Objective: This forum presents the current state of research in the screening and identification of people with eating disorders in community and primary care, taking a longer-term perspective that highlights the slow rate of progression in development of instruments, and impact on polices and practice.
Method: An historical overview is presented, followed by a critique of contemporary instruments and practice, and barriers to case detection and appropriate referral pathways.
Results: There are now many instruments but all lack high levels of positive predictive power. However, some do have high sensitivity. Barriers contributing to poor detection and the treatment gap include need for improved education and support for primary care professionals and lack of confidence of individuals with eating disorders to initiate a discussion with health professionals. The best screening instrument would not overcome either of these barriers.
Discussion: We purport there is an urgent need to improve current screening instruments (not to develop more), particularly those with high sensitivity. These should be being employed alongside programs to both improve primary care professionals' skills in assessment and management of people with eating disorders, and to empower consumers to navigate care pathways.
Public significance statement: We argue that further screening instruments for eating disorders are not needed. Rather, it is more urgent to have a greater research focus on how to encourage primary care workers to ask about eating and body image and how to best translate that to more individuals with eating disorders being offered treatment. This work needs to be linked with tools that empower consumers to navigate care pathways.
Keywords: SCOFF; detection; eating disorders; identification; treatment.
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