Not enough evidence to recommend for or against screening for eating disorders, Task Force says

In a recent statement, the U.S. Preventive Services Task Force found that the current evidence was insufficient to assess the balance of benefits and harms of screening for eating disorders in adolescents and adults.

The Task Force, which had not previously made a recommendation on this topic, commissioned a systematic review to evaluate the benefits and harms of screening for eating disorders in those ages 10 years and older with a normal or high body mass index. The review did not consider evidence limited to populations who are underweight or who have other physical signs or symptoms of eating disorders (e.g., rapid weight loss, weight gain, or pronounced deviation from growth trajectory; pubertal delay; bradycardia; oligomenorrhea; and amenorrhea). The recommendation statement and evidence report were published March 15 by JAMA.

The review found no trials that directly assessed the benefits or harms of screening for eating disorders. Among other limitations of the available evidence, most studies of screening test accuracy assessed the SCOFF questionnaire in adult women, but few evaluated screening tools in men, adolescents, or other populations, the authors noted. They concluded that more studies are needed in several areas, including the potential harms of screening, such as labeling and false-positive results, and enrollment of screen-detected populations from general primary care settings in trials that focus on health outcomes.

One barrier limiting the ability of studies to link screening in primary care to health benefits or harms is that eating disorder care typically involves an interdisciplinary approach, including behavioral, medical, and nutritional specialists, noted an accompanying editorial published in JAMA Internal Medicine. Even if primary care clinicians screen for eating disorders, treatment services are often limited to specialty or academic centers that may have long wait lists, the editorial said.

“Therefore, easy and quick access to specialists from primary care or development of primary care interventions for eating disorders are needed to demonstrate a benefit for those who have positive screens for eating disorders in primary care,” the editorialists wrote. “Without access to care, identifying eating disorders by screening could create anxiety while awaiting specialty care or the stigma associated with a presumed eating disorder diagnosis, which could be potential harms.”

Finally, clinicians should not assume that the lack of a Grade A, B, or C recommendation by the Task Force on screening for eating disorders changes any of the current recommendations for screening higher-risk individuals, according to another editorial in JAMA. “An I statement is not a recommendation for or against screening but rather indicates there is insufficient evidence to make a recommendation either way,” the editorialists wrote. “Clinicians are encouraged to use their clinical judgment in deciding whether or not to screen.”

A cover article in the February 2021 ACP Internist explained why eating disordered behaviors are on the rise and how internists can spot symptoms in their adult patients.