Purpose
Abstract
The incidence and prevalence of eating disorders (ED) is low in general practice (GP) settings. Studies in secondary care suggest that the general practitioner has an important role to play in the early detection of patients with EDs. The aim of this study was to describe the effect (clinical outcomes and care trajectory) of screening for EDs among patients in general practice settings.
Methods
A systematic review was conducted on Medline, PsycINFO, CINAHL, Embase and WOS. The studies included were to have been carried out in a primary care setting, with screening explicitly performed in GP practices and follow-up information.
Results
Ten studies met the inclusion criteria. For all ED patients, there was an increase in the frequency of consultations in GP setting, referrals to psychiatric resources and drug prescriptions such as antidepressants, following screening procedures. Clinical outcomes remained unclear and heterogeneous. One study focused on the course and outcome of ED patients identified by screening in the GP setting and reported recovery for anorexia nervosa (AN) and BN in more than half of the cases, after 4.8 years of mean follow-up. In this study, early age at detection predicted better recovery.
Conclusion
Most of the literature on the role of the GP in screening for and managing EDs consists of opinion papers and original studies designed in a secondary care perspective. The impact of systematically screening for EDs in a primary care setting is not clarified and requires further investigation in collaborative cohort studies with a patient-centered approach, and outcomes focused on symptoms.
Similar content being viewed by others
References
American Psychiatric Association (2000) Diagnostic and statistical manual of mental disorders (4th edition, text revision). American Psychiatric Association, Washington
Hudson J, Hiripi E (2007) The prevalence and correlates of eating disorders in the national comorbidity survey replication. Biol Psychiatry 61:348–358. doi:10.1016/j.biopsych.2006.03.040
Keski-Rahkonen A, Hoek H, Susser ES (2007) Epidemiology and course of anorexia nervosa in the community. Am J Psychiatry 164:1259–1265. doi:10.1176/appi.ajp.2007.06081388
Keski-Rahkonen A, Hoek HW, Linna MS, Raevuori A, Sihvola E, Bulik CM, Rissanen A, Kaprio J (2009) Incidence and outcomes of bulimia nervosa: a nationwide population-based study. Psychol Med 39:823–831. doi:10.1017/S0033291708003942
Roux H, Chapelon E, Godart N (2013) Epidemiolgy of anorexia nervosa: a review. Encephale 39:85–93. doi:10.1016/j.encep.2012.06.001
Godart N, Legleye S, Huas C, Côté S, Choquet M, Falissard B, Touchtette E (2013) Epidemiology of anorexia nervosa in a French community-based sample of 39,542 adolescents. Open J Epidemiol 3:53–61. doi:10.4236/ojepi.2013.32009
Hoek HW (2006) Incidence, prevalence and mortality of anorexia nervosa and other eating disorders. Curr Opin Psychiatry 19:389–394. doi:10.1097/01.yco.0000228759.95237.78
Patton GC, Coffey C, Carlin JB, Sanci L, Sawyer S (2008) Prognosis of adolescent partial syndromes of eating disorder. Br J Psychiatry 192:294–299. doi:10.1192/bjp.bp.106.031112
Roux H, Blanchet C, Stheneur C, Chapelon E, Godart N (2013) Somatic outcome among patients hospitalised for anorexia nervosa in adolescence: disorders reported and links with global outcome. Eat Weight Disord 18:175–182. doi:10.1007/s40519-013-0030-2
Hoang U, Goldacre M, James A (2014) Mortality following hospital discharge with a diagnosis of eating disorder: National record linkage study, England, 2001-2009. Int J Eat Disord 47:507–515. doi:10.1002/eat.22249
Huas C, Caille A, Godart N, Foulon C, Pham-Scottez A, Divac S, Dechartres A, Lavoisy G, Guelfi JD, Rouillon F, Falissard B (2011) Factors predictive of ten-year mortality in severe anorexia nervosa patients. Acta Psychiatr Scand 123:62–70. doi:10.1111/j.1600-0447.2010.01627
