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Screening for Eating Disorders in Adolescents and AdultsUS Preventive Services Task Force Recommendation Statement

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

Importance  Eating disorders (eg, binge eating disorder, bulimia nervosa, and anorexia nervosa) are a group of psychiatric conditions defined as a disturbance in eating or eating-related behaviors that impair physical or psychosocial functioning. According to large US cohort studies, estimated lifetime prevalences for anorexia nervosa, bulimia nervosa, and binge eating disorder in adult women are 1.42%, 0.46%, and 1.25%, respectively, and are lower in adult men (anorexia nervosa, 0.12%; bulimia nervosa, 0.08%; binge eating disorder, 0.42%). Eating disorder prevalence ranges from 0.3% to 2.3% in adolescent females and 0.3% to 1.3% in adolescent males. Eating disorders are associated with short-term and long-term adverse health outcomes, including physical, psychological, and social problems.

Objective  The US Preventive Services Task Force (USPSTF) commissioned a systematic review to evaluate the benefits and harms of screening for eating disorders in adolescents and adults with a normal or high body mass index. Evidence limited to populations who are underweight or have other physical signs or symptoms of eating disorders was not considered. The USPSTF has not previously made a recommendation on this topic.

Population  Adolescents and adults (10 years or older) who have no signs or symptoms of eating disorders (eg, rapid weight loss, weight gain, or pronounced deviation from growth trajectory; pubertal delay; bradycardia; oligomenorrhea; and amenorrhea).

Evidence Assessment  The USPSTF concludes that the evidence is insufficient to assess the balance of benefits and harms of screening for eating disorders in adolescents and adults. The evidence is limited and the balance of benefits and harms cannot be determined.

Recommendation  The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for eating disorders in adolescents and adults. (I statement)

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Article Information

Corresponding Author: Karina W. Davidson, PhD, MASc, Feinstein Institutes for Medical Research, 130 E 59th St, Ste 14C, New York, NY 10032 (chair@uspstf.net).

Accepted for Publication: February 7, 2022.

The US Preventive Services Task Force (USPSTF) members: Karina W. Davidson, PhD, MASc; Michael J. Barry, MD; Carol M. Mangione, MD, MSPH; Michael Cabana, MD, MA, MPH; David Chelmow, MD; Tumaini Rucker Coker, MD, MBA; Esa M. Davis, MD, MPH; Katrina E. Donahue, MD, MPH; Carlos Roberto Jaén, MD, PhD, MS; Martha Kubik, PhD, RN; Li Li, MD, PhD, MPH; Gbenga Ogedegbe, MD, MPH; Lori Pbert, PhD; John M. Ruiz, PhD; Michael Silverstein, MD, MPH; James Stevermer, MD, MSPH; John B. Wong, MD.

Affiliations of The US Preventive Services Task Force (USPSTF) members: Feinstein Institutes for Medical Research at Northwell Health, Manhasset, New York (Davidson); Harvard Medical School, Boston, Massachusetts (Barry); University of California, Los Angeles (Mangione); Albert Einstein College of Medicine, New York, New York (Cabana); Virginia Commonwealth University, Richmond (Chelmow); University of Washington, Seattle (Coker); University of Pittsburgh, Pittsburgh, Pennsylvania (Davis); University of North Carolina at Chapel Hill (Donahue); University of Texas Health Science Center, San Antonio (Jaén); George Mason University, Fairfax, Virginia (Kubik); University of Virginia, Charlottesville (Li); New York University, New York, New York (Ogedegbe); University of Massachusetts Medical School, Worcester (Pbert); University of Arizona, Tucson (Ruiz); Brown University, Providence, Rhode Island (Silverstein); University of Missouri, Columbia (Stevermer); Tufts University School of Medicine, Boston, Massachusetts (Wong).

Author Contributions: Dr Davidson 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. The USPSTF members contributed equally to the recommendation statement.

Conflict of Interest Disclosures: Authors followed the policy regarding conflicts of interest described at https://www.uspreventiveservicestaskforce.org/Page/Name/conflict-of-interest-disclosures. All members of the USPSTF receive travel reimbursement and an honorarium for participating in USPSTF meetings.

Funding/Support: The USPSTF is an independent, voluntary body. The US Congress mandates that the Agency for Healthcare Research and Quality (AHRQ) support the operations of the USPSTF.

Role of the Funder/Sponsor: AHRQ staff assisted in the following: development and review of the research plan, commission of the systematic evidence review from an Evidence-based Practice Center, coordination of expert review and public comment of the draft evidence report and draft recommendation statement, and the writing and preparation of the final recommendation statement and its submission for publication. AHRQ staff had no role in the approval of the final recommendation statement or the decision to submit for publication.

Disclaimer: Recommendations made by the USPSTF are independent of the US government. They should not be construed as an official position of AHRQ or the US Department of Health and Human Services.

Additional Contributions: We thank Iris Mabry-Hernandez, MD, MPH (AHRQ), who contributed to the writing of the manuscript, and Lisa Nicolella, MA (AHRQ), who assisted with coordination and editing.

