Eating Disorder Screening: a Systematic Review and Meta-analysis of Diagnostic Test Characteristics of the SCOFF

  • Amanda M. KutzEmail author
  • Alison G. Marsh
  • Craig G. Gunderson
  • Shira Maguen
  • Robin M. Masheb



Eating disorders affect upwards of 30 million people worldwide and often go undertreated and underdiagnosed. The purpose of this systematic review and meta-analysis was to evaluate the diagnostic accuracy of the Sick, Control, One, Fat and Food (SCOFF) questionnaire for DSM-5 eating disorders in the general population.


The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) were followed. A PubMed search was conducted among peer-reviewed articles. Information regarding validation of the SCOFF was required for inclusion. Study quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool.


The final analysis included 25 studies. The validity of the SCOFF was high across samples with a pooled sensitivity of 0.86 (95% CI, 0.78–0.91) and specificity of 0.83 (95% CI, 0.77–0.88). Subgroup analyses were conducted to examine the impact of methodology, study quality, and clinical characteristics on diagnostic accuracy. Studies with the highest sensitivity tended to be case-control studies of young women with anorexia nervosa (AN) and bulimia nervosa (BN). Studies which included more men, included those diagnosed with binge eating disorder, and recruited from large community samples tended to have lower sensitivity. Few studies reported on BMI and race/ethnicity; thus, subgroups for these factors could not be examined. No studies used reference standards which assessed all DSM-5 eating disorders.


This meta-analysis of 25 validation studies demonstrates that the SCOFF is a simple and useful screening tool for young women at risk for AN and BN. However, there is not enough evidence to support utilizing the SCOFF for screening for the range of DSM-5 eating disorders in primary care and community-based settings. Further examination of the validity of the SCOFF or development of a new screening tool, or multiple tools, to screen for the range of DSM-5 eating disorders heterogenous populations is warranted.

Trial Registration

This study is registered online with PROSPERO (CRD42018089906).


eating disorders SCOFF screening systematic review diagnostic test accuracy 


Author Contributions

RMM, SM, and AMK were involved in conception of the review. AMK and AGM were involved in review of literature, extraction of data, and creation of data tables. AMK and CGG were involved in statistical analyses. CGG provided expert guidance on systematic review manuscript preparation. AMK, AGM, and RMM drafted the manuscript. All authors were involved in critical review of the manuscript.

Funding Information

This project was supported in part by the VA’s Heath Services Research and Development (CIN 13-407) (HSR&D) Center of Innovation (COIN) Pain Research, Informatics, Multi-morbidities, and Education (PRIME) Center, West Haven, CT.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they do not have a conflict of interest.


The content of this research is solely the responsibility of the authors and does not necessarily represent the official views of the VA or the Veterans Health Administration.

Supplementary material

11606_2019_5478_MOESM1_ESM.docx (21 kb)
ESM 1 (DOCX 18 kb)
11606_2019_5478_MOESM2_ESM.docx (16 kb)
ESM 2 (DOCX 14 kb)


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Copyright information

© Society of General Internal Medicine (This is a U.S. government work and not under copyright protection in the U.S.; foreign copyright protection may apply) 2019

Authors and Affiliations

  1. 1.VA Salt Lake City Health Care SystemSalt Lake CityUSA
  2. 2.VA Connecticut Healthcare SystemWest HavenUSA
  3. 3.Department of Internal Medicine, Section of General Internal MedicineYale University School of MedicineNew HavenUSA
  4. 4.San Francisco VA Healthcare SystemSan FranciscoUSA
  5. 5.Department of PsychiatryUniversity of California San Francisco, School of MedicineSan FranciscoUSA
  6. 6.Department of PsychiatryYale University School of MedicineNew HavenUSA

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