Working with eating disorder (ED) clients (in a helpful way) is very different than how most of us were trained in school.

As a Registered Dietitian, I have worked with hundreds of ED clients throughout the years, and honed my intake questions to figure out what is really going on with someone who uses food as a way to cope.

Let's take a look at some questions you may use outside of anthropometic numbers/ labs/ food frequency.

Here are questions I ask everyone, regardless of ED or not:

• Preferred pronouns
• religion/religious dietary observances
• Food insecurity: do you have enough food (access, money to purchase)? Do you use SNAP (food stamps), WIC, or other food assistance programs?
• Do you have access to a working kitchen (refrigerator/freezer, stove, microwave, etc.)?
• Current living situation? (who do they live with, what type of housing)
• If you have a uterus: when was your last menstrual period? Is it consistent? Have you ever gone more than 2 months without getting your period?

I will also ask about mental health, suicidal thoughts/attempts, medications, drug/alcohol use and frequency, any supplements/herbal/alternative medicines used, and more.

Once I am talking with them, some of the questions in our first session may include:
*The following questions may or may not be used based on how I read the person that day, the severity of the disorder, co-morbid issues, or other reasons that you just feel.

• Do you count calories/macros/other? 
• Follow up to the above - Since you already count, do you know your average number of calories/day? (I don't want them to count, but they will be more specific than I can calculate, so I may as well know the info. We'll work on getting them to not count in sessions, but this is useful information if they already know it).
• What is the most frustrating thing about how you eat?
• History of dieting? What diets have you done? ...As you see, diets don't work (I say this with more conversation between, but this is a summary).
• Do you compensate for eating? (if they don't understand, I'll explain: do you feel the need to make yourself throw-up, exercise to "burn off what you ate," take laxatives or diet pills, or other ways of "getting rid" of what you ate?)
• Do you ever feel that eating gets out of control? (this may be a restrictive person feeling that eating at all is out of control, or someone genuinely binge eating. Follow up with conversation).
• What are your food rules? (If they don't understand: Are there any foods you won't eat/are scared of? Do you have any rituals around eating like using certain utensils, eating in a particular order...?)

Among other questions. 

Bottom line, eating disorders are complex mental health issues that manifest behaviorally with food behaviors, and can turn into gnarly medical problems. Treat the person with compassion, understanding, and be a good listener. This will get you more information, and allow you to help them the best you can. Don't rush to conclusions or "fixes." Treat the whole person.

What would you like to learn about working with eating disorders?
Drop me an email, and I'll choose some topics for future blog posts and training :)
​Libby@notyouraveragenutritionist.com

~Libby Parker, MS, RD

5-Question Screening Tool for Eating Disorders

I get it, as medical professionals you are go-go-go! How do you take the time to assess if someone has an eating disorder when they are not presenting?

In 1999, the “SCOFF Questionnaire” was developed to give providers a fast way to assess for Anorexia or Bulimia (false positive rate of only 12.5% for the controls – but maybe they developed one later, there was not commentary on follow up).

Answering “yes” to at least two of the following questions led to a nearly 100% positive diagnosis of anorexia nervosa or bulimia nervosa.
Ask your patient(s):
​
The SCOFF questions*

• Do you make yourself Sick because you feel uncomfortably full?
• Do you worry that you have lost Control over how much you eat?
• Have you recently lost more than One stone (14 lb) in a 3-month period?
• Do you believe yourself to be Fat when others say you are too thin?
• Would you say that Food dominates your life?

Although the authors’ state there is need for further testing to increase validity of the SCOFF questions, this questionnaire has been standard in various health care settings for many years.

Sources:

1. Morgan JF, Reid F, Lacey JH. The SCOFF questionnaire: assessment of a new screening too for eating disorders. BMJ 1999;319:1467
2. Morgan JF, Reid F, Lacey JH. The SCOFF questionnaire: a new screening tool for eating disorders. Western Journal of Medicine. 2000;172(3):164-165.