The use and misuse of the SCOFF screening measure over two decades: a systematic literature review.

PURPOSE: The SCOFF questionnaire was designed as a simple, memorable screening tool to raise suspicion that a person might have an eating disorder. It is over 20 years since the creation of the SCOFF, during which time it has been widely used. Considering this, we wish to review the use of the SCOFF in peer-reviewed scientific journals, and to assess whether it is being used appropriately in the manner in which it was originally devised and tested. METHODS: The Preferred Reporting Items for a Systematic Review and Meta-analysis (PRISMA) guidelines were followed, and all search strategies and methods were determined before the onset of the study. PubMed and Wiley Online Library were searched using the terms SCOFF and eating. Two reviewers were involved in the reviewing process. Criteria for appropriate use of the SCOFF were formalised with the tool's original authors. RESULTS: 180 articles were included in the final review. 48 articles had used the SCOFF appropriately, 117 articles inappropriately and 15 articles had been mixed in the appropriateness of their use. CONCLUSION: This systematic review highlights the inappropriate use of the SCOFF in diverse languages and settings. When used correctly the SCOFF has made a significant contribution to the understanding of eating disorders and its simplicity has been applauded and led to widespread use. However in over two-thirds of studies, the use of the SCOFF was inappropriate and the paper highlights how and in what way it was misused, Guidelines for the appropriate use of the SCOFF are stated. Future validation and avenues of research are suggested. LEVEL OF EVIDENCE: Level I.

The Brief Evaluation of Adolescents and Children Online (BEACON): Psychometric development of a mental health screening measure for school students.

This paper describes the development and psychometric evaluation of a brief self-report measure (BEACON) to inform universal mental health screening in schools. Items assess symptoms and impairment associated with anxiety and attention/hyperactivity problems (grades 4-11) as well as depression and eating difficulties (grades 6-11), with optional items for suicidality and self-harm (grades 7-11). Initial item examination based on Item Response Theory (IRT) and classical test theory involved 3844 students in grades 4 through 11 (Study 1) and identified 18 items for grades 4-5 and 31 items for grades 6-11 that fulfilled pre-set criteria. Study 2 extended testing with 10,479 students in grades 4-11 and added an additional four items assessing impairment associated with eating difficulties for older students (grades 6-11) creating a total of 35 items for grades 6-11. All items, for both grade-level versions, met the pre-set criteria for IRT and classical test theory analysis supporting their strength in the measurement of the dimensions of concern. The measure showed good reliability (subscale alphas .87 to .95). Validity was also demonstrated against standard symptom measures, school grades, school absenteeism, and help-seeking. The BEACON appears to be a psychometrically sound measure to use in the first stage of school-based screening for mental health problems.

Body appreciation predicts lower levels of orthorexia nervosa symptoms: Prospective findings.

Recent evidence shows that negative body image may be a potential risk factor for symptoms of orthorexia nervosa (ON). However, whether positive body image plays a protective role against symptoms of ON remains unclear. Although prior research has established associations between body appreciation (a core component of positive body image) and ON symptoms, this research is limited to cross-sectional designs, precluding inferences of temporal precedence. Thus, the present study overcomes this limitation by testing whether body appreciation prospectively predicts ON symptoms. Data were analysed from 1253 adult women (M age = 34 years (SD = 9.4), 81.3% Caucasian) who completed the Orthorexia Nervosa Inventory (ONI) and Body Appreciation Scale 2-Short Form (BAS2-SF) at baseline (T1) and at three-month follow-up (T2). Multiple linear regressions were used to test whether body appreciation scores at T1 predicted ONI subscale scores (behaviours, emotions, and impairments) at T2. Results revealed that higher body appreciation scores at T1 significantly predicted decreased scores on each ONI subscale at T2, though effect sizes were small. Findings provide preliminary evidence that body appreciation may protect against ON symptoms. If replicated, efforts to address ON symptoms may be enhanced by promoting body appreciation.

Effects of videoconferencing use on momentary changes in disordered eating urges, body dissatisfaction, and mood.