Arcelus J, Mitchell A, Wales J, Nielsen S (2011) Mortality rates in patients with anorexia nervosa and other eating disorders. Arch Gen Psychiatry 68:724–731. doi:10.1001/archgenpsychiatry.2011.74
Huas C, Godart N, Caille A, Pham-Scottez A, Foulon C, Divac S, Lavoisy G, Guelfi JD, Falissard B, Rouillon F (2013) Mortality and its predictors in severe bulimia nervosa patients. Eur Eat Disord Rev 21:15–19. doi:10.1002/erv.2178
Suokas JT, Suvisaari JM, Gissler M, Löfman R, Linna MS, Raevuori A, Haukka J (2013) Mortality in eating disorders: a follow-up study of adult eating disorder patients treated in tertiary care, 1995-2010. Psychiatry Res 210:1101–1106. doi:10.1016/j.psychres.2013.07.042
Nielsen S (2001) Epidemiology and mortality of eating disorders. Psychiatr Clin N Am 24:201–214. doi:10.1016/S0193-953X(05)70217-3
Crow SJ, Peterson CB, Swanson SA, Raymond NC, Specker S, Eckert ED (2009) Increased mortality in bulimia nervosa and other eating disorders. Am J Psychiatry 166:1342–1346. doi:10.1176/appi.ajp.2009.09020247
Godart N, Flament MF, Perdereau F, Jeammet P (2002) Comorbidity between eating disorders and anxiety disorders: a review. Int J Eat Disord 32:253–270. doi:10.1002/eat.10096
Godart N, Perdereau F, Rein Z, Berthoz S, Wallier J, Jeammet P (2007) Comorbidity studies of eating disorders and mood disorders. Critical review of the literature. J Affect Disord 97:37–49. doi:10.1016/j.jad.2006.06.023
Lucas AR, Melton LJIII, Crowson CS, O’Fallon WM (1999) Long-term fracture risk among women with anorexia nervosa: a population-based cohort study. Mayo Clin Proc 74:972–977. doi:10.4065/74.10.972
Lissner L, Odell PM, D’Agostino RB, Stokes J, Kreger BE, Belanger AJ, Brownell KD (1991) Variability of body weight and health outcomes in the Framingham population. N Engl J Med 324:1839–1844. doi:10.1056/NEJM199106273242602
Johnson JG, Spitzer RL, Williams JBW (2001) Health problems, impairment and illnesses associated with bulimia nervosa and binge eating disorder among primary care and obstetric gynaecology patients. Psychol Med 31:1455–1456. doi:10.1017/S0033291701004640
Arcelus J, Haslam M, Farrow C, Meyer C (2013) The role of interpersonal functioning in the maintenance of eating psychopathology: a systematic review and testable model. Clin Psychol Rev 33:156–167. doi:10.1016/j.cpr.2012.10.009
Godart N, Perdereau F, Curt F, Lang F, Venisse JL, Halfon O, Bizouard P, Loas G, Corcos M, Jeammet P, Flament MF (2004) Predictive factors of social disability in anorexic and bulimic patients. Eat Weight Disord 9:249–257
Johnson JG, Cohen P, Kasen S, Brook JS (2002) Eating disorders during adolescence and the risk for physical and mental disorders during early adulthood. Arch Gen Psychiatry 59:545–552. doi:10.1001/archpsyc.59.6.545
National Institute for Health and Care Excellence (2004) Eating disorders: Core interventions in the treatment and management of anorexia nervosa, bulimia nervosa and related eating disorders. Clinical Guideline 9. http///www.nice.org.uk/nicemedia/live/10932/29217/29217.pdf. Accessed 19 Oct 2015
American Psychiatric Association (2005) Treatment of Patients with Eating Disorders (3rd edition, text revision). American Psychiatric Association, Washington. doi:10.1176/appi.books.9780890423363.138660. http://psychiatryonline.org/pb/assets/raw/sitewide/practice_guidelines/guidelines/eatingdisorders.pdf. Accessed 19 Oct 2015
Haute Autorité de Santé (2013) Guidelines, Anorexia Nervosa:Management. Haute Autorité de Santé, Paris. http://www.has-sante.fr/portail/upload/docs/application/pdf/2013-05/anorexia_nervosa_guidelines_2013-05-15_16-34-42_589.pdf. Accessed 19 Oct 2015
Walsh JME, Wheat ME, Freund K (2000) Detection, evaluation and treatment of eating disorders, the role of the primary care physician. J Gen Intern Med 15:577–590. doi:10.1046/j.1525-1497.2000.02439.x
