Recommendations for the Assessment and Monitoring of Eating Disorder Risk in Weight Management Programs


Initial Risk Assessment for Eating Disorders


Health professionals providing weight management interventions may serve as initial detectors of patients’ eating disturbances. Providers should be trained to recognize and monitor patients for symptoms of disordered eating behaviors or attitudes and intervene if they emerge. Thus, conducting an initial risk assess- ment for eating disorders in all patients before initiating interventions for weight management is advised.54


Recommended procedures for the initial screening are


described in Figure 16.2. These recommendations are indicated for weight man- agement programs that prescribe moderate energy restriction (eg, BWL therapy). The Eating Disorder Examination Questionnaire with instructions (EDE-Q-I)—a version of the Eating Disorder Examination Questionaire that includes descrip- tions of binge episodes to assist patients with responding—assesses the frequency of binge eating, extreme weight-control behaviors, and overevaluation of weight or shape.166,167


The EDE-Q-I demonstrates high accuracy at assessing the frequency of


binge eating and has excellent convergent validity with the gold-standard Eating Disorder Examination133


clinical interview.168,169 Providers are advised to use an


abbreviated version of the EDE-Q-I (refer to Box 16.6 on page 306) for initial screening and ongoing monitoring of risk for eating disorders. The standard form of the EDE-Q-I assesses symptoms occurring within the previous 28 days. Because an accurate count of the number of binge-eating episodes during the previous 3 months is needed for diagnostic assessment of BED, the adapted version of the EDE-Q-I includes an assessment of binge eating for the preceding 3 months. If no symptoms are present, or if a patient reports subclinical levels of binge


eating (fewer than 12 episodes in the previous 3 months) or subclinical levels of overvaluation of weight or shape (a score of less than 4 on the “importance of shape/weight” item in the previous 28 days), providers should to begin a program of weight management and conduct ongoing monitoring of the patient’s risk status, with monthly assessments and monitoring at each session. Patients who report any self-induced vomiting or misuse of laxatives or diuretics (ie, one or more times in the past 3 months) at the initial screening should be excluded from weight man- agement interventions and be referred for further evaluation and specialized care. Providers should also refer the following patients who screen positive at a clinical level for an eating disorder for further evaluation and specialized care: patients who report moderate (four to seven binge episodes per week), severe (eight to 13 episodes per week), or extreme (14 or more episodes per week) levels of binge eating, as well as those who report mild levels of binge eating (one to three episodes per week) and overvaluation of weight or shape. When eating pathology warrants further evaluation, providers should supply the telephone number and website address for the National Eating Disorders Association helpline to assist patients in accessing treatment options. With patients who report mild binge eating in the absence of overvaluation of weight or shape, a patient-centered approach to determining a treatment course is appropriate. As discussed previously, BWL and specialized psychological treatments (ie, CBT and IPT) each have shown beneficial effects in the treatment of BED. The appropriate treatment approach may differ from patient to patient based on factors such as the individual’s treatment goals, access to specialized care, and medical comorbidities. Providers should assess patients for potential risk factors as needed, including excessive weight gain the past year, depression, and anxiety, and should discuss these factors and treatment options with patients before jointly formulating a treatment plan.


304 SECTION 3: Interventions for the Treatment of Overweight and Obesity


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