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Minimal cost, maximum benefit: Screening for eating disorders in schools

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New research, released Aug. 4, shows that screening for eating disorders in schools is highly cost-effective and therefore, worth considering. Published in the American Journal of Public Health, the findings come from a Boston Children's Hospital study led by one of the key scientists researching eating disorders in kids, Dr. Bryn Austin.

The research was based on a computer simulation that compared a screening of 10-17 year-olds using the SCOFF questionnaire (which asks about making yourself sick, control over eating, losing more than one stone (approximately seven pounds) in a 3-month period, belief of fatness, and whether food dominates your life) to a no-screening scenario. The hypothetical students who were screened using those five questions and were found at-risk were referred to clinicians for further evaluation and treatment.

Results from this computer simulation were staggering. Using just five questions, students at-risk for an eating disorder were identified and received more treatment and subsequently recovered more quickly from their eating disorders than students in the control or no-screen situation. Since eating disorders can often be a secretive or hidden disease unless the symptoms become visible, many students could remain undiagnosed and untreated. This is seen especially with low-income, minority, overweight, and male teenagers, because those demographic groups are incorrectly assumed to be far less likely to suffer from an eating disorder.

The cost-benefit analysis of this simulated screening were also very promising. Per student, it was estimated to cost $2,260 and result in a savings of $9,041 per life-year with an eating disorder that was avoided. On average, hypothetical students screening positive had 0.25 fewer life-years with an eating disorder and an improved quality of life.

With so few questions and minimal time and cost relative to benefit, the SCOFF questionnaire seems ideal for use as a school screening tool. The question remains, however, whether the public will accept the integration of this screening. A recent survey showed promising results, though, with 53% of adults supportive of school-based eating disorder screening.

Obviously, this screening would have to be done with support of parents (most ideally an opt-out solution, so that the majority of students would be screened) and be sensitive to the privacy of the students. More research will have to be done regarding the long-term cost effectiveness of a screening program like this simulation, but the hope is that this could be integrated easily into schools in the near future. Such a simple mechanism that could prevent so much suffering is surely worth consideration, at least.

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