outpatient settings.39,40


In addition, several questionnaires are available to assess


for specific types of food experiences, including appetite management, cravings, and even “food addiction” that may influence eating behavior and subsequent weight gain. For example, the Power of Food Scale is a 21-item scale that mea- sures a person’s appetite for (but not necessarily consumption of) highly palatable foods at three different food proximities (food available, food present, and food tasted).41


The Food Craving Inventory uses 28 items to assess a person’s motiva-


tional drive for food in general, as well as the motivational drive (or craving) for specific foods, such as high-fat foods, sweets, carbohydrates or starches, and fast foods.42


The Yale Food Addiction Scale, Version 2, proposes that individuals may


have signs and symptoms of addiction to highly palatable foods that are similar to those exhibited by individuals with a substance use disorder.43,44


This 25-item


measure determines the number of food addiction symptoms a patient has; this score is then used to determine whether the patient can be considered to have food addiction. It also evaluates for the presence of substantial distress or interference with daily functioning. Ideally, the assessment of eating behaviors should also look for potential eating


pathology. The Eating Disorder Examination (EDE), a semistructured interview examining eating-disordered behaviors and attitudes, is the most widely used and best validated assessment for eating disorders.45


It must be administered by a trained


clinician and is effective for the diagnosis of anorexia nervosa, bulimia nervosa, binge eating disorder, and otherwise specified or unspecified eating disorders. The interview focuses on symptoms present within the previous 28 days and also extends to the preceding 2 months to gather diagnostic data for a full 3 months, which is required to make a diagnosis. Eating pathologies assessed by the EDE include fast- ing or restricting food intake, grazing (ie, picking and nibbling on small amounts of food throughout the day, between planned meals and snacks), binge eating, loss- of-control eating, and compensatory behaviors after eating to avoid gaining weight (eg, self-induced vomiting, use of laxatives or diuretics, excessive exercising). Four subscales can also be derived from the individual’s responses regarding restraint, eating concerns, shape concerns, and weight concerns, as well as a global score. Clinics that do not have a trained clinician to administer the EDE or the time


to do so can use self-report questionnaires to assess eating disorder constructs. The Eating Disorder Examination-Questionnaire (EDE-Q) focuses on the previous 28 days, like the interview version, and it examines symptoms and attitudes using 28 items.46


The EDE-Q also provides scores for the same four subscales as well as


a global score. The Questionnaire on Eating and Weight Patterns-5 (QEWP-5) is a face-valid, 26-item measure that assesses patients for the symptoms listed in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders associated with binge eating disorder and bulimia nervosa, including loss-of-control eating and compensatory behaviors; it also collects information about weight history and family weight history.47


The Binge Eating Scale is a 16-item self-report question-


naire designed to capture both the behavioral features of objective binge episodes (eg, consuming a large amount of food) and the cognitive and emotional features (eg, feeling out of control while eating, preoccupation with food and eating).48


The


Night Eating Questionnaire includes 14 items and assesses for the psychological and behavioral symptoms consistent with night eating syndrome.49


In particular,


it assesses for the presence of nocturnal eating episodes or consuming a large por- tion of one’s daily energy intake after dinnertime, as well as associated symptoms of morning anorexia, mood and sleep issues, and thoughts that one must eat to resume sleep. A score of 25 or greater suggests night eating syndrome. All of these self-report questionnaires help identify the presence of disordered eating behavior


CHAPTER 9: Behavioral Health Assessment 149


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