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SCOFF screening

Julie Schreiner, DNP, MSN, FNP, PMHS, discussed the use of the SCOFF questionnaire as a standardised screening tool for eating disorders, which are too often missed by health care professionals. One study found that a health examination which did not use the SCOFF questionnaire missed 81% of patients who screened positive for an eating disorder with the questionnaire (Hautala L, et al. International Journal of Nursing Studies. 2009;46(11):1439-1447).

Eating disorders have the highest mortality rate of any mental illness, and although common among young women, the condition is not limited to them, Dr. Schreiner said. Of the 8 million Americans with an eating disorder, 1 million are men.

Dr. Schreiner outlined four types of eating disorders that primary care providers may encounter: anorexia nervosa, which is characterised by a distorted body image, a pathological fear of gaining weight, and severe dieting that leads to excessive weight loss; bulimia nervosa, which involves frequent episodes of binge eating followed by inappropriate compensatory behaviours, such as self-induced vomiting, to avoid weight gain; binge eating disorder, in which binge eating is not followed by subsequent purging episodes; and an unspecified eating disorder that consists of symptoms of a combination of any of the first three.

The long-term effects of eating disorders, according to Dr. Schreiner, include muscle atrophy, dental complications including tooth erosion and loss, stomach ulcers, chronic constipation, osteoporosis at ages as young as 18 years, chronic cardiac complications, infertility, failure of organs such as the kidney, liver, and pancreas, heart attack, seizures, and death.

The mortality rate associated with anorexia nervosa alone is 12 times higher than the death rate of all causes of death for females aged 15 years to 24 years, she added. “With screening tools, these complications are potentially preventable.”

The SCOFF questionnaire

SCOFF is an acronym for the four questions in the questionnaire. Answering yes to two or more of the following questions indicates a likely case of anorexia or bulimia:

  • SICK: Do you make yourself sick or vomit after a meal because you feel uncomfortably full?

  • CONTROL: Do you fear loss of control over how much you eat?

  • ONE STONE: Has the patient lost one stone (or 14 lbs) in a 3-month period? (The questionnaire originated here in the United Kingdom, where we still commonly use stones as a  measure of weight.)

  • FAT: Do you believe you are fat even when others tell you that you are too thin?

  • FOOD: Does food dominate your life?

When asked if patients respond honestly to these questions, Dr. Schreiner said, “If the questions aren't asked, patients won't get the care they need. They may not be ready the first couple of times, but if you keep asking the questions, the patients will respond eventually. They want to talk to someone about it.”


  1. Schreiner J. “Eating Disorder Screening: Implementation of the SCOFF questionnaire.” Presented at: AANP 2015. June 9-14, 2015. New Orleans, Louisiana.

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