Welcome to the training on Eating Disorders: Screening and Intervention provided by the Texas Health and Human Services Commission (HHSC) and the Texas Department of State Health Services (DSHS).
Goal
The goal of this module is to equip Texas Health Steps providers and others to identify eating disorders in children and adolescents and to provide appropriate interventions and referrals as part of routine clinical care.
Target Audience
Texas Health Steps providers and other interested health-care professionals.
Specific Learning Objectives
After completing the activities of this module, you will be able to:
- Specify the prevalence of and health risks associated with eating disorders.
- Assess risk factors for eating disorders and conduct effective screening as part of routine clinical practice.
- Employ practical intervention strategies and resources in the medical home.
Please note this module expires on 7/29/2024.
This module was released on 7/29/2021.
Accreditation Statement
Continuing Medical Education
The Texas Department of State Health Services, Continuing Education Service is accredited by the Texas Medical Association to provide continuing medical education for physicians.
The Texas Department of State Health Services, Continuing Education Service designates this enduring material for a maximum of 1.00 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Continuing Nursing Education
The Texas Department of State Health Services, Continuing Education Service is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation. The Texas Department of State Health Services, Continuing Education Service has awarded 1.00 contact hour(s) of Continuing Nursing Education.
Social Workers
The Texas Department of State Health Services, Continuing Education Service, the continuing education provider, ensures that the education provided is directly related to the practice of social work; and that the individuals presenting the information have the necessary experience and knowledge in the topics presented. The Texas Department of State Health Services, Continuing Education Service has awarded 1.00 hours of credit.
Certificate of Attendance
The Texas Department of State Health Services, Continuing Education Service has designated 1.00 hour(s) for attendance.
Disclosures
One of the requirements of continuing education is disclosure of the following information to the learner:
- Notice of requirements for successful completion of continuing education activity. To receive continuing education credit the learner must successfully complete the following activities:
- Create a Texas Health Steps account.
- Complete on-line registration process.
- Thoroughly read the content of the module.
- Complete the on-line examination.
- Complete the evaluation.
- Commercial Support.
The THSTEPS Web-based Continuing Education Series has received no commercial support. - Disclosure of Relevant Financial Relationships.
The THSTEPS Continuing Education Planning Committee and the authors of these modules have no relevant financial relationships to disclose. - Non-Endorsement Statement.
Accredited status does not imply endorsement of any commercial products or services by the Department of State Health Services, Continuing Education Service; Texas Medical Association; or American Nurse Credentialing Center. - Off-Label Use.
Using a disclosure review process, the THSTEPS Continuing Education Planning Committee has examined documents and has concluded that the authors of these modules have not included content that discusses off-label use (use of products for a purpose other than that for which they were approved by the Food and Drug Administration).
The following are policies and definitions of terms related to continuing education disclosure:
The intent of disclosure is to allow Department of State Health Services (DSHS) Continuing Education Service the opportunity to resolve any potential conflicts of interest to assure balance, independence, objectivity and scientific rigor in all of its Continuing Education activities.
All faculty, planners, speakers and authors of Department of State Health Services (DSHS) Continuing Education Service sponsored activities are expected to disclose to the Department of State Health Services (DSHS) Continuing Education Service any relevant financial, relationships with any commercial or personal interest that produces health care goods or services concerned with the content of an educational presentation. Faculty, planners, speakers and authors must also disclose where there are any other potentially biasing relationships of a professional or personal nature.
Glossary of Terms
Conflict of Interest: Circumstances create a conflict of interest when an individual has an opportunity to affect Continuing Education content about products or services of a commercial interest with which she/he has a financial relationship or where there are any other potentially biasing relationships of a professional or personal nature.
Commercial Interest: Any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients.
