Eating disorder screening: A systematic review and meta-analysis of diagnostic test characteristics of the SCOFF
Open accessAbstract
Background Eating disorders affect upwards of 30 million people worldwide and often go undertreated and underdiagnosed. The purpose of this systematic review and meta-analysis was to evaluate the diagnostic accuracy of the Sick, Control, One, Fat and Food (SCOFF) questionnaire for DSM-5 eating disorders in the general population.Method The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) were followed. A PubMed search was conducted among peer-reviewed articles. Information regarding validation of the SCOFF was required for inclusion. Study quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool.Results The final analysis included 25 studies. The validity of the SCOFF was high across samples with a pooled sensitivity of 0.86 (95% CI, 0.78-0.91) and specificity of 0.83 (95% CI, 0.77-0.88). Subgroup analyses were conducted to examine the impact of methodology, study quality, and clinical characteristics on diagnostic accuracy. Studies with the highest sensitivity tended to be case-control studies of young women with anorexia nervosa (AN) and bulimia nervosa (BN). Studies which included more men, included those diagnosed with binge eating disorder, and recruited from large community samples tended to have lower sensitivity. Few studies reported on BMI and race/ethnicity; thus, subgroups for these factors could not be examined. No studies used reference standards which assessed all DSM-5 eating disorders.Conclusion This meta-analysis of 25 validation studies demonstrates that the SCOFF is a simple and useful screening tool for young women at risk for AN and BN. However, there is not enough evidence to support utilizing the SCOFF for screening for the range of DSM-5 eating disorders in primary care and community-based settings. Further examination of the validity of the SCOFF or development of a new screening tool, or multiple tools, to screen for the range of DSM-5 eating disorders heterogenous populations is warranted.Trial registration This study is registered online with PROSPERO (CRD42018089906).
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A recently published meta-analysis reported a pooled sensitivity of 86% and specificity of 83% for SCOFF using full-syndrome eating disorders or other established eating disorder questionnaires as reference.
“A recently published meta-analysis reported a pooled sensitivity of 86% and specificity of 83% using full-syndrome eating disorders or other established eating disorder questionnaires as reference [40].”
From Psychopathological symptoms and well-being in overweight and underweight adolescents: A network analysis (2021) · cites this paper as [40]
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- Authors
- Kutz, A. M., Marsh, A. G., Gunderson, C. G., Maguen, S., & Masheb, R. M.
- Affiliations
- VA Salt Lake City Healthcare System (US)
- VA Connecticut Healthcare System (US)
- Yale University (US)
- University of California, San Francisco (US)
- Corresponding author
- Kutz, Amanda M.
- Venue
- Journal of General Internal Medicine
- Published
- 2019-11-08
- Volume
- 35
- Issue
- 3
- Pages
- 885-893
- ISSN
- 0884-8734 (ISSN-L)
- 1525-1497
- PMC
- PMC7080881
- OpenAlex
- W2983584659
- Cited by
- 209
- References
- 35
- Citations by year
- 2026: 23 · 2025: 40 · 2024: 48 · 2023: 39 · 2022: 24 · 2021: 29 · 2020: 6
- FWCI
- 2.33
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of General Internal Medicine (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- Funders
- Health Services Research and Development (CIN 13-407)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Eating Disorders and Behaviors
- Health Sciences › Nursing › Nutrition and Dietetics › Nutrition, Health and Food Behavior
- Health Sciences › Medicine › Psychiatry and Mental health › Child Nutrition and Feeding Issues
- Keywords
- SCOFF questionnaire, eating disorder screening, diagnostic accuracy, anorexia nervosa, bulimia nervosa, binge eating disorder, young women, primary care, community-based screening, sensitivity and specificity
- MeSH terms
- Anorexia Nervosa, Feeding and Eating Disorders, Diagnostic Tests, Routine, Female, Humans, Male, Mass Screening, Surveys and Questionnaires
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