July 22, 2020.
We are writing to express our views on the U.S. Preventive Services Task Force (USPSTF) draft research plan regarding screening for eating disorders in adolescents and adults.
The National Center for Health Research is a nonprofit think tank that conducts, analyzes, and scrutinizes research on a range of health issues, with particular focus on which prevention strategies and treatments are most effective for which patients and consumers. We do not accept funding from companies that make products that are the subject of our work, so we have no conflicts of interest.
We commend USPSTF’s intention to include studies that assess both the benefits and harms of the screening process for eating disorders. It is essential to examine these benefits and harms for subgroup populations based on age, sex, race/ethnicity, and gender identity. However, we urge USPSTF to include SES as one of the subgroups for whom the benefits and harms of screening are assessed. Much of the research on eating disorders is done among more affluent populations, and it is important to gather information relevant to those from various socioeconomic backgrounds because eating disorders affect people across SES.1
We also support USPSTF’s plan to include mental health comorbidities as a subgroup, because that could enhance the understanding of how other mental health factors affect eating disorders. For example, anxiety is commonly comorbid with eating disorders.2
We support USPSTF’s intention to screen individuals based on a broader scope of risk factors beyond an underweight classification, since eating disorders can affect individuals of all weight classifications. Including studies that address all patients at risk will also serve as an important signal for providing screening recommendations in different group and healthcare settings.
Additionally, patients may be motivated to conceal evidence of an eating disorder, answering questionnaires inaccurately to avoid detection. We therefore suggest that USPSTF reconsider which types of studies will be excluded from review. The exclusion of studies that only focus on particular risk factors may lead to the exclusion of information regarding risk factors that patients may be more willing to disclose, such as their attitudes about weight or restricting behaviors. Better understanding of these additional risk factors may lead to the development of more effective screening methods.
- Mulders-Jones B, Mitchison D, Girosi F, Hay P. Socioeconomic correlates of eating disorder symptoms in an Australian population-based sample. PLoS One. 2017; 12(1):e0170603.
- Swinbourne J, Hunt C, Abbott M, Russell J, St Clare T, Touyz S. The comorbidity between eating disorders and anxiety disorders: Prevalence in an eating disorder sample and anxiety disorder sample. Australian & New Zealand Journal of Psychiatry. 2012; 46(2):118-31.