SCOFF questionnaire screening tool

Related Subjects: |Psychiatric Emergencies |Personality Disorders |Eating Disorders |SCOFF questionnaire screening tool |SUSS test for eating disorder examinations

🥗 SCOFF questionnaire is a brief 5-question screening tool for possible eating disorders. It is designed to identify people who may need a fuller assessment for anorexia nervosa, bulimia nervosa, binge-eating disorder or other eating difficulties.

✅ What It Is Used For

• Screening for possible eating disorders in primary care, mental health, general medicine or student health settings.
• Opening a sensitive conversation about eating, weight, body image and control.
• Identifying patients who may need further assessment or referral.
• It is a screening tool, not a diagnostic test.

📋 The 5 SCOFF Questions

• S - Sick: Do you make yourself sick because you feel uncomfortably full?
• C - Control: Do you worry you have lost control over how much you eat?
• O - One stone: Have you recently lost more than one stone, about 6.35 kg or 14 lb, in a 3-month period?
• F - Fat: Do you believe yourself to be fat when others say you are too thin?
• F - Food: Would you say that food dominates your life?

🔢 Scoring

• Score 1 point for each “yes” answer.
• Total score range: 0–5.
• A score of 2 or more suggests a possible eating disorder and should prompt further assessment.

⚠️ Important: A low SCOFF score does not fully exclude an eating disorder, especially if there is clinical concern, weight loss, purging, restriction, binge eating, excessive exercise, abnormal blood tests or family concern.

🚩 Red Flags

• Rapid weight loss or very low BMI.
• Syncope, chest pain, palpitations or marked postural dizziness.
• Bradycardia, hypotension, hypothermia or dehydration.
• Electrolyte disturbance, especially hypokalaemia.
• Vomiting, laxative misuse, diuretic misuse or insulin misuse.
• Suicidal thoughts, self-harm or severe depression.
• Pregnancy with significant restriction, purging or weight loss.
• Children or adolescents with faltering growth or delayed puberty.

🩺 What to Assess Next

• Eating pattern: restriction, fasting, binge eating, purging or avoidance.
• Body image concerns and fear of weight gain.
• Weight history, BMI and rate of weight loss.
• Compensatory behaviours: vomiting, laxatives, diuretics, excessive exercise or insulin omission.
• Physical observations: pulse, blood pressure, lying/standing BP, temperature and hydration.
• Blood tests if indicated: U&Es, LFTs, FBC, glucose, phosphate, magnesium, calcium and TFTs.
• ECG if medically unwell, underweight, purging, electrolyte disturbance or bradycardia.
• Risk assessment: self-harm, suicide, safeguarding and capacity.

💬 How to Ask Sensitively

• Use a calm, non-judgemental approach.
• Explain that eating difficulties are common and treatable.
• Avoid blaming language or focusing only on weight.
• Ask about function, distress, control and health consequences.
• Offer follow-up even if the patient is not ready to accept help immediately.

🏥 Management Principles

• Positive screening should lead to a fuller clinical assessment.
• Consider referral to eating disorder services, CAMHS, mental health services or specialist dietetic support depending on age, severity and local pathways.
• Assess physical risk and escalate urgently if medically unstable.
• Treat complications such as dehydration, electrolyte disturbance, syncope or severe malnutrition.
• Involve family or carers where appropriate, especially for children, adolescents or high-risk adults.

🧠 Clinical Pearl

The SCOFF questionnaire is useful because it asks about control, weight loss, body image and food preoccupation rather than simply asking “Do you have an eating disorder?”. Eating disorders may present with normal BMI, vague gastrointestinal symptoms, menstrual disturbance, dizziness, dental problems, fatigue or mental health symptoms, so the score must be interpreted in clinical context.

📚 Exam Pearl

🥗 SCOFF = Sick, Control, One stone, Fat, Food. Score 1 point for each “yes”; a score of 2 or more suggests possible eating disorder and should prompt further assessment.