How to Screen for Eating Disorders

With 9% of the U.S. population, or 28.8 million Americans, having an eating disorder in their lifetime (ANAD) and a person dying due to complications related to their eating disorder every 52 minutes, it is essential that healthcare professionals screen all their patients for eating disorders. The majority of people with eating disorders do come into contact with healthcare professionals, presenting an opportunity to detect symptoms and intervene early. 

October is National Depression and Mental Health Screening Month, which works to bring awareness to the need for depression and mental health screenings. Screening for eating disorders should be included in all mental health screenings. When it comes to eating disorder detection, knowing the physical symptoms to look out for, the questions to ask, and the people often left out of screenings is essential knowledge to have as a provider. 

Common Health Presentations of Eating Disorders

Eating disorders can cause many health issues that can lead those suffering to seek out help from a provider for those symptoms. Therefore, it is very important to know what symptoms can be an indicator of an eating disorder, as the individual may not explicitly ask for help for their disorder, even if they are willing to seek help for their symptoms. Here are some common health presentations of eating disorders that you might come across:

• Mental health issues
• Menstrual irregularity/amenorrhea
• Gastrointestinal problems
• Injuries caused by over-exercising
• Fainting or dizziness
• Dry skin and nails
• Sore throat
• Cold intolerance
• Leg cramps
• Hair loss

What to Ask Every Patient

The earlier an eating disorder is detected, the better the outcome will be. That is one reason why asking questions about food with your patients is so vital. If you were not taught how to screen for eating disorders in your training, that is unfortunately not rare. Oftentimes, asking someone with an eating disorder about food and exercise can be very triggering, so make sure to use broad, non-leading questions. The following questionnaire is a very simple, straightforward tool that addresses people across eating disorder diagnoses. Here are some questions we recommend asking your patients:

• Do you worry about your weight and body shape more than other people? 
• Do you avoid certain foods for reasons other than allergies or religious reasons? 
• Are you often on a diet? 
• Do you feel your weight is an important aspect of your identity? 
• Are you fearful of gaining weight? 
• Do you often feel out of control when you eat? 
• Do you regularly eat what others may consider to be a large quantity of food at one time? 
• Do you regularly eat until feeling uncomfortably full? 
• Do you hide what you eat from others, or eat in secret? 
• Do you often feel fat? 
• Do you feel guilty or depressed after eating? 
• Do you ever make yourself vomit (throw up) after eating? 
• Do you use your insulin in ways not prescribed to manage your weight? 
• Do you take any medication or supplement to compensate for eating or to give yourself permission to eat? 
• Do you exercise for the sole purpose of weight control? 
• Have people expressed concern about your relationship with food or your body? 

If your patient answers “yes” to two or more of these questions, further assessment may be necessary. If there is a concern, the best course of action is a referral for a comprehensive assessment done by an eating disorder specialist.

People Often Left Out of Screening 

In the past, there has been a misconception that eating disorders affect only thin, young, white females. In reality, eating disorders DO NOT discriminate! This misconception has caused healthcare providers to miss eating disorder diagnoses in different groups, including people in larger bodies, people of color, men, and older adults. Below are different things to remember when screening for each of these misrepresented groups:

1. People in larger bodies

Our society is entrenched in diet culture, which pushes the message that thinness equates health, success, beauty, and worthiness. Weight bias fuels the idea that people in larger bodies should take whatever measures necessary to make themselves smaller, no matter how damaging. Weight bias can lead to weight stigma, which can lead to healthcare providers missing the signs of an eating disorder in a person in a larger body. Working on your own implicit and explicit biases is essential to ensuring that all patients get the help they need.

2. People of color

While medical education has improved and the larger culture has started to understand that eating disorders can affect anyone, some of the initial bias has not gone away. The National Eating Disorder Association states that “People of color—especially African Americans—are significantly less likely to receive help for their eating issues.” Despite the fact that people of color are not being diagnosed as often or receiving care as often, they are equally at risk for the development of an eating disorder as their white peers. 

3. Men 

While we think that there are anywhere from four to six million men with eating disorders in America, only one in 10 people getting eating disorder treatment is male. Eating disorders are serious and potentially life-threatening, with some research suggesting that this risk be even higher for men; that is why it is so important to remember that men develop eating disorders as well. Men often express the desire to be more muscular and leaner, rather than weigh less. The idea that all people with eating disorders want to lose weight can be a detriment to diagnosing men with eating disorders. 

4. Older adults

More than 70 percent of people don’t get treatment for their eating disorder because of stigma, access, barriers, and misinformation. Eating disorders do often present themselves in early adulthood, but with such a large percentage of people not getting help, many people continue suffering into their middle-age and beyond. After decades of suffering, people may be more accustomed to their symptoms and fear being a burden to those around them by asking for help. In addition to the people who develop eating disorders at a young age and do not receive help, there are also individuals who do not develop their eating disorder until later in life. 

You Can Make a Difference

It is highly likely that healthcare professionals will come into contact with someone suffering with an eating disorder during their career. These individuals often present with apparently unrelated symptoms and do not generally disclose what’s really going on. It’s important to ask questions about their eating habits in a non-judgmental way in order to create a welcoming environment where they feel comfortable seeking help. It is also important to note that eating disorders come in all sizes, races, ages, genders, and socioeconomic statuses, and not everyone will need the same exact approach. With the proper tools, healthcare providers can help in diagnosing people with eating disorders, resulting in more people recovering and living happier lives. By knowing the symptoms to look for, the questions to ask, and the populations not to overlook, healthcare professionals can make a real difference in the lives of so many people suffering with these mental illnesses. 

If you believe that your patient could be suffering from an eating disorder, you can refer them to The Emily Program for a comprehensive assessment by calling 1-888-364-5977 or by completing an online referral form.