Jury Is Out on Universal Screening for Eating Disorders

Megan Brooks

March 22, 2022

There is insufficient evidence to weigh the balance of benefits and harms of screening for eating disorders in adolescents and adults, the US Preventive Services Task Force (USPSTF) says in their first-ever statement on the topic.

Eating disorders (binge eating disorder, bulimia nervosa, and anorexia nervosa) can cause "serious harms to physical and psychosocial health and take a tremendous toll on individuals and families," task force member Lori Pbert, PhD, told Medscape Medial News.

"Screening for eating disorders has the potential to improve health by leading to early detection and effective treatment," said Pbert, with the Department of Population and Quantitative Health Sciences, UMass Chan Medical School, Worcester, Massachusetts.

However, a "deep dive" into the available literature failed to turn up adequate evidence to recommend for or against routine screening for eating disorders for children and adolescents aged 10 years and older and for adults who have no signs or symptoms of an eating disorder or concerns about their eating and who have not previously been diagnosed with an eating disorder, Pbert said.

The task force, therefore, issued an "I" statement (insufficient evidence), meaning it cannot at this time recommend for or against screening for eating disorders.

An "I" statement is "fundamentally a call for more research," Pbert noted.

Adolescents and adults who have signs and symptoms of an eating disorder ― which include rapid weight loss; weight gain or pronounced deviation from growth trajectory; pubertal delay; bradycardia; oligomenorrhea; and amenorrhea ― are not included in this recommendation.

The USPSTF recommendation statement and accompanying evidence report were published online March 15 in JAMA.

Clinical Judgment Key

In the absence of evidence, clinicians should use their judgment when determining whether or not to screen an individual patient for an eating disorder, Pbert advised.

One thing to consider is whether the patient is in a group at higher risk for eating disorders, such as athletes, females, young adults aged 18 to 29, and transgender individuals.

Another is whether the patient reports engaging in unhealthy weight control behaviors, such as fasting or skipping meals, Pbert said.

Importantly, any patient who has signs or symptoms of an eating disorder or is expressing concerns about their eating should be assessed and referred for appropriate care, Pbert said.

"The good news is that eating disorders can be treated," she said.

Several organizations currently recommend screening in the context of monitoring changes in weight and other vital signs or signs and symptoms to determine whether a patient might have an eating disorder.

Pbert said it's important to recognize that the USPSTF statement "doesn't really conflict" with the recommendations of other organizations. "We all agree that patients who present with signs or symptoms of an eating disorder should be assessed further."

Evidence Gaps

The authors of an invited commentary in JAMA say the task force has identified several "notable deficiencies" in the available data on screening for eating disorders.

"Directing attention to rigorous research to close this evidence gap will be important to find optimal approaches to identify patients with these complex disorders and improve their health outcomes," write Evelyn Attia, MD, with Weill Cornell Medicine in New York City, and Angela Guarda, MD, with Johns Hopkins School of Medicine, Baltimore, Maryland.

This "I" statement, they say, "highlights the need to prioritize research aimed at closing the evidence gap identified by USPSTF in a timely manner and underscores the need for new studies that address screening for eating disorders, treatment trials that enroll screen-detected populations from primary care settings, and screening in specific populations.

"Research on screening in primary care also should be paired with development and assessment of early brief intervention strategies for those individuals who screen positive, especially adolescents," Attia and Guarda say.

Members of the USPSTF have disclosed no relevant financial relaitonships. Attia has received research support from the National Institute of Mental Health and the Hilda & Preston David Foundation; royalties from UpToDate; and has served as a clinical advisor to Equip Health. Guarda has received support from the Stephen and Jean Robinson Fund and research funding from the Klarman Family Foundation.

JAMA. Published online March 15, 2022. Full text, Commentary

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