Draft Research Plan
Eating Disorders in Adolescents and Adults: Screening
June 25, 2020
Recommendations made by the USPSTF are independent of the U.S. government. They should not be construed as an official position of the Agency for Healthcare Research and Quality or the U.S. Department of Health and Human Services.
1. a. Does screening for eating disorders in adolescents and adults improve health outcomes?
b. Does the effectiveness of screening differ for subgroups defined by age, sex, race/ethnicity, gender identity, or mental health comorbidity?
2. a. What is the accuracy of primary care–relevant screening tools for eating disorders in adolescents and adults?
b. Does the accuracy of screening tools differ for subgroups defined by age, sex, race/ethnicity, gender identity, or mental health comorbidity?
3. a. What are the harms of screening for eating disorders in adolescents and adults?
b. Do the harms of screening differ for subgroups defined by age, sex, race/ethnicity, gender identity, or mental health comorbidity?
4. a. How effective are interventions for improving health outcomes in screen-detected or previously untreated adolescents and adults with eating disorders?
b. Does the effectiveness of treatment differ for subgroups defined by age, sex, race/ethnicity, gender identity, or mental health comorbidity?
5. a. What are the harms of interventions for eating disorders?
b. Do the harms of interventions differ for subgroups defined by age, sex, race/ethnicity, gender identity, or mental health comorbidity?
The Proposed Research Approach identifies the study characteristics and criteria that the Evidence-based Practice Center will use to search for publications and to determine whether identified studies should be included or excluded from the Evidence Review. Criteria are overarching as well as specific to each of the key questions.
| Included | Excluded | |
|---|---|---|
| Condition definition | All KQs: Anorexia nervosa, bulimia nervosa, binge eating disorder, other specified feeding and eating disorder, and avoidant restrictive food intake disorder, based on DSM-5 criteria or other valid diagnostic criteria (e.g., DSM-IV)
KQs 4, 5: Studies enrolling populations with subthreshold conditions (e.g., meeting most but not all diagnostic criteria for the disorders above, as defined by study authors) are also eligible |
Other DSM-5 categories of eating disorders (e.g., pica, rumination disorder) or potentially unhealthy eating behaviors or syndromes not recognized by DSM-5 (e.g., orthorexia) |
| Populations | KQs 1–3: Unselected or explicitly asymptomatic adolescents and adults (age ≥10 years) without signs or symptoms of an eating disorder, including populations selected for increased risk of an eating disorder (e.g., based on age, sex, race/ethnicity, gender identity, or mental health comorbidity) and populations selected based on high BMI
KQs 2, 4, 5: Studies enrolling adolescents and adults (age ≥10 years) who screen positive for eating disorders in a primary care setting or are identified through other population-based screening; studies enrolling populations from specialty settings who have not been previously treated for eating disorders are also eligible |
Studies limited to participants undergoing evaluation for bariatric surgery; studies limited to individuals who are underweight (BMI <18.5 kg/m2 for adults or BMI <5th percentile on growth charts for age and sex for adolescents) or with other physical signs or symptoms of an eating disorder |
| Screening | KQs 1–3: Screening questionnaires designed to detect eating disorders or risk of eating disorders that are feasible for use or screening in primary care (i.e., brief, easy to interpret) | KQs 1–3: Serologic screening (e.g., using leptin or other biomarkers) |
| Interventions | KQs 4, 5: Individual, group, or family therapy (cognitive behavioral therapy or other forms of psychotherapy); pharmacotherapy with FDA-approved medications | KQs 4, 5: Public awareness campaigns without specific interventions linked to screening, complementary and alternative therapies, or those considered to be adjunctive therapy (e.g., acupuncture, herbal supplements, massage, light therapy) |
| Comparisons | KQs 1, 3: Screened vs. nonscreened groups
KQ 2: Comparison with acceptable reference standard (structured or semistructured diagnostic interview or a nonbrief [>5 minutes] unstructured interview with mental health clinician) KQs 4, 5: No treatment, attention control, wait-list control, or minimal intervention (e.g., brief education about eating disorders); placebo-controlled studies of pharmacotherapy |
KQs 4, 5: Head-to-head comparisons of two active interventions |
| Outcomes | KQs 1, 4: Eating disorder remission or symptom reduction; general health-related quality of life or function; eating disorder–related quality of life or function; depression; anxiety; suicide; mortality
KQ 2: Sensitivity, specificity, positive and negative predictive values, positive and negative likelihood ratios, and diagnostic odds ratios KQ 3: Anxiety, labeling, stigma, psychosocial harms, and false-positive results KQ 5: Any harms that result as an effect of interventions such as increased depression, increased anxiety, worsening of the eating disorder, or adverse effects from medications |
KQs 1, 4: Screening or referral rates, attitudes about screening; intermediate outcomes (e.g., weight change, frequency of menses, frequency of specific behaviors [e.g., change in frequency of binge eating episodes])
KQ 2: Theory or survey development and validation without correlation to eating disorder outcomes, studies that focus only on particular risk factors, or assessment of provider or participant attitudes toward the instrument |
| Study Designs | All KQs: RCTs
KQ 2: Cross-sectional and cohort studies of screening test accuracy are also eligible KQs 3, 5: Cohort studies with a concurrent control group are also eligible |
All other study designs, including case-series and case-control studies; systematic reviews; and others |
| Quality | Studies rated good or fair quality | Studies rated poor quality |
| Clinical Setting | All KQs: Primary care clinics or other settings where primary care services are offered, such as student health centers
KQs 2, 4, 5: Settings referable from primary care are also eligible |
Nonclinically-based settings or inpatient settings |
| Country Setting | Research conducted in the United States or in populations similar to U.S. populations with services and interventions applicable to U.S. practice (countries categorized as “very high” on the Human Development Index [as defined by the United Nations Development Programme]) | Research not relevant to the United States in countries categorized as less than “very high” on the Human Development Index |
| Language | Full text published in English | Not English language |
Abbreviations: BMI=body mass index; DSM-5=Diagnostic and Statistical Manual of Mental Disorders (5th edition); DSM-IV=Diagnostic and Statistical Manual of Mental Disorders (4th edition); FDA=U.S. Food and Drug Administration; KQ= key question; RCT=randomized, controlled trial.