4
Nutrition
KEY POINTS:
Obtaining an Eating Behavior History
1. An eating behavior history is crucial for the management of
obesity. A comprehensive assessment of eating patterns,
including meal timing, portion sizes, speed, distractions, and
emotional triggers, helps identify behaviors contributing to
obesity and possible disordered eating.
2. Disordered eating is common in obesity. Binge eating disorder
(BED), bulimia nervosa, and night eating syndrome (NES) are
prevalent among patients with obesity and can hinder weight
loss efforts if left undiagnosed and untreated.
3. Use validated screening tools. Brief assessment tools such as the
Sick, Control, One, Fat, Food (SCOFF) and Eating Disorder Screen
for Primary Care (EDS-PC [ESP]) are practical for identifying
at-risk individuals in primary care settings. Positive screening
results should prompt further evaluation or referral.
4. Be culturally responsive. Respect dietary customs, differentiate
cultural practices from disordered patterns, and integrate
culturally familiar foods into care plans to improve adherence.
5. Address social determinants of health. Acknowledge how food
insecurity and limited access to healthy foods shape eating
behaviors, and tailor recommendations to fit the patient's
circumstances.
6. Recognize red flags. Rapid weight changes, secretive eating,
purging behaviors, or laxative use indicate high risk for
disordered eating and require prompt attention.
7. Acknowledge mental health associations. Disordered eating
often co-occurs with depression, anxiety, posttraumatic
stress disorder, or attention-deficient/hyperactivity disorder.
Addressing these underlying conditions can improve eating
behavior and outcomes.