The coronavirus disease 2019 (COVID-19) pandemic led to a global surge in videoconferencing use for work/study-related reasons. Although these platforms heighten exposure to one's image, the implications of videoconferencing use on body image and eating concerns remain scantly examined. This study sought to investigate, in an Australian sample, whether videoconferencing for work/study-related reasons predicted increases in body dissatisfaction (BD), urge to engage in disordered eating (DE; restrictive eating, exercise, overeating/purging), and negative mood at the state level. Participants (N = 482, 78.8% women, Mage  = 20.5 years [SD = 5.3]) completed baseline demographic measures, accompanied by an ecological momentary assessment (EMA) of videoconferencing for work/study-related reasons, BD, DE urges, and negative mood six times a day for 7 days via a smartphone application. Most participants (n = 429; 89.0%) reported state-based videoconferencing use during the EMA phase. Consistent with expectations, state-based videoconferencing use was associated with an increase in state-level urges to engage in exercise. However, contrary to predictions, state-based videoconferencing use was linked to a decrease in state-level BD at the next assessment point and failed to predict negative mood and urges to engage in restrictive eating or overeating/purging at the state level. Given the simplified measure of videoconferencing use, the current research is considered preliminary and future replication and extension, using more nuanced measures, is warranted.

Hyperemesis gravidarum and eating disorders before and after pregnancy: A register-based study.

OBJECTIVE: Hyperemesis gravidarum (HG) is a severe form of excessive vomiting during pregnancy. The connection between psychiatric morbidity and HG has been debated, but only a few studies have focused on eating disorders (EDs). The objective of this study was to evaluate the association between HG and both pre-pregnancy and new post-pregnancy EDs. METHODS: A register-based controlled study. HG diagnoses were retrieved from healthcare registers between 2005 and 2017. Women with HG in their first pregnancy resulting in delivery were chosen as cases (n = 4265; the HG group) and women with no HG as controls (n = 302,663; the non-HG group). The associations between EDs and HG were analyzed by binary logistic regression, adjusted with age, body mass index, smoking, socioeconomic status, and pre-pregnancy psychiatric diagnoses. RESULTS: In the HG group, 1.6% and in the non-HG group, 0.2% had a pre-pregnancy ED. Women with ED were more likely to have HG in their first pregnancy compared with women with no history of EDs (adjusted odds ratio [AOR] 9.4, 95% CI 6.52-13.66, p < .0001). Moreover, 0.4% of the women in the HG group and 0.1% of the women in the non-HG group had a new ED diagnosis after pregnancy, and thus the women in the HG group were more likely to have an ED diagnosis after pregnancy (AOR I 3.5, 95% CI 1.71-7.15, p < .001, AOR II 2.7, 95% CI 1.30-5.69, p = .008). DISCUSSION: We found a bidirectional association between ED and HG, suggesting a shared etiology or risk factors between these disorders. This finding emphasizes the importance of collaboration across various specialties when treating these patients. PUBLIC SIGNIFICANCE: Our findings suggest a bidirectional association between HG and EDs before and after pregnancy. This finding provides essential information for healthcare professionals working with pregnant women. As both of these disorders are known to have far-reaching effects on the lives of both the mother and her offspring, our results help clinicians to target special attention and interventions to the patients suffering from these disorders.

Prevalence of eating disorder symptomatology among outpatients referred to health promotion from somatic hospital departments.

