About screening

Eating disorders often go undetected

This is largely because people rarely present to their GPs for the eating disorder itself. Instead, they present with a range of other physical and psychological symptoms directly related to the eating disorder. This may be due to ambivalence, denial, secrecy, shame, or lack of insight about their behaviours.

Picking up an eating disorder before it becomes severe improves chances of recovery1 ,2

Opportunities for routine screening

Routine screening for eating disorders can pick up mild and emerging eating disorders before they become severe.

QI Tip

Identifying screening points and implementing routine screening can form the basis of a practice improvement activity.

GP's have many opportunities to screen for eating disorders among high-risk populations. Identifying common points of contact for these populations can suggest opportunities for routine screening.

Practice nurses also have many opportunities for screening. Having a conversation between practice GPs and Nurses can identify when nurses should screen patients and how this is recorded.

Some opportunities include:

When immunising teens
When conducting HEADSS assessment or mental health treatment plan
On any presentation for an adolescent
Postnatal check ups
When talking about menopause
When discussing Menstrual or fertility difficulties
Any gastrointestinal problems (i.e., irritable bowel; self-diagnosed allergies or food intolerance)

As eating disorders can take some time to identify, it could be useful for the team to have a way to flag or highlight it as a consideration on a patient's file.

What screeners to use?

There are a few options for screening already in use.

InsideOut Screener IOI-S

The new InsideOut Institute screener (IOI-S) is aimed at helping to open discussion and begin the conversation. It is a short screener and can be saved in the templates on your software then printed out for GP rooms and practice nurses if needed. Your GPs can also complete together with the patient on practice software, by making the answers bold and then saving straight to file. (Saves scanning!).

IOI-Screener

6-question survey that takes 2 minutes to deliver

EDE-Q

The EDE-Q is a detailed screener and is a requirement for eating disorder plans (EDP) for those without a diagnosis of Anorexia Nervosa. This can be imported to your practice software and GPs can print or send digitally to patients to complete. There is also an online version on this website that scores the answers and prepares a printable report for the GP, talk to your GPs to know which or if both versions are most helpful.

Eating Disorder Examination Questionnaire (EDE-Q)

28-item self-report questionnaire to support clinical diagnosis

Others

The K10 is a screener for mental health and is needed when completing a Mental Health Care Plan (MHCP) but is not screening for eating disorders specifically. It may often be used in conjunction with other screeners.

The BED-7 is a screener used to identify binge eating behaviours.

The SCOFF is also a common screener for eating disorders and shorter than the EDE-Q, but the wording can sometimes be confronting to those completing it.

Other screeners include the SCOFF Questionnaire and the BED-7 Screener. The K10 can be used to measure psychological distress.

SCOFF

This is a simple 5 question screening tool that will quickly flag the need for a detailed eating disorder history if required.

BEDS-7

This tool is a self-reported questionnaire that helps clinicians to screen for Binge Eating Disorder.

K10

The K10 is widely recommended as a simple measure of psychological distress and as a measure of outcomes following treatment for common mental health disorders.

Using screeners & flags

How the screener and the flags are used may depend on each doctor's preferences, or you may decide as a practice on a standard system for when to screen and how to flag files if there is concern.

References