights opportunities for advocacy; Committee on Adolescence, American Academy of Pediatrics.

Kliem S, Schmidt R, Vogel M, Hiemisch A, Kiess W, Hilbert A.
An 8-item short form of the Eating Disorder Examination-Questionnaire adapted for children (ChEDE-Q8).
Int J Eat Disord. 2017;50(6):679-686. PubMed abstract
A psychometric evaluation of a short form of the child version of the Eating Disorder Examination (ChEDE‐Q) to provide a valid self‐report assessment of eating disorder psychopathology in children.

Lock J, La Via MC.
Practice parameter for the assessment and treatment of children and adolescents with eating disorders.
J Am Acad Child Adolesc Psychiatry. 2015;54(5):412-25. PubMed abstract
This practice parameter from the American Academy of Child and Adolescent Psychiatry reviews evidence-based practices for the evaluation and treatment of eating disorders in children and adolescents.

Mairs R, Nicholls D.
Assessment and treatment of eating disorders in children and adolescents.
Arch Dis Child. 2016;101(12):1168-1175. PubMed abstract
This review article focuses on the psychiatric assessment and treatment of four feeding or eating disorders: anorexia nervosa, avoidant-restrictive food intake disorder, bulimia nervosa and binge eating disorder. The article emphasizes the importance of a family-focused, developmentally appropriate and multidisciplinary approach to care but does not address medical assessment and treatment.

McEnery F, Fitzgerald A, McNicholas F, Dooley B.
Fit for Purpose, Psychometric Assessment of the Eating Attitudes Test-26 in an Irish Adolescent Sample.
Eat Behav. 2016;23:52-57. PubMed abstract
This study examined the psychometric properties of the original Eating Attitudes Test-26 (EAT-26) and explained why a revised, six-factor EAT-18 model may be more suitable for the general adolescent population.

Medical Care Standards Committee.
Eating Disorders: A Guide to Medical Care.
Academy for Eating Disorders. 3rd ed; 2016. / https://www.aedweb.org/resources/online-library/publications/medical-c...
Critical Points for Early Recognition & Medical Risk Management in the Care of Individuals with Eating Disorders

Rosen DS.
Identification and management of eating disorders in children and adolescents.
Pediatrics. 2010;126(6):1240-53. PubMed abstract
This AAP clinical report includes a discussion of diagnostic criteria and outlines the initial evaluation, treatment including pharmacotherapy, and monitoring of the patient with disordered eating. Reaffirmed Feb 2018

Rubino F, Puhl RM, Cummings DE, Eckel RH, Ryan DH, Mechanick JI, Nadglowski J, Ramos Salas X, Schauer PR, Twenefour D, Apovian CM, Aronne LJ, Batterham RL, Berthoud HR, Boza C, Busetto L, Dicker D, De Groot M, Eisenberg D, Flint SW, Huang TT, Kaplan LM, Kirwan JP, Korner J, Kyle TK, Laferrère B, le Roux CW, McIver L, Mingrone G, Nece P, Reid TJ, Rogers AM, Rosenbaum M, Seeley RJ, Torres AJ, Dixon JB.
Joint international consensus statement for ending stigma of obesity.
Nat Med. 2020;26(4):485-497. PubMed abstract / Full Text
To inform healthcare professionals, policymakers, and the public about this issue, a multidisciplinary group of international experts, including representatives of scientific organizations, reviewed available evidence on the causes and harms of weight stigma and developed a joint consensus statement with recommendations to eliminate weight bias.

Siu AL.
Screening for Depression in Children and Adolescents: US Preventive Services Task Force Recommendation Statement.
Pediatrics. 2016;137(3):e20154467. PubMed abstract

Solmi F, Hatch SL, Hotopf M, Treasure J, Micali N.
Validation of the SCOFF questionnaire for eating disorders in a multiethnic general population sample.
Int J Eat Disord. 2015;48(3):312-6. PubMed abstract / Full Text
A study aimed to validate the SCOFF, an eating disorders (ED) screening questionnaire, in a multi-ethnic general population sample of adults.

Striegel-Moore RH, Perrin N, DeBar L, Wilson GT, Rosselli F, Kraemer HC.
Screening for binge eating disorders using the Patient Health Questionnaire in a community sample.
Int J Eat Disord. 2010;43(4):337-43. PubMed abstract / Full Text

Watson HJ et al.
Genome-wide association study identifies eight risk loci and implicates metabo-psychiatric origins for anorexia nervosa.
Nat Genet. 2019;51(8):1207-1214. PubMed abstract / Full Text
The results of this study encourage a reconceptualization of anorexia nervosa as a metabo-psychiatric disorder. Elucidating the metabolic component is a critical direction for future research, and paying attention to both psychiatric and metabolic components may be key to improving outcomes.

Wilfley DE, Agras WS, Taylor CB.
Reducing the burden of eating disorders: a model for population-based prevention and treatment for university and college campuses.
Int J Eat Disord. 2013;46(5):529-32. PubMed abstract / Full Text