BACKGROUND AND AIMS: All eating disorders (EDs) lead to a significant decrease of health status, psychosocial functioning and quality of life (QoL). Individuals with untreated binge eating disorder (BED) tend to gain weight over time, which may contribute to serious health issues. In somatic hospital departments, some outpatients have reduced compliance with lifestyle changes. This may, to some extent, be due to patients with an undiagnosed ED receiving the incorrect treatment. In this cross-sectional study, we aimed to investigate the prevalence of EDs among patients referred to lifestyle courses. RESULTS: A total of 136 patients referred from somatic hospital departments to lifestyle changes in a specialized hospital unit were included in the study. The response rate was 69.4%. Self-reported ED or sub-clinical symptoms of ED according to the Eating Disorder Examination Questionnaire (EDE-Q) were found in 17.65%. Of these, 11.03% fulfilled the self-reported criteria for an ED (BED, 7.35%; bulimia nervosa, 3.68%). Patients with an ED or subclinical ED symptoms had elevated grazing behaviour compared to those without ED symptomatology. A statistically significant difference in QoL was also found. DISCUSSION AND CONCLUSIONS: The prevalence of self-reported ED or subclinical ED symptoms in patients referred to a lifestyle course is substantial. This ED group had reduced QoL and larger grazing behaviour compared to patients without ED symptomatology. Thus, the prevalence of undiagnosed EDs among patients within somatic hospital departments may be substantial, underlining the importance of screening and further research within this topic. LEVEL OF EVIDENCE: Level III, well-designed cohort study. SIGNIFICANCE: What is already known on this subject? In a review including populations from Scandinavia, the USA and South America, the estimated BED prevalence in individuals with higher body weight seeking help to lose weight is 13-27% [22]. Dawes et al. (2016) conducted a meta-analysis investigating the prevalence of mental health conditions among bariatric surgery candidates and recipients. They included 25 studies with a total of 13,769 patients and found that the prevalence of BED was 17% (13-21%) [10]. What this study adds? We have identified a group of patients who may be receiving inappropriate treatment with weight loss intervention instead of specialized ED intervention. It appears that this issue is valid in various somatic hospital departments. Thus, this is a field that requires further attention and investigation.

Feeding and Eating Disorders in Bariatric Surgery: A Retrospective Study.

INTRODUCTION: Obese subjects undergoing bariatric surgery often display medical and psychiatric comorbidities, influencing post-operative course and long-term prognosis. Candidates for bariatric surgery are evaluated through a multidisciplinary assessment in the pre-operative phase, including a psychiatric visit. The psychiatric examination aims to screen psychiatric comorbidities, including feeding and eating disorders (FEDs). Indeed, there is evidence of the association between obesity and several psychiatric disorders, such as FEDs, but also anxiety disorders, mood disorders, psychotic disorders, neurodevelopment disorders and personality disorders, particularly B and C cluster personalities. This study aims to evaluate the presence of psychiatric comorbidities among a population of candidates for bariatric surgery, and to underline the clinical correlates of FEDs diagnosis at the pre-operative assessment. SUBJECTS AND METHODS: Patients were recruited at the outpatient service of the Section of Psychiatry, Clinical Psychology and Rehabilitation of the General Hospital/University of Perugia. Psychiatric comorbidities were investigated by a psychiatric interview and hetero-administered scales for the evaluation of DSM-5 psychiatric syndromes (Structured Interview for DSM-5 Disorders - clinical version - SCID-5-CV), psychopathological and personality characteristics (Minnesota Multiphasic Personality Inventory - MMPI-2 and Structured Clinical Interview for DSM-5-Personality Disorders - SCID-5-PD) and specific scales for the evaluation of FEDs (Binge Eating Scale - BES, Obesity Questionnaire - OQ, Bulimia Test-Revised - BULIT-R and Body Shape Questionnaire - BSQ). After performing descriptive statistics, we performed bivariate analyses to assess significant differences between subjects with and without FEDs diagnosis (p˂0.05). RESULTS: The sample was composed of 160 subjects (70.6% F versus 29.4% M). The average BMI was 42.90 ±6.258 and 86.8% of subjects had a Class 3 Obesity (BMI ≥40). 41.3% of patients received a psychiatric diagnosis and, specifically, a diagnosis of FEDs was highlighted in 28.7% cases. Individuals with FEDs more frequently had a family history of obesity and FEDs. As for psychopathological characteristics, altered scores on the BES and on the BULIT-R were more frequent in the group with psychiatric disorders excluding FEDs. CONCLUSIONS: Patients evaluated in bariatric surgery pre-operative assessment often display FEDs. Patients with FEDs more frequently suffer from other psychiatric disorders, showing the need for specific support pathways in this group of patients.

The relation of food insecurity to eating disorder characteristics and treatment-seeking among adult respondents to the National Eating Disorders Association online screen.

