Interpretation and use of weight information in the evaluation of eating disorders: Counselor response to weight information in a National Eating Disorders Educational and Screening Program

Authors

  • Anne E. Becker MD, PhD,

    1. Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
    2. Department of Social Medicine, Harvard Medical School, Boston, Massachusetts
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  • Jennifer J. Thomas BA,

    1. Department of Psychology, Yale University, New Haven, Connecticut
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  • Debra L. Franko PhD,

    Corresponding author
    1. Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
    2. Harvard Eating Disorders Center, Boston, Massachusetts
    3. Department of Counseling and Applied Educational Psychology, Northeastern University, Boston, Massachusetts
    • Harvard Eating Disorders Center, Massachusetts General Hospital, WACC 725, 15 Parkman St., Boston, MA 02114
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  • David B. Herzog MD

    1. Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
    2. Harvard Eating Disorders Center, Boston, Massachusetts
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Abstract

Objective

Eating disorders are frequently undetected and inadequately treated in clinical settings. The current study investigated whether weight data were used appropriately in making recommendations for further care in the first National Eating Disorders Screening Program (NEDSP).

Method

Accuracy of counselors' assessment of appropriateness of weight for height and adherence to an algorithm using weight to determine need for further evaluation were assessed for the 5,684 adult participants in a two-stage screening program held on college campuses.

Results

In 95% of cases, the counselors correctly used the algorithm developed for the NEDSP to assign participants to weight categories ranging from normal to extremely underweight. However, counselors were poorly adherent to an algorithm directing them to recommend urgent evaluation to all extremely underweight participants—that is, those with a weight at or below 75% of expected weight. Of the extremely underweight participants (n = 32), only 25.0% (n = 8) received an appropriate recommendation for urgent evaluation, whereas 59.4% (n = 19) received a recommendation for further (but nonurgent) evaluation, and 15.6% (n = 5) did not receive a recommendation to seek any evaluation.

Discussion

Clinicians appeared not to use weight data appropriately to make clinical recommendations for extremely underweight individuals. These results suggest that further specific emphasis on the health risks of extreme underweight may be helpful in training clinicians to manage patients with eating disorders. © 2004 by Wiley Periodicals, Inc.

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