Financial Relationships: Those relationships in which the individual benefits by receiving a salary, royalty, intellectual property rights, consulting fee, honoraria, ownership interest (e.g., stocks, stock options or other ownership interest, excluding diversified mutual funds), or other financial benefit. Financial benefits are usually associated with roles such as employment, management position, independent contractor (including contracted research), consulting, teaching, membership on advisory committees or review panels, board membership, and other activities for which remuneration is received or expected. Relevant financial relationships would include those within the past 12 months of the person involved in the activity and a spouse or partner. Relevant financial relationships of your spouse or partner are those of which you are aware at the time of this disclosure.
Off Label: Using products for a purpose other that that for which it was approved by the Food and Drug Administration (FDA).
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- American Academy of Pediatrics. (2021). Clinical Report: Identification and Management of Eating Disorders in Children and Adolescents. Pediatrics, 147(1):e2020040279.
- American Academy of Pediatrics. (2016). Clinical Report: Preventing Obesity and Eating Disorders in Adolescents. Pediatrics; 138(3).
- American Academy of Pediatrics. Treating Eating Disorders.
- American Psychiatry Association. What are Eating Disorders?
- Bright Futures, from the American Academy of Pediatrics. Adolescent Visits 11 through 21 years.
- EAT26 screening tool.
- Eating Disorder Foundation.
- Eating Disorders 101: a resource for professionals.
- EDE Questionnaire screening tool.
- Let’s Talk About Eating Disorders. Infographic from the National Institute of Mental Health (appropriate for posting).
- Motivational interviewing training resources. Center for Evidence-Based Practices at Case Western Reserve University.
- National Institute for Health and Clinical Excellence Guidelines. Eating Disorders.
- National Eating Disorders Association.
- Rapid Adolescent Prevention Screening (RAAPS).
- SCOFF Questionnaire screening tool.
- Texas Health and Human Services Commission, Texas Health Steps Periodicity Schedule.
- What to Say & What Not to Say. Video with tips on how to talk with patients about eating and weight concerns, from the National Eating Disorders Association.
- American Academy of Pediatrics. (2021). Clinical Report: Identification and Management of Eating Disorders in Children and Adolescents. Pediatrics, 147(1):e2020040279.
- American Academy of Pediatrics. (2016). Clinical Report: Preventing Obesity and Eating Disorders in Adolescents. Pediatrics; 138(3).
- American Psychiatric Association. (2017). What are Eating Disorders?
- Arikawa, A., Ross, J., Wright, L., Elmore, M., Marrero Gonzalez, A., & Wallace, T. C. (2020). Results of an Online Survey about Food Insecurity and Eating Disorder Behaviors Administered to a Volunteer Sample of Self-Described LGBTQ+ Young Adults Aged 18 to 35 Years. Journal of the Academy of Nutrition and Dietetics, S2212-2672(20):31341-1.
- Bello, N. T., & Yeomans, B. L. (2017). Safety of pharmacotherapy options for bulimia nervosa and binge eating disorder. Expert Opinion on Drug Safety, 17(1):17-23.
- Centers for Disease Control and Prevention. (2018). Overweight & Obesity: Defining Childhood Obesity.
- Chapa, D., Kite, B. A., Forbush, K. T., Tregarthen, J. P., & Argue, S. (2020). Eating-disorder psychopathology and driven exercise change models: A latent change score analysis. International Journal of Eating Disorders, Nov 3.
- Ciao, A. C., Lebow, J., VandenLangenberg, E., Ohls, O., & Berg K. C. (2020). A qualitative examination of adolescent and parent perspectives on early identification and early response to eating disorders. Eating Disorders,1-18.
- O’Connell, M., Boat, T., & Warner, K. (2009). Committee on the Prevention of Mental Disorders and Substance Abuse Among Children, Youth, and Young Adults: Research Advances and Promising Interventions.
- Cotton, M., Ball, C., & Robinson, P. (2003). Four Simple Questions Can Help Screen for Eating Disorders. Journal of General Internal Medicine, 18(1): 53–56.
- Deloitte Access Economics. (2020). Social and economic cost of eating disorders in the United States of America. Harvard University T.H. Chan School of Public Health’s Strategic Training Initiative for the Prevention of Eating Disorders and the Academy for Eating Disorders.
