New Screen Offers Faster, More Accurate Detection of Disordered Eating in Teen Athletes

Michael Vlessides

October 31, 2019

CHICAGO — A new screening tool may offer a more rapid and accurate screen for disordered eating in adolescent athletes, new research shows.

Investigators at Michigan State University College of Human Medicine in East Lansing found the six-item Disordered Eating Screen for Athletes (DESA-6) screen yielded higher sensitivity and specificity compared to the Eating Attitudes Test (EAT-26) and in a fraction of the time.

"In addition to demonstrating the viability of the DESA-6 as a screening tool, our study also showed just how common disordered eating is among high school athletes," study investigator Samantha Kennedy, DO, told Medscape Medical News. "We found a prevalence of almost 10%, which is why we believe that having a valid screening tool is so important."

The investigators note that the DESA-6 can be used by a variety of professionals to quickly and effectively screen young athletes, who are particularly vulnerable to disordered eating.

The findings were presented here at the American Academy of Child & Adolescent Psychiatry (AACAP) 66th Annual Meeting.

Big Problem

Disordered eating is a growing concern among teen athletes, resulting in a host of negative sequelae, both mental and physical. Even more concerning is the fact that untreated disordered eating can progress to a clinical eating disorder, which has itself been associated with a series of potentially life-threatening complications. 

Given the potential severity of disordered eating in athletes, several sports-related organizations have released statements in support of regular screening, using a tool specifically designed for athletes.

Unfortunately, current tools are not applicable to the entire athletic population. For example, four such tools have only been validated in female athletes, and none has been validated in a variety of sports and competition levels.

In comparison, the DESA-6 is designed to take a broader approach to testing for disordered eating. The tool was previously tested in an adult athlete population (ages 18 to 65) of all genders, in all sports, and in all levels of competition, yielding acceptable specificity and sensitivity.

"I spent four years racing as a professional triathlete and have seen fellow athletes struggle with eating problems. When I started looking into it, I saw there wasn't a screening tool that could be used by everyone. So I developed the DESA-6," Kennedy said.

"I really wanted something that could be administered quickly and easily because it's a big problem, and one that's not being currently recognized," she added.

To help test the potential applicability of the DESA-6, the investigators enrolled 303 athletes (ages 12 to 19) into the first phase of the trial. All participants completed a paper survey comprising a series of demographic questions and anthropometric questions, as well as the DESA-6 and the EAT-26. The only criteria for athletes was that they be enrolled in a high school-sponsored sport.

"The EAT-26 is not a great tool for use in athletes, but it's the best we have," said Kennedy.

In the second phase of the study, 42 participants with EAT-26 scores ≥13 (indicating potential clinical concern for eating disorder/disordered eating) were invited to participate in a clinical interview. Roughly the same number (41 participants) with negative EAT-26 scores underwent the same interview process and served as controls.

The clinical interview included the Eating Disorder Examination (version 17), a semi-structured interview that is considered the current gold standard for diagnosing eating disorders.

"A positive score on the EAT-26 is actually 20 or greater, but that's for eating disorders," Kennedy noted. "We wanted to identify disordered eating before it becomes a full-blown disorder, because there are much better outcomes if you can identify it early."

"Only a Minute or Two"

Analyses of the novel tool's reliability relative to the EAT-26 yielded promising results. In the first phase, specificity was 80.6%, while sensitivity was 80%.

These figures improved in the second phase, where specificity was 93.85% and sensitivity 84.21% relative to the EAT-26. Similarly, Cronbach's alpha was 0.7154, while the Pearson correlation coefficient was 0.7822.

The strength of the DESA-6 lies in its simplicity and broad applicability. With only six questions, the screen can be administered to all adolescent athletes in a minute or two, obviating the need for more involved, time-consuming tests.   

Most importantly, it helps identify people at risk of eating disorders before they progress to that stage, opening the door to more personalized care.

"The dream would be for this screening tool to be given in a variety of environments, because these kids aren't being screened for this. You go into an office and you might be screened for depression or anxiety or a host of other things, but there is no screening for eating disorders, Kennedy said.

"Nevertheless, I think eating disorders are going to keep growing. So we need to be better at recognizing this and getting kids the treatment they need before it becomes a full-blown disorder like anorexia," she added.

Commenting on the findings for Medscape Medical News, Bettina Bernstein, DO, clinical assistant professor of psychiatric medicine at Philadelphia College of Osteopathic Medicine in Pennsylvania, agreed that the advent of the DESA-6 has the potential to change the way adolescent athletes are screened for disordered eating.

"This is very exciting and potentially helpful as it is a brief screen," said Bernstein, who was not involved with the current research. "Younger athletes are at high risk for eating disorders."

Kennedy and Bernstein have disclosed no relevant financial relationships.

American Academy of Child & Adolescent Psychiatry (AACAP) 66th Annual Meeting: Abstract 1.7. Presented October 16, 2019.

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