Additional Information: The US Preventive Services Task Force (USPSTF) makes recommendations about the effectiveness of specific preventive care services for patients without obvious related signs or symptoms. It bases its recommendations on the evidence of both the benefits and harms of the service and an assessment of the balance. The USPSTF does not consider the costs of providing a service in this assessment. The USPSTF recognizes that clinical decisions involve more considerations than evidence alone. Clinicians should understand the evidence but individualize decision-making to the specific patient or situation. Similarly, the USPSTF notes that policy and coverage decisions involve considerations in addition to the evidence of clinical benefits and harms. Published by JAMA®—Journal of the American Medical Association under arrangement with the Agency for Healthcare Research and Quality (AHRQ). ©2022 AMA and United States Government, as represented by the Secretary of the Department of Health and Human Services (HHS), by assignment from the members of the United States Preventive Services Task Force (USPSTF). All rights reserved.

References
1.
Feltner  C , Peat  C , Reddy  S ,  et al.  Screening for Eating Disorders in Adolescents and Adults: An Evidence Review for the U.S. Preventive Services Task Force. Evidence Synthesis No. 212. Agency for Healthcare Research and Quality; 2022. AHRQ publication 21-05284-EF-1.
2.
American Psychiatric Association.  Diagnostic and Statistical Manual of Mental Disorders. 5th ed. American Psychiatric Association; 2013.
3.
Udo  T , Grilo  CM .  Prevalence and correlates of DSM-5-defined eating disorders in a nationally representative sample of US adults.   Biol Psychiatry. 2018;84(5):345-354. doi:10.1016/j.biopsych.2018.03.014PubMedGoogle ScholarCrossref
4.
US Preventive Services Task Force. US Preventive Services Task Force Procedure Manual. Published May 2021. Accessed January 26, 2022. https://www.uspreventiveservicestaskforce.org/uspstf/procedure-manual
5.
Treasure  J , Duarte  TA , Schmidt  U .  Eating disorders.   Lancet. 2020;395(10227):899-911. doi:10.1016/S0140-6736(20)30059-3PubMedGoogle ScholarCrossref
6.
Bakalar  JL , Shank  LM , Vannucci  A , Radin  RM , Tanofsky-Kraff  M .  Recent advances in developmental and risk factor research on eating disorders.   Curr Psychiatry Rep. 2015;17(6):42. doi:10.1007/s11920-015-0585-xPubMedGoogle ScholarCrossref
7.
Mitchell  KS , Mazzeo  SE , Schlesinger  MR , Brewerton  TD , Smith  BN .  Comorbidity of partial and subthreshold PTSD among men and women with eating disorders in the national comorbidity survey-replication study.   Int J Eat Disord. 2012;45(3):307-315. doi:10.1002/eat.20965PubMedGoogle ScholarCrossref
8.
Hudson  JI , Hiripi  E , Pope  HG  Jr , Kessler  RC .  The prevalence and correlates of eating disorders in the National Comorbidity Survey Replication.   Biol Psychiatry. 2007;61(3):348-358. doi:10.1016/j.biopsych.2006.03.040PubMedGoogle ScholarCrossref
9.
Sundgot-Borgen  J , Torstveit  MK .  Prevalence of eating disorders in elite athletes is higher than in the general population.   Clin J Sport Med. 2004;14(1):25-32. doi:10.1097/00042752-200401000-00005PubMedGoogle ScholarCrossref
10.
Marques  L , Alegria  M , Becker  AE ,  et al.  Comparative prevalence, correlates of impairment, and service utilization for eating disorders across US ethnic groups: implications for reducing ethnic disparities in health care access for eating disorders.   Int J Eat Disord. 2011;44(5):412-420. doi:10.1002/eat.20787PubMedGoogle ScholarCrossref
11.
Diemer  EW , Grant  JD , Munn-Chernoff  MA , Patterson  DA , Duncan  AE .  Gender identity, sexual orientation, and eating-related pathology in a national sample of college students.   J Adolesc Health. 2015;57(2):144-149. doi:10.1016/j.jadohealth.2015.03.003PubMedGoogle ScholarCrossref
12.
Udo  T , Grilo  CM .  Psychiatric and medical correlates of DSM-5 eating disorders in a nationally representative sample of adults in the United States.   Int J Eat Disord. 2019;52(1):42-50. doi:10.1002/eat.23004PubMedGoogle ScholarCrossref
13.
Kaye  WH , Bulik  CM , Plotnicov  K ,  et al.  The genetics of anorexia nervosa collaborative study: methods and sample description.   Int J Eat Disord. 2008;41(4):289-300. doi:10.1002/eat.20509PubMedGoogle ScholarCrossref
14.
