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Screening for Eating Disorders in Adolescents and AdultsEvidence Report and Systematic Review for the US Preventive Services Task Force

Educational Objective
To identify the key insights or developments described in this article
1 Credit CME

Importance  Eating disorders are associated with adverse health and social outcomes.

Objective  To review the evidence on screening for eating disorders in adolescents and adults to inform the US Preventive Services Task Force.

Data Sources  MEDLINE, Cochrane Library, PsycINFO, and trial registries through December 19, 2020; surveillance through January 1, 2022.

Study Selection  English-language studies of screening test accuracy, randomized clinical trials (RCTs) of screening or interventions for eating disorders in populations with screen-detected or previously untreated eating disorders (trials limited to populations who are underweight were ineligible).

Data Extraction and Synthesis  Dual review of abstracts, full-text articles, and study quality. Meta-analysis of test accuracy studies and intervention trials.

Main Outcomes and Measures  Test accuracy, eating disorder symptom severity, quality of life, depression, and harms.

Results  Fifty-seven studies were included (N = 10 773); 3 (n = 1073) limited to adolescents (mean or median age, 14-15 years). No study directly evaluated the benefits and harms of screening. Seventeen studies (n = 6804) evaluated screening test accuracy. The SCOFF questionnaire (cut point ≥2) had a pooled sensitivity of 84% (95% CI, 74% to 90%) and pooled specificity of 80% (95% CI, 65% to 89%) in adults (10 studies, n = 3684). Forty RCTs (n = 3969) evaluated interventions for eating disorders; none enrolled a screen-detected population. Lisdexamfetamine for binge eating disorder (4 RCTs; n = 900) was associated with larger reductions in eating disorder symptom severity on the Yale-Brown Obsessive Compulsive Scale modified for binge eating (YBOCS-BE) than placebo (pooled mean difference, −5.75 [95% CI, −8.32 to −3.17]). Two RCTs (n = 465) of topiramate for binge eating disorder found larger reductions in YBOCS-BE scores associated with topiramate than placebo, from −6.40 (95% CI, −8.16 to −4.64) to −2.55 (95% CI, −4.22 to −0.88). Nine pharmacotherapy trials (n = 2006) reported on harms. Compared with placebo, lisdexamfetamine was associated with higher rates of dry mouth, headache, and insomnia, and topiramate was associated with higher rates of paresthesia, taste perversion, confusion, and concentration difficulty. Twenty-four trials (n = 1644) assessed psychological interventions. Guided self-help for binge eating disorder improved eating disorder symptom severity more than control (pooled standardized mean difference, −0.96 [95% CI, −1.26 to −0.67]) (5 studies, n = 391). Evidence on other interventions was limited.

Conclusions and Relevance  No studies directly assessed the benefits and harms of screening. The SCOFF questionnaire had adequate accuracy for detecting eating disorders among adults. No treatment trials enrolled screen-detected populations; guided self-help, lisdexamfetamine, and topiramate were effective for reducing eating disorder symptom severity among referred populations with binge eating disorder, but pharmacotherapies were also associated with harms.

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Article Information

Corresponding Author: Cynthia Feltner, MD, MPH, Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, 725 Martin Luther King Jr Blvd, CB#7295, Chapel Hill, NC 27599 (cindy_feltner@med.unc.edu).

Accepted for Publication: February 2, 2022.

Author Contributions: Dr Feltner had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Feltner, Peat, Berkman, Jonas.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Feltner, Peat, Reddy, Riley, Middleton, Jonas.

Critical revision of the manuscript for important intellectual content: Feltner, Peat, Reddy, Riley, Berkman, Balio, Coker-Schwimmer.

Statistical analysis: Feltner, Peat, Reddy.

Obtained funding: Feltner, Jonas.

Administrative, technical, or material support: Feltner, Riley, Berkman, Middleton, Coker-Schwimmer, Jonas.

Supervision: Feltner, Jonas.

Conflict of Interest Disclosures: Dr Peat reported serving as a member of a clinical advisory board for Equip Health. No other disclosures were reported.

Funding/Support: This research was funded under contract HHSA-290-2015-00011-I, Task Order 15, from the Agency for Healthcare Research and Quality (AHRQ), US Department of Health and Human Services, under a contract to support the US Preventive Services Task Force (USPSTF).

Role of the Funder/Sponsor: Investigators worked with USPSTF members and AHRQ staff to develop the scope, analytic framework, and KQs for this review. AHRQ had no role in study selection, quality assessment, or synthesis. AHRQ staff provided project oversight, reviewed the report to ensure that the analysis met methodological standards, and distributed the draft for peer review. Otherwise, AHRQ had no role in the conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript findings. The opinions expressed in this document are those of the authors and do not reflect the official position of AHRQ or the US Department of Health and Human Services.

Additional Contributions: The authors gratefully acknowledge the following individuals for their contributions to this project, including AHRQ staff (Iris Mabry-Hernandez, MD, MPH; and Tracy Wolff, MD, MPH) and RTI International–University of North Carolina Evidence-based Practice Center staff (Carol Woodell, BSPH; Christiane Voisin, MSLS; Sharon Barrell, MA; Loraine Monroe; Caroline Rains, MPH; Kayla Giger; and Ina Wallace, PhD), who received compensation for their role in this project. The USPSTF members, expert consultants, peer reviewers, and Federal partner reviewers did not receive financial compensation for their contributions.

Additional Information: A draft version of the full evidence report underwent external peer review from 4 content experts (Bryn Austin, ScD, Harvard Medical School; Denise Wilfley, PhD, Washington University School of Medicine; Devan Kansagara, MD, Oregon Health & Science University; Susan Kornstein, MD, Virginia Commonwealth University). Comments from reviewers were presented to the USPSTF during its deliberation of the evidence and were considered in preparing the final evidence review.

Editorial Disclaimer: This evidence report is presented as a document in support of the accompanying USPSTF Recommendation Statement. It did not undergo additional peer review after submission to JAMA.

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AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

  • 1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
  • 1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
  • 1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
  • 1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
  • 1.00 CME points in the American Board of Surgery’s (ABS) Continuing Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.

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