- Deloitte Access Economics. (2020). Social & economic cost of eating disorders in Texas. Harvard University T.H. Chan School of Public Health’s Strategic Training Initiative for the Prevention of Eating Disorders and the Academy for Eating Disorders.
- Desai, N. (2019). The Role of Motivational Interviewing in Children and Adolescents in Pediatric Care. Pediatrics Annals, 48(9):e376-e379.
- Ellis, J. M., Essayli, J. H., Zickgraf, H. F., Rossi, J., Hlavka, R., Carels, R. A., & Whited, M. C. (2020). Comparing stigmatizing attitudes toward anorexia nervosa, binge-eating disorder, avoidant-restrictive food intake disorder, and subthreshold eating behaviors in college students. Eating Behaviors, 39:101443.
- Eskander, N., Chakrapani, S., & Ghani, M.R. (2020). The Risk of Substance Use Among Adolescents and Adults With Eating Disorders. Cureus, 12(9): e10309.
- Goldstein, M. A., Dechant, E. J., & Beresin, E. V. (2011). Eating Disorders. Pediatrics in Review, 32(12): 508-521.
- Gonzales, M., & Blashill, A. (2020). Ethnic/racial and gender differences in body image disorders among a diverse sample of sexual minority U.S. adults. Body Image, 36:64-73.
- Griffiths, S., Mond, J. M., Murray, S. B., & Touyz, S. (2015). The prevalence and adverse associations of stigmatization in people with eating disorders. International Journal of Eating Disorders, 48(6):767-74.
- Hackert, A. N., Kniskern, M. A., & Beasley, T. M. (2020). Academy of Nutrition and Dietetics: Revised 2020 Standards of Practice and Standards of Professional Performance for Registered Dietitian Nutritionists (Competent, Proficient, and Expert) in Eating Disorders. Journal of the Academy of Nutrition and Dietetics, 120(11):1902-1919.
- Haines, J., Gillman, M. W., Rifas-Shiman, S., Field, A. E., & Austin, S.B. (2010). Family dinner and disordered eating behaviors in a large cohort of adolescents. Eating Disorders, 18(1): 10–24.
- Herpertz-Dahlmann, B. (2015). Adolescent Eating Disorders: Update on Definitions, Symptomatology, Epidemiology, and Comorbidity. Child and Adolescent Psychiatric Clinics of North America, 24(1): 177-196.
- Iwajomo, T., Bondy, S., de Oliveira, C., Colton, P., Trottier, K., & Kurdyak, P. (2020). Excess mortality associated with eating disorders: population-based cohort study. The British Journal of Psychiatry, 1-7.
- Lavender, J. M., Brown, T. A., & Murray, S. B. (2017). Men, Muscles, and Eating Disorders: An Overview of Traditional and Muscularity-Oriented Disordered Eating. Current Psychiatry Reports, 19(6):32.
- Lee, E. B., Barney, J. L., Twohig, M. P., Lensegrav-Benson, T., & Quakenbush, B. (2020). Obsessive compulsive disorder and thought action fusion: Relationships with eating disorder outcomes. Eating Behaviors, 37:101386.
- Le Grange, D. (2005). The Maudsley family-based treatment for adolescent anorexia nervosa. World Psychiatry, 4(3): 142–146.
- Mehanna, H. M., Moledina, J., & Travis, J. (2008). Refeeding syndrome: what it is, and how to prevent and treat it. The BMJ; 336:1495.
- Meier, M., Kossakowski, Y. K., Jones, P. J., Kay, B., Riemann, B. C., & McNally, R. J. (2020). Obsessive-compulsive symptoms in eating disorders: A network investigation. International Journal of Eating Disorders, 53(3):362-371.
- Meneguzzo, P., Collantoni, E., Gallicchio, D., Busetto, P., Solmi, M., Santonastaso, P., & Favaro, A. (2018). Eating disorders symptoms in sexual minority women: A systematic review. European Eating Disorders Review, 26(4):275-292.
