Researchers at Yale School of Medicine, University of California San Francisco, and the U.S. Department of Veterans Affairs have developed a new eating disorder screener for use in healthcare and community settings that serve veterans.
There is an urgent need to address eating disorders in adult and aging populations, said Robin M. Masheb, PhD, professor of psychiatry and director of the Veterans Initiative for Eating and Weight at the VA Connecticut Healthcare System in West Haven.
To date, screening has mostly been designed for female adolescents and young adults. Procedures to identify eating disorders are lacking in United States healthcare systems.
Military staff and veterans have become an important population for understanding eating disorders given heightened risk due to, among other reasons, trauma exposure and the need to meet stringent military weight criteria.
As part of a VA-funded study, two cohorts of veterans completed a survey of potential screening items, and a subgroup participated in a follow-up interview to determine who had an eating disorder diagnosis. Analyses of these items resulted in a final screener named the 5-item BRief Eating Disorder Screener (BREDS). As expected, the terminology used in these items differed greatly from language in existing screeners.
“It is very common in the eating disorder field to talk about eating behavior as being out of control. This terminology does not feel relatable to many of our veterans, as military training emphasizes precision and control. It’s not surprising then that the screening item for binge eating turned out to be, ‘Do you ever eat an extremely large amount of food without thinking?’” which better reflects their experience, said Masheb.
Masheb is first author of the paper, published in General Hospital Psychiatry. Marney A. White, PhD, MS, professor of public health (social and behavioral sciences) and psychiatry, is a co-author.
This new screener coincides with Eating Disorder Awareness Week 2025. The annual campaign, which this year is Feb. 24-March 2, raises the visibility of, and educates the public about, the realities of eating disorders.
Contrary to conventional wisdom, people with eating disorders are more likely to be overweight or obese rather than extremely underweight. Instead of the standard, “Have you recently lost greater than 14 pounds in a 3-month period?” the comparable item on the BREDS reads, “Are you or other people in your life concerned about a recent change in your weight?”
“This research is ground-breaking for its relevance to men, as well as women, and for capturing a wide range of eating disorder diagnoses with only 5-items. We expect our new eating disorder screener will be used in clinical settings to detect veterans who are at risk for eating disorders so that they can be connected with the care they deserve.” said Shira Maguen, PhD, professor, UCSF School of Medicine, psychologist at the San Francisco VA Health Care System, and Co-Principal Investigator with Masheb. The hope is that this brief screener will have relevance for other adult populations as well.
The Veterans Health Administration is the largest healthcare system in the U.S. with multiple efforts to address eating disorders. This research will support efforts toward screening, diagnosing, and treating eating disorders, and other related problems such as food insecurity, to improve care for veterans.