Watson  HJ , Yilmaz  Z , Thornton  LM ,  et al; Anorexia Nervosa Genetics Initiative; Eating Disorders Working Group of the Psychiatric Genomics Consortium.  Genome-wide association study identifies eight risk loci and implicates metabo-psychiatric origins for anorexia nervosa.   Nat Genet. 2019;51(8):1207-1214. doi:10.1038/s41588-019-0439-2PubMedGoogle ScholarCrossref
15.
Maguen  S , Hebenstreit  C , Li  Y ,  et al.  Screen for Disordered Eating: improving the accuracy of eating disorder screening in primary care.   Gen Hosp Psychiatry. 2018;50:20-25. doi:10.1016/j.genhosppsych.2017.09.004PubMedGoogle ScholarCrossref
16.
Berkman  ND , Brownley  KA , Peat  CM ,  et al.  Management and Outcomes of Binge-Eating Disorder. Agency for Healthcare Research and Quality; 2015. AHRQ publication 15(16)-EHC030-EF.
17.
Berkman  ND , Bulik  CM , Brownley  KA ,  et al.  Management of eating disorders.   Evid Rep Technol Assess (Full Rep). 2006;(135):1-166.PubMedGoogle Scholar
18.
Miller  KK , Grinspoon  SK , Ciampa  J , Hier  J , Herzog  D , Klibanski  A .  Medical findings in outpatients with anorexia nervosa.   Arch Intern Med. 2005;165(5):561-566. doi:10.1001/archinte.165.5.561PubMedGoogle ScholarCrossref
19.
Forney  KJ , Buchman-Schmitt  JM , Keel  PK , Frank  GK .  The medical complications associated with purging.   Int J Eat Disord. 2016;49(3):249-259. doi:10.1002/eat.22504PubMedGoogle ScholarCrossref
20.
Zakzanis  KK , Campbell  Z , Polsinelli  A .  Quantitative evidence for distinct cognitive impairment in anorexia nervosa and bulimia nervosa.   J Neuropsychol. 2010;4(pt 1):89-106. doi:10.1348/174866409X459674PubMedGoogle Scholar
21.
Chesney  E , Goodwin  GM , Fazel  S .  Risks of all-cause and suicide mortality in mental disorders: a meta-review.   World Psychiatry. 2014;13(2):153-160. doi:10.1002/wps.20128PubMedGoogle ScholarCrossref
22.
Siu  AL , Bibbins-Domingo  K , Grossman  DC ,  et al; US Preventive Services Task Force (USPSTF).  Screening for depression in adults: US Preventive Services Task Force recommendation statement.   JAMA. 2016;315(4):380-387. doi:10.1001/jama.2015.18392PubMedGoogle ScholarCrossref
23.
Siu  AL ; US Preventive Services Task Force.  Screening for depression in children and adolescents: US Preventive Services Task Force recommendation statement.   Ann Intern Med. 2016;164(5):360-366. doi:10.7326/M15-2957PubMedGoogle ScholarCrossref
24.
Curry  SJ , Krist  AH , Owens  DK ,  et al; US Preventive Services Task Force.  Interventions to prevent perinatal depression: US Preventive Services Task Force recommendation statement.   JAMA. 2019;321(6):580-587. doi:10.1001/jama.2019.0007PubMedGoogle ScholarCrossref
25.
Curry  SJ , Krist  AH , Owens  DK ,  et al; US Preventive Services Task Force.  Behavioral weight loss interventions to prevent obesity-related morbidity and mortality in adults: US Preventive Services Task Force recommendation statement.   JAMA. 2018;320(11):1163-1171. doi:10.1001/jama.2018.13022PubMedGoogle Scholar
26.
Grossman  DC , Bibbins-Domingo  K , Curry  SJ ,  et al; US Preventive Services Task Force.  Screening for obesity in children and adolescents: US Preventive Services Task Force recommendation statement.   JAMA. 2017;317(23):2417-2426. doi:10.1001/jama.2017.6803PubMedGoogle Scholar
27.
Feltner  C , Peat  C , Reddy  S ,  et al.  Screening for eating disorders in adolescents and adults: an evidence review and systematic review for the US Preventive Services Task Force.   JAMA. Published March 15, 2022. doi:10.1001/jama.2022.1807Google Scholar
28.
Hornberger  LL , Lane  MA ; Committee on Adolescence.  Identification and management of eating disorders in children and adolescents.   Pediatrics. 2021;147(1):e2020040279. doi:10.1542/peds.2020-040279PubMedGoogle Scholar
29.
Academy for Eating Disorders Medical Care Standards Committee.  Eating Disorders: A Guide to Medical Care. 3rd ed. Academy for Eating Disorders; 2016.
30.
Lock  J , La Via  MC ; American Academy of Child and Adolescent Psychiatry (AACAP) Committee on Quality Issues (CQI).  Practice parameter for the assessment and treatment of children and adolescents with eating disorders.   J Am Acad Child Adolesc Psychiatry. 2015;54(5):412-425. doi:10.1016/j.jaac.2015.01.018PubMedGoogle ScholarCrossref
31.
 ACOG Committee Opinion No. 740: gynecologic care for adolescents and young women with eating disorders.   Obstet Gynecol. 2018;131(6):e205-e213. doi:10.1097/AOG.0000000000002652PubMedGoogle ScholarCrossref
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