Screening for eating disorders in adolescents and adults an evidence review for the U.S. Preventive Services Task Force
One treatment study was limited to adolescents, and all others enrolled adults; the majority focused on BED and bulimia nervosa. No eligible treatment studies focused on populations with anorexia nervosa. CONCLUSIONS: No studies directly assessed the benefits and harms of screening. Screening questi...
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| Corporate Authors: | , , |
| Format: | eBook |
| Language: | English |
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Rockville, MD
Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services
2022, March 2022
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| Series: | Evidence synthesis
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| Online Access: | |
| Collection: | National Center for Biotechnology Information - Collection details see MPG.ReNa |
| Summary: | One treatment study was limited to adolescents, and all others enrolled adults; the majority focused on BED and bulimia nervosa. No eligible treatment studies focused on populations with anorexia nervosa. CONCLUSIONS: No studies directly assessed the benefits and harms of screening. Screening questionnaires available for use in primary care have adequate accuracy for detecting eating disorders among adults; the most commonly studied screening questionnaire is the SCOFF. The accuracy of screening questionnaires for detecting eating disorders among adolescents is unclear. No treatment studies were found that enrolled participants who were screen-detected in primary care. Guided self-help interventions are effective for reducing eating disorder symptom severity and depressive symptoms among referred populations. Lisdexamfetamine and topiramate are effective in reducing eating disorder symptom severity in populations with BED but are also associated with adverse effects Similarly, self-help interventions for BED also reduced depression symptoms more than inactive control, including both guided self-help (pooled SMD, −0.73 [95% CI, −1.04 to −0.43]; 4 studies; 324 participants) and unguided self-help (pooled SMD, −0.37 [95% CI, −0.68 to −0.05]; 3 studies; 156 participants). Group therapy (7 trials; 253 participants) for BED and bulimia nervosa was associated with larger reductions in depression scores from baseline than inactive control (pooled SMD, −0.48 [95% CI, −0.69 to −0.27]). Few trials of self-help or group therapy reported on other outcomes. Four studies assessed different forms of individual therapy and measured heterogeneous outcomes. Nine trials of pharmacotherapy (2,006 participants) reported on adverse effects over a relatively short duration (6 to 16 weeks); few reported on more than one medication. PURPOSE: To systematically review the evidence on (1) benefits and harms of screening for eating disorders in adults and adolescents, (2) accuracy of screening tools, and (3) benefits and harms of interventions for eating disorders that were screen detected or not previously treated for populations and settings relevant to primary care in the United States. DATA SOURCES: PubMed/MEDLINE, the Cochrane Library, PsycINFO, and trial registries through December 18, 2020; reference lists of retrieved articles; outside experts; and reviewers, with surveillance of the literature through January 1, 2022. STUDY SELECTION: English-language controlled trials for eating disorder screening or evaluation of interventions for screen-detected or previously untreated eating disorders and studies of screening test accuracy. DATA EXTRACTION: One investigator extracted data and a second checked accuracy. Two reviewers independently rated quality for all included studies using predefined criteria. Four trials of lisdexamfetamine for binge-eating disorder (BED) (900 participants) measured change in eating disorder symptom severity using the Yale-Brown Obsessive Compulsive Scale modified for binge eating (YBOCS-BE) and found larger reductions in changes from baseline scores associated with lisdexamfetamine 50 to 60 mg/day than placebo (pooled mean difference, −5.75 [95% CI, −8.32 to −3.17]). Two trials compared topiramate with placebo for BED and both found significantly larger reductions in YBOCS-BE scores from baseline among the topiramate group than the placebo group, from −6.40 (p<0.001) to −2.55 (p=0.004). Five trials assessed various selective serotonin reuptake inhibitors among persons with BED (not selected based on comorbid depression), only two reported on change in eating disorder symptoms and results were imprecise. All other screening questionnaires were evaluated using only one study each. Only one other study evaluated a screening questionnaire among adolescents (11 to 18 years); the Adolescent Binge Eating Questionnaire (designed to detect binge eating) had a sensitivity of 100 percent and specificity of 27 percent in a population recruited from a pediatric obesity clinic. Forty studies assessed interventions for populations with recently detected or previously untreated eating disorders, 17 assessed pharmacotherapy, 22 assessed psychological intervention, and two assessed both. None enrolled a population with screen-detected eating disorders. DATA SYNTHESIS: No studies directly assessed the benefits and harms of screening. Seventeen studies evaluated the accuracy of screening questionnaires for identifying eating disorders. For detecting any eating disorder among adults, the SCOFF (cut point ≥2) had a pooled sensitivity of 84 percent (95% confidence interval [CI], 74% to 90%) and a pooled specificity of 80 percent (95% CI, 65% to 89%) (10 studies; 3,684 participants). At a higher cut point (≥3), the pooled sensitivity was lower (69% [95% CI, 56% to 80%]) and specificity was higher (90% [95% CI, 69% to 98%]) (7 studies; 2,749 participants). In one study enrolling adolescents, the SCOFF (cut point ≥2) had a sensitivity of 73 percent and specificity of 78 percent. Two studies assessed the Eating Disorders Screen for Primary Care among adults using a cut point of 2 or greater; sensitivity was similar (97% and 100%), and specificity varied (40% and 71%). Lisdexamfetamine was associated with higher rates of dry mouth, headache, and insomnia than placebo, and topiramate was associated with significant higher rates of paresthesia, taste perversion, and difficulty with concentration or confusion than placebo. LIMITATIONS: Included studies of screening test accuracy primarily enrolled populations of adult women. Few reported on the accuracy of screening tests among men, adolescents or other specific populations. Aside from the SCOFF, most were assessed by only one study each, and some enrolled populations from specialty settings (e.g., obesity clinics) that may have a higher prevalence of binge eating. No included treatment studies enrolled populations who were screen detected; most were recruited via advertisements or enrolled referred populations and reported on outcomes over a relatively short duration (6 to 16 weeks). Selective serotonin reuptake inhibitors were associated with a larger reduction in depression symptom scores than placebo over 6 to 16 weeks (pooled standardized mean difference [SMD], −0.6 [95% CI, −0.90 to −0.33]) (5 studies; 208 participants). Three trials assessed fluoxetine for populations with bulimia nervosa; two found benefit favoring fluoxetine for eating disorder symptom severity and depression symptoms. Twenty-four trials assessed a psychological intervention. Guided self-help for BED improved eating disorder symptom severity more than inactive control (pooled SMD, −0.96 [95% CI, −1.26 to −0.67]) (5 studies; 391 participants); pooled estimates for unguided self-help (6 studies; 368 participants) also favored the intervention, but the difference between groups was not statistically significant (SMD, −0.18 [95% CI, −0.38 to 0.03]). |
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| Physical Description: | 1 PDF file (vi, 256 pages) illustrations |