BACKGROUND: Food insecurity (FI), characterized by limited or uncertain access to adequate food, has been associated with eating disorders (EDs). This study explored whether FI was associated with ED behaviors, ED diagnosis, current treatment status, and treatment-seeking intentions among adults who completed an online ED screen. METHODS: Respondents to the National Eating Disorders Association online screening tool self-reported demographics, FI, height and weight, past 3-month ED behaviors, and current treatment status. Respondents were also asked an optional question about treatment-seeking intentions. Hierarchical regressions evaluated relations between FI and ED behaviors, treatment status, and treatment-seeking intentions. Logistic regressions explored differences in probable ED diagnosis by FI status. RESULTS: Of 8714 respondents, 25 % screened at risk for FI. FI was associated with greater binge eating (R2Change = 0.006), laxative use (R2Change = 0.001), and presence of dietary restriction (R2Change = 0.001, OR: 1.32) (ps < .05). Having FI was associated with greater odds of screening positive for a probable ED or as high risk for an ED (ps < .05). FI was not associated with current treatment status or treatment-seeking intentions (ps > .05). CONCLUSIONS: Findings add to existing literature supporting a relation between FI and EDs. Implications include a need to disseminate EDs screening and treatment resources to populations affected by FI and to tailor treatments to account for barriers caused by FI.

Current approaches in the recognition and management of eating disorders.

Eating disorders are now well acknowledged mental health problems that are common and present in people from diverse sociodemographic backgrounds. The past decade has seen a rapid expansion in research into eating disorder interventions. In response to the increasing burden of eating disorders, the Australian Government Department of Health and Aged Care has implemented significant policy changes to improve patient access to Medicare and inpatient treatment facilities. There are several international clinical practice guidelines and a robust evidence base particularly for first line care with specific psychological therapies, including guidelines for the management of eating disorders in individuals with a high weight. Medications play an important adjunct role in care, and novel neuromodulating treatments, such as psychostimulants, are under study. There is emerging evidence for increased person-centred care, with more choice in the form of alternatives to hospital inpatient programs and more respectful consideration of care for all who experience an eating disorder, including people with high weight.

Weight-based discrimination and disordered eating behaviors in a cohort of U.S. sexual minority young adults.

OBJECTIVE: Though prevalent, weight-based discrimination is understudied and has been linked to disordered eating behaviors (DEB) among adolescents and adults. Sexual minority populations experience elevated risk of DEB, but little is known about the role of weight discrimination in this elevated risk. METHODS: Participants were 1257 sexual minority women and men (ages 18-31 years) in the US Growing Up Today Study cohort. We examined cross-sectional associations between weight discrimination victimization and three DEB in the past year: unhealthy weight control behaviors, overeating, and binge eating. Generalized estimating equations, adjusted for potential confounders, were used to estimate prevalence ratios (PRs) and 95% confidence intervals (CIs). RESULTS: Three in 10 participants (31%) reported weight-based discrimination victimization. Sexual minority young adults who reported weight-based discrimination had greater relative prevalence of unhealthy weight control behaviors (PR [95% CI]: 1.92 [1.35, 2.74]), overeating (3.15 [2.24, 4.44]), and binge eating (3.92 [2.51, 6.13]), compared with those who reported no weight-based discrimination. Associations with overeating and binge eating remained significant after adjusting for BMI. DISCUSSION: The role of weight-based discrimination, and its intersections with other forms of stressors for sexual minority young adults, must be included in efforts to advance eating disorder prevention for this underserved population. PUBLIC SIGNIFICANCE: Three in 10 sexual minority young adults in this study had experienced weight-based discrimination, a common but understudied form of discrimination. Sexual minority young adults who experienced weight-based discrimination were at greater risk of disordered eating behaviors than those who had not experienced weight-based discrimination. These findings suggest that weight-based discrimination may be an important-and preventable-risk factor for disordered eating behaviors among sexual minority young adults.

An exploratory structural equation modelling (ESEM) of the Eating Disorders Examination Questionnaire (EDE-Q) in bariatric patients.

Several studies in clinical and non-clinical populations indicate differences between rationally and empirically derived subscales for the Eating Disorder Examination Questionnaire (EDE-Q), including samples of patients seeking bariatric surgery. This study aimed to use exploratory structural equation modelling (ESEM) to estimate the factor structure of the EDE-Q and assess for the additive value of alternative measurement of eating disorder symptoms. Adolescents and adults completed the EDE-Q and a psychiatric evaluation prior to bariatric surgery. Data from 330 participants were analysed using the original four-factor and modified three-factor structure of the EDE-Q using both confirmatory factor analysis (CFA) and exploratory structural equation modelling (ESEM). Age, ethnicity, and body mass index were examined as covariates in the best fitting model, and model subscales used to generate a predictive model of clinician screened DSM-5 eating disorder diagnoses for criterion validity. A CFA of the four-factor EDE-Q provided poor model fit for a pre-surgical bariatric population, but the three-factor EDE-Q and an ESEM of the four-factor EDE-Q provided excellent model fit. The Eating Concern subscale of the four-factor ESEM model significantly predicted eating disorder diagnosis and was positively correlated with age. Our results suggest the ESEM derived factors of the EDE-Q offered some improvements to the original empirically derived factor structure, as subscale scores based on the original items and cross-loading items yielded an adequate prediction of clinician diagnoses.

