Questions You Should Ask Every Patient About Their Relationship With Food

A doctor in a telehealth session

You’re invited!

Whether in-person or virtually, you’re invited to assess, assess, assess! In school, we clinicians are taught to ask questions—so many questions. We are taught to ask about our patients’ history, about their current happenings, and about their future hopes and dreams. We are taught to ask about easy things and hard things. We are taught to ask about things that aren’t socially appropriate, things that are extremely uncomfortable outside the confines of medical and mental health settings. We are trained to ask questions about substance use, depression, anxiety, suicide, sexual behaviors, and peculiarities of the human body and its functioning.

Yet, so often, we forget to ask questions about one of the things that sustains life: FOOD! We know that to survive we need to eat. From the moment of conception to the moment of death, we are required to consume, in some way, calories that feed and nourish the systems within the body. Why, then, do we shy away from asking questions about this life-giving, life-sustaining human behavior?

Anecdotally, I hear medical and mental health providers say, “We have never had training,” “I don’t know what to ask,” and “I’m not sure what to do if it seems as though there might be a problem.” However, in the same way that we all learned how to ask and how to respond or intervene following questions about suicidal ideation or even substance use, we all can become more comfortable with integrating questions about eating disorders into our assessments of 100% of our patients.

Why should we ask all patients?

Well, the honest answer is this: If we don’t ask, we will miss it. With 9% of the U.S. population, or 28.8 million Americans, having an eating disorder in their lifetime (ANAD) and a person dying due to complications related to their eating disorder every 52 minutes, it seems essential that we add this area of assessment into our patient evaluations.

In addition, the stereotypical eating disorder patient is often portrayed to be underweight and suffering from body dysmorphia. In reality, fewer than 6% of people with eating disorders are medically diagnosed as “underweight” (ANAD). Asking screening questions of only those who “tip the scales” high or low means that we miss a vast majority of individuals who may be actively struggling with their relationship with food. Questions about eating disorders, as well as screening assessment tools and measures, need to consider that weight may not always tell a story of a person’s relationship with food.  

To truly learn each person’s story, we need to ask questions designed with disordered eating and eating disorders in mind. We must go beyond visible signs to assess whether a patient’s relationship with food warrants further attention and care.

Screening is always important, and it’s especially important now. Many people have experienced worsening eating disorder symptoms during COVID-19, and many others have developed them for the first time. There is a clear need we must address: Millions are currently suffering from eating disorders, many of them all by themselves.  

Rather than wait until “things go back to normal” or we return to in-person appointments more fully, let’s integrate questions about food into our practice now. These questions are just as useful in virtual settings as they are in in-person ones—and the earlier eating disorders are identified and treated, the better the outcomes will be.

What should we ask?

The SCOFF questionnaire (Morgan, Reid, & Lacy-BMJ, 1999) is a very simple, very straightforward questionnaire that addresses people across eating disorder diagnoses.

Here are six questions we recommend asking, adapted from the SCOFF questionnaire:

  1. Do you feel like you sometimes lose or have lost control over how you eat?
  2. Do you ever make yourself sick because you feel uncomfortably full?
  3. Do you believe yourself to be fat, even when others say you are too thin?
  4. Do food or thoughts about food dominate your life?
  5. Do thoughts about changing your body and/or your weight dominate your life?
  6. Have others become worried about your weight and/or eating?

Take some time to read these questions and make them your own. Asking these questions in a way that fits for you, your clinical style, and personality will allow it to feel more authentic and like something a patient can respond to honestly.

If a patient answers “yes” to two or more of the questions, a further assessment should be considered. You could at that time, refer them to The Emily Program for a comprehensive assessment by calling 1-888-364-5977 or by completing our online referral form. If you want to assess further in your own practice, you could consider the EAT-26. If there is a concern, the best course of action is a referral for a comprehensive assessment done by an eating disorder specialist.

What happens following a referral?

Providers often ask what happens following a referral. Patients who are referred for an assessment come (virtually or in person) for an intake. That intake is completed by an intake specialist. During the intake process, the provider completes a clinical interview. Patients are asked about their current and historical relationship with food, including questions about their specific food intake and any eating disorder behaviors (restriction, bingeing, purging, etc.).

Following these guidelines increases positive outcomes in treatment. One of the greatest gifts the referring provider can give to their patient is their support of the level of care (LOC) recommendation. Hopefully, knowing that the professional who made the recommendation used these universal standards and “prescribed” the treatment at that LOC—holding the best interest of the patient in mind—allows you, as a referring provider to support, encourage, and uphold the recommendation made to your patient. When all treatment providers support the patient, it is very helpful for the patient’s recovery journey.

Your patient will then be admitted into the LOC that was recommended. Prior to the treatment start date, patients may need a medical appointment to ensure it is safe for them to begin programming at the recommended LOC. We highly recommended that a patient completes the care plan recommended by their treatment team. With your patient’s permission, you can stay informed as they progress through treatment.

We hope that you will join us in helping change the attitudes and stigma associated with eating disorders and providing treatment for those who struggle every day. Without you, the first line of providers, screening regularly and often, we will miss many of those who struggle. Together, though, we can make a difference in their lives and the lives of families impacted by eating disorders today.

ABOUT THE AUTHOR


 Krista Kubiak Crotty

Krista Crotty, LMFT, PsyD

Krista is the National Director of Brain-Based Therapies and a Clinical Education Specialist. Clinically she draws from a variety of methods, including TBT-S, EMDR, cognitive behavioral therapy (CBT), FBT, and acceptance and commitment therapy (ACT), and often incorporates the use of the creative process in conjunction with the more traditional therapeutic process. She earned her Masters of Science from Fuller Theological Seminary, School of Psychology and her Doctorate in Clinical Psychology with an emphasis in family and pediatrics from Azusa Pacific University. She trained at Harbor UCLA Medical Center and Loma Linda Children’s Hospital in neuropsych. Away from work, Krista loves being a mom to her three boys, playing outside, going on adventures with her family, skiing, hiking, biking, and camping.

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