Yeo M, Hughes E (2011) Eating disorders-early identification in general practice. Aust Fam Physician 40:108–111
Ogg EC, Millar HR, Pusztai EE, Alison S, Thom AS (1997) General practice consultation patterns preceding diagnosis of eating disorders. Int J Eat Disord 22:89–93. doi:10.1002/(SICI)1098-108X(199707)22:1<89:AID-EAT12>3.0.CO;2-D
Smink FR, van Hoeken D, Hoek HW (2012) Epidemiology of eating disorders: incidence, prevalence and mortality rates. Curr Psychiatry Rep 14:406–414. doi:10.1007/s11920-012-0282-y
Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JPA, Devereaux PJ, Kleijnen J, Moher D (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. Br Med J 339:b2700. doi:10.1136/bmj.b2700
Equator Network. (2010). Key reporting guidelines. http://www.equator-network.org/reporting-guidelines/consort/. Accessed 19 Oct 2015
Van Son GE, Van Hoeken D, Van Furth EF, Donker GA, Hoek HW (2010) Course and outcome of eating disorders in a primary care-based cohort. Int J Eat Disord 43:130–138. doi:10.1002/eat.20676
King MB (1989) Eating disorders in a general practice population. Prevalence, characteristics and follow-up at 12 to 18 months. Psychol Med Monogr Suppl 14:1–34
King MB (1991) The natural history of eating pathology in attenders to primary medical care. Int J Eat Disord 10:379–387. doi:10.1002/1098-108X(199107)10:4<379:AID-EAT2260100402>3.0.CO;2-I
Aguilar Hurtado ME, Sagredo Pérez J, Heras Salvat G, Estévez Muñoz JC, Linares López ML, Peña Rodríguez E (2004) Care by a primary care team for patients with eating behaviour disorders: identifying possibilities for improvement. Aten Primaria 34:26–31
Striegel-Moore RH, DeBar L, Wilson GT, Dickerson J, Rosselli F, Perrin N, Lych F, Kramer HC (2008) Health services use in eating disorders. Psychol Med 38:1465–1474. doi:10.1017/S0033291707001833
Van Son GE, Hoek HW, Van Hoeken D, Schellevis FG, Van Furth EF (2012) Eating disorders in the general practice: a case-control study on the utilization of primary care. Eur Eat Disord Rev 20:410–413. doi:10.1002/erv.2185
Turnbull S, Ward A, Treasure J, Jick H, Derby L (1996) The demand for eating disorder care. An epidemiological study using the general practice research database. Br J Psychiatry 169:705–712. doi:10.1192/bjp.169.6.705
Banasiak SJ, Paxton SJ, Hay P (2005) Guided self-help for bulimia nervosa in primary care: a randomized controlled trial. Psychol Med 35:1283–1294. doi:10.1017/S0033291705004769
Walsh BT, Fairburn CG, Mickley D, Sysko R, Parides MK (2004) Treatment of bulimia nervosa in a primary care setting. Am J Psychiatry 161:556–561
Durand MA, King M (2003) Specialist treatment versus self-help for bulimia nervosa: a randomised controlled trial in general practice. Br J Gen Pract 53:371–377
Waller D, Fairburn CG, McPherson A, Kay R, Lee A (1996) Nowell T (1996) Treating bulimia nervosa in primary care: a pilot study. Int J Eat Disord 19:99–103. doi:10.1002/(SICI)1098-108X(199601)19:1<99:AID-EAT12>3.0.CO;2-L
Garner DM, Garfinkel PE (1979) The eating attitudes test: an index of the symptoms of anorexia nervosa. Psychol Med 9:273–279
Garner DM, Olmsted MP, Bohr Y, Garfinkel PE (1982) The eating attitudes test: psychometric features and clinical correlates. Psychol Med 12:871–878
Morgan JF, Reid F, Lacey JH (1999) The SCOFF questionnaire: assessment of a new screening tool for eating disorders. BMJ 319:1467–1468. doi:10.1136/bmj.319.7223.1467
Henderson M, Freeman CPL (1987) A self-rating scale for bulimia. The “BITE”. Br J Psychiatry 150:18–24
Luce KH, Crowther JH (1999) The reliability of the eating disorder examination-self-report questionnaire version (EDE-Q). Int J Eat Disord 25:349–351. doi:10.1002/(SICI)1098-108X(199904)25:33.3.CO;2-D
Franke RH, Kaul J (1978) The Hawthorne experiments: first statistical interpretation. Am Soc Rev 43:623–643
Tonkin RS (1994) Practical approaches to eating disorders in adolescence: primer for family physicians. Can Fam Physician 40:299–304
Kreipe RE, Birndorf SA (2000) Eating disorders in adolescents and young adults. Med Clin North Am 84:1027–1049. doi:10.1016/S0025-7125(05)70272-8
Flahavan C (2006) Detection, assessment and management of eating disorders; how involved are GPs? Ir J Psych Med 23:96–99. doi:10.1017/S079096670000971X
Hill LS, Reid F, Morgan JF, Lacey JH (2010) SCOFF, the development of an eating disorder screening questionnaire. Int J Eat Disord 43:344–351. doi:10.1002/eat.20679
Mond JM, Myers TC, Crosby RD, Hay PJ, Rodgers B, Morgan JF, LaceyJH Mitchell JE (2008) Screening for eating disorders in primary care: EDE-Q versus SCOFF. Behav Res Ther 46:612–622. doi:10.1016/j.brat.2008.02.003
Garcia-Campayo J, Sanz-Carrillo C, Ibañez JA, Lou S, Solano V, Alda M (2005) Validation of the Spanish version of the SCOFF questionnaire for the screening of eating disorders in primary care. J Psychosom Res 59:51–55. doi:10.1016/j.jpsychores.2004.06.005
Tilsley L, Young M (2005) Eating disorders in primary care—are we doing enough? Pract Nurs 30:35
Isabel Hach I, Ruhl UE, Rentsch A, Becker ES, Türke V, Margraf J, Kirch W (2005) Recognition and therapy of eating disorders in young women in primary care. J Public Health 13:160–165. doi:10.1007/s10389-005-0102-5
Van Royen P, Beyer M, Chevallier P, Eilat-Tsanani S, Lionis C, Peremans L, Petek D, Rurik I, Soler JK, Stoffers HE, Topsever P, Ungan M, Hummers-Pradier E (2010) The research agenda for general practice/family medicine and primary health care in Europe. Part 3. Results: person centred care, comprehensive and holistic approach. Eur J Gen Pract 16:113–119. doi:10.3109/13814788.2010.481018
Button EJ, Benson E, Nollett C, Palmer RL (2005) Don’t forget EDNOS (eating disorder not otherwise specified): patterns of service use in an eating disorders service. Psychiatr Mar 29:134–136. doi:10.1192/pb.29.4.134
Soler J-K, Okkes I, Wood M, Lamberts H (2008) The coming of age of ICPC: celebrating the 21st birthday of the international classification of primary care. Fam Pract 25:312–317. doi:10.1093/fampra/cmn028
Colles SL, Dixon JB, O’Brien PE (2008) Loss of control is central to psychological disturbance associated with binge eating disorder. Obesity 16:608–614. doi:10.1038/oby.2007.99
Reid M, Williams S, Hammersley R (2010) Managing eating disorder patients in primary care in the UK: a qualitative study. Eat Disord 18:1–9. doi:10.1080/10640260903439441
Green H, Johnston O, Cabrini S, Fornai G, Kendrick T (2008) General practitioner attitudes towards referral of eating-disordered patients: a vignette study based on the theory of planned behavior. Ment Health Fam Med 5:213–218
Courtney EA, Gamboz J, Johnson JG (2008) Problematic eating behaviors in adolescents with low self-esteem and elevated depressive symptoms. Eat Behav 9:408–414. doi:10.1016/j.eatbeh.2008.06.001
Jennifer Dixon J, Holland P, Mays N (1998) Primary care: core values develo** primary care: gatekee**, commissioning, and managed care. BMJ 317:125
Acknowledgments
We acknowledge Aurelie Deniau, GP in Tours, who helped to collect data.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Funding
No funding.
Conflict of interest
None.
Ethical approval
This article does not contain any studies with human participants performed by any of the authors.
Informed consent
For this type of study, formal consent is not required.
Rights and permissions
About this article
Cite this article
Cadwallader, J.S., Godart, N., Chastang, J. et al. Detecting eating disorder patients in a general practice setting: a systematic review of heterogeneous data on clinical outcomes and care trajectories. Eat Weight Disord 21, 365–381 (2016). https://doi.org/10.1007/s40519-016-0273-9
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s40519-016-0273-9