Do the SCOFF items function differently by food-security status in U.S. college students?: Statistically, but not practically, significant differences.

Despite food insecurity (FI) being associated with eating disorders (EDs), little research has examined if ED screening measures perform differently in individuals with FI. This study tested whether items on the SCOFF performed differently as a function of FI. As many people with FI hold multiple marginalized identities, this study also tested if the SCOFF performs differently as a function of food-security status in individuals with different gender identities and different perceived weight statuses. Data were from the 2020/2021 Healthy Minds Study (N = 122,269). Past-year FI was established using the two-item Hunger Vital Sign. Differential item functioning (DIF) assessed whether SCOFF items performed differently (i.e., had different probabilities of endorsement) in groups of individuals with FI versus those without. Both uniform DIF (constant between-group difference in item-endorsement probability across ED pathology) and non-uniform DIF (variable between-group difference in item-endorsement probability across ED pathology) were examined. Several SCOFF items demonstrated both statistically significant uniform and non-uniform DIF (ps < .001), but no instances of DIF reached practical significance (as indicated by effect sizes pseudo ΔR2 ≥ 0.035; all pseudo ΔR2's ≤ 0.006). When stratifying by gender identity and weight status, although most items demonstrated statistically significant DIF, only the SCOFF item measuring body-size perception showed practically significant non-uniform DIF for perceived weight status. Findings suggest the SCOFF is an appropriate screening measure for ED pathology among college students with FI and provide preliminary support for using the SCOFF in individuals with FI and certain marginalized identities.

Exploring the relationship between food disgust and avoidant/restrictive food intake disorder (ARFID) presentations in a non-clinical collegiate sample.

OBJECTIVE: Disgust is an established mechanism driving restrictive eating behavior. Avoidant/restrictive food intake disorder (ARFID) is a restrictive eating disorder diagnosis characterized by extremely selective eating with three hypothesized presentations. It has been suggested that disgust is significantly associated with ARFID; however, there is limited empirical research to support this hypothesis. This study explores relationships between food-specific disgust, ARFID symptoms, and ARFID presentations. METHOD: Undergraduate students (n = 443, Mage = 19.14 years [SD = 1.25], 50.1% female, 52.7% White) completed a validated measure of food-specific disgust and an established self-report screening tool for the likely presence of ARFID and hypothesized ARFID presentations. RESULTS: Sixty-nine (14.5%) participants screened positively for the likely presence of ARFID. Food disgust did not differ between those who did and did not screen positively for ARFID (p > .05). Within the subsample of those screening positive for ARFID, disgust was not related to any of the three hypothesized presentations of ARFID (all p > .05). DISCUSSION: Our results did not show a significant association between disgust and positive ARFID screen or any of the hypothesized ARFID presentations. Importantly, these negative findings were obtained using validated screening tools for ARFID. Future research should seek to replicate these findings in clinical samples to further inform treatment. PUBLIC SIGNIFICANCE: Avoidant/restrictive food intake disorder (ARFID) is associated with significant medical and psychosocial complications, but the mechanism involved in its development and maintenance remain poorly understood. Findings from this study of college students screening positively for ARFID suggests that food disgust in not a key driver of ARFID symptoms. Exposure-based approaches, which are generally not thought to be effective in targeting disgust, may thus be appropriate in the treatment of ARFID.

Considerations of eating disorder risk during obesity treatment in Australia: Current practice, attitudes and barriers.

INTRODUCTION: People with obesity are vulnerable to eating disorders. It has been suggested that screening for eating disorder risk be part of obesity care. However, it is unclear what current practice entails. OBJECTIVE: To explore considerations of eating disorder risk during treatment of obesity, including assessment and intervention strategies used in clinical practice. MATERIALS AND METHODS: An online (REDCap) cross-sectional survey was distributed to health professionals working with individuals with obesity in Australia through professional societies and social media. The survey had three sections: 1. Characteristics of Clinician/Practice, 2. Current Practice, 3. Attitudes. Data were summarised using descriptive statistics and free-text comments were independently coded in duplicate to identify themes. RESULTS: 59 health professionals completed the survey. Most were dietitians (n = 29), identified as women (n = 45) and worked within a public hospital (n = 30) and/or private practice (n = 29). Overall, 50 respondents reported assessing for eating disorder risk. Most reported that having a history of, or risk factors of eating disorders should not preclude obesity care but emphasised the importance of treatment modification including using a patient-centred approach involving a multidisciplinary team and promoting healthy eating behaviours, with less emphasis on calorie restriction or bariatric surgery. Management approaches did not differ for those with eating disorder risk factors or a diagnosed eating disorder. Clinicians identified the need for additional training and clear referral pathways. CONCLUSION: Individualised care, balancing models of care for eating disorders and obesity and further access to training and services will be important in improving care of patients with obesity.

Factor structure and measurement invariance of the English- versus Spanish-language Eating Disorder Examination Questionnaire: Brief Form (S-EDE-Q-BF) in Hispanic/Latino/a/x persons seeking bariatric surgery.

BACKGROUND: Assessment of eating disorder psychopathology during preoperative psychological evaluations could be facilitated with psychometrically valid measures. One of the most commonly used measures, the Eating Disorder Examination Questionnaire (EDE-Q), is lengthy and has been found to have psychometric limitations. Research has identified a shorter version that has received reliable support across diverse samples but requires further validation for use with patients being evaluated for bariatric surgery. OBJECTIVES: To cross-validate the factor structure of the EDE-Q: Brief Form (EDE-Q-BF, standalone, nonnested version) with patients being evaluated for bariatric surgery across English- and Spanish-language versions and establish measurement invariance for gender and language. SETTING: Northeastern hospital in the United States. METHODS: Participants (n = 618) undergoing evaluations prior to bariatric surgery who identified as Hispanic/Latino/a/x and consented to participate in this research study (which did not influence eligibility for bariatric surgery) completed self-reports. Of the 618 participants, 92 were male and 526 were female, 318 preferred English and were administered English versions of the measures, and 300 preferred Spanish and were administered Spanish versions of the measures. RESULTS: The 3-factor structure ("Restraint," "Weight/Shape Concerns," and "Body Dissatisfaction") of the EDE-Q-BF fit the data well (χ2 [11] = 18.47; P = .071; root mean square error of approximation [RMSEA] = .033; comparative fit index [CFI] > .99; standardized root mean squared residual [SRMR] = .02). Scaler invariance was met for both gender and language. Correlations with external criteria further supported its validity. CONCLUSION: The EDE-Q-BF can easily be administered as part of a preoperative psychological assessment battery to screen for eating disorder psychopathology and is valid for Hispanic/Latino/a/x men and women who speak either English or Spanish.

Clinician perspectives on assessing for disordered eating and body image disturbance in adolescents and young adults with cystic fibrosis.

BACKGROUND: Maintaining a healthy weight is a focus of Cystic Fibrosis (CF) care. With the increased use of highly effective CFTR modulators, many people with CF are gaining weight more easily, which may affect eating habits and body image. This study investigates providers' understanding and current practices surrounding body image disturbance and disordered eating in people with CF. METHODS: We distributed a one-time web-based survey to United States (U.S.)-based CF healthcare providers via CF Foundation list servs. The survey investigated providers' understanding and perceived importance of issues surrounding disordered eating and body image disturbance in adolescent and young adults (AYA) with CF as well as current screening practices. We used descriptive statistics to analyze participants' characteristics and practices. RESULTS: A total of 232 healthcare providers completed the survey. While most participants felt that screening for both body image disturbance and disordered eating should be standardized in CF care (79% and 82%, respectively), fewer than one third felt comfortable screening, and only one quarter actually screened for various eating disordered behaviors in daily practice. Only 2.7% reported using a formal screening tool. Participants reported provider assessment tools (86%), standardized partnerships with eating disorder specialists (80%), and CFF or national guidelines (79%) would be helpful to improve screening and counseling. CONCLUSION: While most CF providers believe that body image disturbance and disordered eating are important topics in AYA with CF, few address these topics with their patients. The development of educational sessions and national guidelines may improve screening and counseling practices.

