Have you ever completed a screening for disordered eating/eating disorders?

If you’ve been diagnosed with an eating disorder and are reading this blog for support in your recovery, you probably have been. (I’m so glad you’re here!)

If you’ve never been diagnosed with an eating disorder or never sought professional support for disordered eating patterns, then I would guess you’re like the vast majority of the population in that your answer to that question is no.

Personally, I’ve never had a doctor ask me about disordered eating/eating disorders except for the follow ups I had with my primary care doctor when I was in high school, after I’d already started outpatient care for my eating disorder. I’ve been to the doctor plenty of times since then and never, not once, have I been asked about a history with eating disorders/disordered eating during a physical exam, or in the intake paperwork. And yet, at the time of many of those doctor’s visits, I was struggling with an active eating disorder. I’m grateful that I had the courage to seek help on my own, but I wonder what might look different in my life if a care provider had intervened sooner.

In my own clinical practice, I use a combination of two screening questionnaires (SCOFF and ESP) designed for use in a primary care setting to identify eating disorders among patients. These two tools have been validated by research to be accurate in both identifying patients with eating disorders and in ruling out eating disorders as a possible diagnosis in a patient. This is extremely important because most of my patients who struggle with eating disorders wouldn’t describe themselves as such. As I mentioned in this post, failing to accurately screen eating disorder behaviors in a medical setting can literally be a matter of life and death. Sometimes, patients don’t self-disclose eating disorders because of shame. They feel badly about their struggles and fear judgment. (Or, they don’t feel ‘sick’ enough to seek care.) But more often than not, these women aren’t aware that their food and body struggles are abnormal. The don’t realize that eating and exercise aren’t supposed to be so hard.

The organization I work for doesn’t currently have a preferred eating disorder screening tool. While each provider on my team is encouraged to actively screen every new patient, it’s up to us how we choose to broach the subject during appointments. The way I ask each patient varies a little bit, especially because eating disorders are so nuanced and individualized. However, I decided to dig around a little bit to see what tools were out there, and what others might be using as a “gold standard” according to the research. I liked the ESP/SCOFF hybrid model the best because I think it’s most comprehensive, but there were a number of other good ones out there too. One of them in particular stuck out to me, though, and it was because of this question:

Are You Okay With Gaining 2 Pounds?

I won’t lie, I think I would roll my eyes a little bit if I knew I had for sure gained two pounds. I am grateful to be at a healthy place in terms of my relationship with food and my body, and I have no intentions of going back to the battle ground. But part of the reason I’m able to maintain that healthy relationship is because my body stays the same for the most part.

So, do I have an eating disorder right now? No, and the questionnaire involving this question doesn’t attempt to make a diagnosis on that question alone. But my internal (or external) sneer that results when I seriously consider that question reminds me that a) I live in a society that glorifies a thin ideal and b) I still have growth to do in the area of releasing the hold of my appearance over my thought life.

Truth be told, I gain and lose about five pounds over the course of the year, every year. It’s taken multiple years of recognizing that this happens repeatedly and naturally for me to be okay with it. But that 5 pound range has also been plus/minus a few every couple years. Again, it takes me a few weeks/months to really be okay with it. I share this openly because I don’t think ‘recovery’ means that we never pay attention to our bodies and their changes, but rather that we intentionally choose to show grace to ourselves, intentionally change our thought patterns, and humbly confess our struggles, our obsessions, and our sins before God and others who will hold us accountable.

There was a time in my life when gaining two pounds might have sent me into a tailspin. It did, on many occasions…even when the scale was up a few pounds because of eating salt, or retaining water, or not having regular bowel habits. All that obsession, all that shame, all that self-destructive behaviors…none of it was worth it, and I chose to lay it down at the cross in the name of a more fulfilling life.

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I share more about my journey of healing my relationship with food in my new book, Fulfilled. In addition to my own experiences, I explain exactly how I walk my clients through the process of surrendering a life of dieting and cultivating a a fulfilling life that is focused on bigger things than food, exercise, and your body. Fulfilled is available for pre-order at Amazon, Barnes & Noble, IndieBound, my publisher’s website, or any online or retail shops where you usually buy books!