- Murakami, J. M., Essayli, J. H., & Latner, J. D. (2016). The relative stigmatization of eating disorders and obesity in males and females. Appetite, 102:77-82.
- National Eating Disorders Association. (2018). Anorexia Nervosa.
- National Eating Disorders Association. (2018). Avoidant Restrictive Food Intake Disorder (ARFID).
- National Eating Disorders Association. (2018). Binge Eating Disorder.
- National Eating Disorders Association. (2018). Bulimia Nervosa.
- National Eating Disorders Association. (2018). Pica.
- National Eating Disorders Association. (2018). Rumination Disorder.
- National Institutes of Mental Health (2016). Eating Disorders.
- Puhl, R., & Suh, Y. (2015). Stigma and eating and weight disorders. Current Psychiatry Reports, 17(3):552.
- Pulcini, C. D., Zettle, S., & Srinath, A. (2016). Refeeding Syndrome. Pediatrics in Review, 37(12): 516-523.
- Rosello, R., Gledhill, J., Yi, I., Watkins, B., Harvey, L., Hosking, A., Viner, R., & Nicholls, D. (2020). Early intervention in child and adolescent eating disorders: The role of a parenting group. European Eating Disorders Review; Oct 21.
- Rosen, D. (2010). Identification and Management of Eating Disorders in Children and Adolescents. Pediatrics, 126:1240.
- Schaumberg, K., Welch, E., Breithaupt, L., Hübel, C., Baker, J. H., Munn-Chernoff, M. A., . . . Bulik, C. M. (2017). The Science Behind the Academy for Eating Disorders’ Nine Truths About Eating Disorders. European Eating Disorders Review; 25(6):432-450.
- Seferovic, A., Dianes, G. N., Juan, B., Larsen, D., & Oyler, V. (2019). What is the best screening tool for eating disorders in the primary care setting? Evidence-Based Practice; 22:3-12.
- Stiles-Shields, E. C., Goldschmidt, A. B., Boepple, L., Glunz, C., & Le Grange, D. (2011). Driven Exercise Among Treatment-Seeking Youth with Eating Disorders, Eating Behaviors, 12(4): 328–331.
- Svedlund, N. E., Norring, C., Ginsberg, Y., & von Hausswolff-Juhlin, Y. (2019). Treatment of eating disorders with concurrent ADHD symptoms: knowledge, knowledge gaps and clinical implications. Lakartidningen, 116.
- The Academy for Eating Disorders. (2020). Nine Truths about Eating Disorders.
- Treasure, J., Duarte, T. A., & Schmidt, U. (2020). Eating Disorders. Lancet, 395(10227):899-911.
- Winter, V. R., Jones, A., & O’Neill, E. (2019). Eating breakfast and family meals in adolescence: the role of body image. Social Work in Public Health, 34, 3.
- Yale School of Medicine. (2018). Driven exercise in the absence of binge eating: Implications for purging disorder.
- American Psychiatric Association. Eating Disorders.
- Center for Discovery, Eating Disorder Treatment. Lists online and physical support groups.
- EAT26 screening tool.
- Eating Disorder Foundation.
- Eating Disorders: About More Than Food. National Institutes of Health.
- Eating Recovery Center. Eating Disorders Information Gateway.
- Eating Recovery Center. Support Groups.
- Families Empowered and Supporting Treatment for Eating Disorders (F.E.A.S.T.). Info for Parents.
- Finding Treatment. A map of providers from the National Eating Disorders Association.
- Global Support and Education Community of and for Parents of Those with Eating Disorders. F.E.A.S.T.
- Health at Every Size.
- National Institute of Mental Health. Psychotherapies.
- National Suicide Prevention Lifeline, 800-273-TALK (8255).
The medical definitions in this module were obtained or adapted from American Academy of Pediatrics, Britannica, Journal of Substance Abuse Treatment, National Eating Disorders Association, National Institutes of Health and WebMD.
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