Skip to main content Accessibility help

A Meta-Analysis of the Diagnostic Accuracy of the SCOFF

  • Juan Botella (a1), Ana Rosa Sepúlveda (a1), Huiling Huang (a1) and Hilda Gambara (a1)


A meta-analysis was conducted to reach a pooled estimate of the diagnostic accuracy of the SCOFF. The 15 selected studies represented a total of 882 cases and 4350 controls. The main criterion for inclusion was that the primary study had provided diagnostic classification with both a diagnostic reference and with the SCOFF (with five items and a cut-off point of two). The pooled estimates were .80 (sensitivity) and .93 (specificity). The moderator variables gender and type of measure for the diagnostic reference (interview versus psychometric tests) account for part of the observed variability. For diagnostic references based on interviews the estimate of the efficacy improves significantly. For the studies that match this criterion the sensitivity is .882 and the specificity .925 (diagnostic odds ratio, 92.19). The main conclusion was that the five questions of the SCOFF constitute a very useful screening tool, in several languages; it is highly recommended for screening purposes.


Corresponding author

*Correspondence concerning this article should be addressed to Juan Botella. Facultad de Psicología. Departamento de Psicología Social y Metodología. Universidad Autónoma de Madrid. Cantoblanco s/n. 28049. Madrid (Spain). E-mail:


Hide All
This research was supported by the project PSI2009–12071, from the Spanish Ministerio de Educación y Ciencia.



Hide All
American Psychiatric Association (2002). Diagnostic and statistical manual of mental disorders (DSM-IV-TR; 4 th Ed). Washington, DC: American Psychiatric Association.
Becker, A. E., Thomas, J. J., Franko, D. L., & Herzog, D. B. (2005). Disclosure patterns of eating and weight concerns to clinicians, educational professionals, family, and peers. International Journal of Eating Disorders, 38, 1823.
Berger, U., Wick, K., Hölling, H., Schlack, R., Bormann, B., Brix, C., …, & Strau, B. (2011). Screening riskanten Essverhaltens bei 12-j ä hrigen M ä dchen und Jungen: Psychometrischer Vergleich der deutschsprachigen Versionen von SCOFF und EAT-26. [Screening of Disordered Eating in 12-Year-Old Girls and Boys: Psychometric Analysis of the German Versions of SCOFF and EAT-26]. Psychotherapie, Psychosomatik & Medizinische Psychologie, 61, 311318.
Borenstein, M., Hedges, L. V., Higgins, J. P. T., & Rothstein, H. R. (2010). A basic introduction to fixed-effect and random-effects models for meta-analysis. Research Synthesis Methods, 1, 97111.
Botella, J., & Huang, H. (2012). Procedimientos de meta-análisis de la precisión de clasificaciones binarias. [Procedures for performing meta-analyses of the accuracy of tools for binary classification]. Psicothema, 24, 133141.
Botella, J., Suero, M., & Gambara, H. (2010). Psychometric inferences from a meta-analysis of reliability and internal consistency coefficients. Psychological Methods, 15, 386397.
Caamaño, F., Aguiar, M., López-Otero, M. J., & Takkouche, B. (2002). Validation of SCOFF questionnaire among preteenagers. British Medical Journal, (rapid response). Retrieved from
Cotrufo, P., Barretta, V., & Monteleone, P. (1998). Un estudio epidemiológico sobre los trastornos de la conducta alimentaria en dos institutos de segunda enseñanza en Nápoles. [An epidemiological study on eating disorders in two high schools in Naples] European Psychiatry, 12, 342344.
Cotton, M. A., Ball, C., & Robinson, P. (2003). Four simple questions can help screen for eating disorders. Journal of General Internal Medicine, 18, 5356.
Devillé, W. L., Buntinx, F., Bouter, L. M., Montori, V. M., de Vet, H. C., van der Windt, D. A., & Bezemer, P. D. (2002). Conducting sytematic reviews of diagnsotic studies: Didactic guidelines. BMC Medical Research Methodology, 2, 29.
Eddy, K. T., Swanson, S. A., Crosby, R. D., Franko, D. L., Engel, S., & Herzog, D. B. (2010). How should DSM-V classify eating disorder not otherwise specified (EDNOS) presentations in women with lifetime anorexia or bulimia nervosa? Psychological Medicine, 40, 17351744.
Favaro, A., Ferrara, S., & Santonastasio, P. (2003). The spectrum of eating disorders in young women: A prevalence study in a general population sample. Psychosomatic Medicine, 65, 701708.
Garcia, F. D., Grigioni, S., Allais, E., Houy-Durand, E., Thibaut, F., & Déchelotte, P. (2011). Detection of eating disorders in patients: Validity and reliability of the French version of the SCOFF questionnaire. Clinical Nutrition, 30, 178181.
Garcia, F. D., Grigioni, S., Chelali, S., Meyrignac, G., Thibaut, F., & Dechelotte, P. (2010). Validation of the French version of SCOFF questionnaire for screening of eating disorders among adults. World Journal of Biological Psychiatry, 11, 888893.
Garcia-Campayo, J., Sanz-Carrillo, C., Ibañez, J. A., Lou, S., Solano, S., & Alda, M. (2005). Validation of the Spanish version of the SCOFF questionnaire for the screening of eating disorders in primary care. Journal of Psychosomatic Research, 59, 5155.
Gatsonis, C., & Paliwal, P. (2006). Meta-analysis of diagnostic and screening test accuracy evaluations: Methodological primer. American Journal of Roentgenology, 187, 271281.
Herpertz-Dahlmann, B., Wille, N., Hölling, H., Vloet, T. D., & Ravens-Sieberer, U. (2008). Disordered eating behavior and attitudes, associated psychopathology and health-related quality of life: Results of the BELLA study. European Child & Adolescent Psychiatry, 17, 8291.
Hill, L. S., Reid, F., Morgan, J. F., & