Quality Measures Database

Diagnosis and initiation of treatment at very early stages of the disease, when little or minimum intervention can bring therapeutic results (e.g., within the first two years of illness).
Additional Domain(s) : Accessibility, Patients with Eating Disorders

Early detection and treatment of eating disorders may improve outcomes in eating disorders. General practitioners and other members of the primary care team are in a good position to identify patients with eating problems early. Screening tools may facilitate this process. The most effective screening device probably remains the general practitioner thinking about the possibility of an eating disorder.
It would be impractical for general practitioners to try and screen all their patients for eating disorders, as the prevalence of eating disorders in the general population is low. It might be possible to screen new patients when they register. One or two screening questions could be used to raise the index of suspicion, either verbally during the registration health check or in writing as part of the registration questionnaire.
High-risk groups within the general practice population could be targeted
opportunistically. Such groups include young women, patients with a low or high BMI, adolescents consulting with weight concerns, menstrual disturbances or amenorrhoea, gastrointestinal disorders and psychological problems. A brief screening questionnaire could be used for such high-risk groups.
A number of brief screening methods have been developed that have some utility in detecting eating disorders. The SCOFF has been shown to be capable of determining cases of eating disorders in adult women in primary care. The place of longer questionnaires (e.g. EAT, EDI, BITE, EDE-Q) may be in further assessment, once index of suspicion has been raised. They may also be useful to facilitate decisions regarding referral to secondary care or other specialist services. Certain clinical presentations should also raise the index suspicion, for example, adolescent girls with concerns about weight, and women consulting with menstrual disturbances, gastrointestinal or psychological symptoms.
A range of questionnaires exists of which the Eating Attitudes Test, EAT (Garner & Garfinkel, 1979) is probably the most widely used as a screening tool in epidemiological studies. In addition there are a number of other pencil and paper measures to assess eating disorder psychopathology (e.g. the Eating Disorder Inventory, EDI Garner et al., 1983). However, these take a long time to administer and may need to be interpreted by specialists. Such instruments may be well suited for evaluating treatment progress in patients with eating disorders, but may not perform well in screening for eating disorders in community samples due to symptom denial and low prevalence (Williams et al., 1982; Carter & Moss, 1984).
Questionnaires of this type may have a role for screening in very high-risk groups in special settings, e.g. in ballet schools, fitness and sports facilities. They may have occasional application in general practice, when a patient with a probable eating disorder has already been identified.
Several brief screening questionnaires, more suitable for use in community samples, have been developed and evaluated. These include the SCOFF (Morgan et al., 1999), Anstine and Grinenko (2000), the BITE and the BES (Ricca et al., 2000), the EDS-5 (Rosenvinge, 2001), Freund et al. (1993), the ESP (Cotton et al., 2003), Ri-BED-8 (Waaddegaard et al.,1999), the EDDS (Stice et al., 2000), the EAT-12 and the EDE-S/Q (Beglin & Fairburn,1992, 1994). The most promising to date is the SCOFF.
The SCOFF questionnaire (Morgan et al., 1999; Luck et al., 2002; Perry et al., 2002) consists of five questions designed to clarify suspicion that an eating disorder might exist rather than to make a diagnosis. The questions can be delivered either verbally or in written form and there is one study validating the use of the SCOFF in adult women in a general practice population (Luck, 2002). Further research is needed to evaluate the SCOFF questions in general practice populations before they can be recommended for use in primary care.

NICE Eating Disorders. Core interventions in the treatment and management of the anorexia nervosa, bulimia nervosa and related eating disorders. Clinical Guideline 9. January 2004. Section 4.3.1.2, pp: 63; Section 5.2.5.4, pp: 79  Retrieved on August 3, 2006 from:http://www.nice.org.uk/page.aspx?o=cg009niceguidance

IV: Evidence based on individual expert opinion.

• This type of investigation may not be effective as most people with this disorder do not realise they have a problem. Input from the family is indispensable.
• Obesity and anorexia are key health risks.
• I think it is more neutral to ask as part of regular physical, what you believe you ideal weight to be. There are many hidden eating disorders and this line of questioning is less stigmatizing than "Do you worry excessively?"

Ratings-based Rank Relevance 94 Actionability 22 Overall Importance 101		Stakeholder Rank Academics 68 Clinicians 65 Consumers 87 Decision Makers 76 �		Special Group Rank First Nations 83 Rural Areas 108 Federal Stakeholders 77
Regional Rank BC AB SK MB ON QC NB NS PE NL YT NT NU 94 75 54 67 74 95 108 56 38 17 58 73 37				Overall Rank        74