Fifteen-minute consultation: Recognition and management of eating disorders presenting to the emergency department.

Eating disorder presentations in children and young people during the COVID-19 pandemic have increased, and this has become a common presentation to paediatric emergency departments (EDs). We cover a structured approach on identifying and managing these presentations within the ED including history taking, what to look for on examination, what investigations are needed and how to decide who requires admission to hospital.

Development and usability testing of a chatbot to promote mental health services use among individuals with eating disorders following screening.

OBJECTIVE: A significant gap exists between those who need and those who receive care for eating disorders (EDs). Novel solutions are needed to encourage service use and address treatment barriers. This study developed and evaluated the usability of a chatbot designed for pairing with online ED screening. The tool aimed to promote mental health service utilization by improving motivation for treatment and self-efficacy among individuals with EDs. METHODS: A chatbot prototype, Alex, was designed using decision trees and theoretically-informed components: psychoeducation, motivational interviewing, personalized recommendations, and repeated administration. Usability testing was conducted over four iterative cycles, with user feedback informing refinements to the next iteration. Post-testing, participants (N= 21) completed the System Usability Scale (SUS), the Usefulness, Satisfaction, and Ease of Use Questionnaire (USE), and a semi-structured interview. RESULTS: Interview feedback detailed chatbot aspects participants enjoyed and aspects necessitating improvement. Feedback converged on four themes: user experience, chatbot qualities, chatbot content, and ease of use. Following refinements, users described Alex as humanlike, supportive, and encouraging. Content was perceived as novel and personally relevant. USE scores across domains were generally above average (~5 out of 7), and SUS scores indicated "good" to "excellent" usability across cycles, with the final iteration receiving the highest average score. DISCUSSION: Overall, participants generally reflected positively on interactions with Alex, including the initial version. Refinements between cycles further improved user experiences. This study provides preliminary evidence of the feasibility and acceptance of a chatbot designed to promote motivation for and use of services among individuals with EDs. PUBLIC SIGNIFICANCE: Low rates of service utilization and treatment have been observed among individuals following online eating disorder screening. Tools are needed, including scalable, digital options, that can be easily paired with screening, to improve motivation for addressing eating disorders and promote service utilization.

Translation and validation of the Chinese version of the orthorexia nervosa assessment questionnaires among college students.

PURPOSE: The main objective of the study was to translate, validate, and compare the Chinese ORTO scales (ORTO-15 and ORTO-R). The secondary objective was to assess factors that may be related with risk of orthorexia nervosa (ON). METHODS: Two cross-sectional surveys were conducted on March-to-June 2021 for ORTO-15 and April 2022 for ORTO-R. ORTO questionnaires were translated into Chinese using the forward-backward-forward method. Exploratory factor analysis (EFA), discriminant validity and confirmatory factor analysis (CFA) were used to examine the construct validity of the questionnaires. The internal consistency was assessed using the Cronbach alpha coefficient and the test-retest reliability. Multivariate linear regression analysis was used to explore potential factors related with ON scores. RESULTS: Totally, 1289 and 1084 eligible participants were included for assessment of ORTO-15 and ORTO-R, with the mean age of 20.9 ± 2.0 years and 21.0 ± 2.3 years. The internal consistency of Chinese ORTO-15 scale and ORTO-R scale were both satisfactory (α = 0.79, ICC = 0.79; α = 0.77, ICC = 0.82). However, all ORTO-15 models showed a poor fit using CFA whereas the ORTO-R was characterized by acceptable goodness-of-fit. Multivariate linear regression indicated that physical activities and mental disorders were positively associated with ON risk assessed by both ORTO-R and ORTO-15. CONCLUSION: The Chinese ORTO-R scale was a more reliable tool to screen for ON tendencies than the Chinese version of ORTO-15. Mental disorders and physical activities might be associated with the increased ON risk. LEVEL OF EVIDENCE: Level V (descriptive cross-sectional study).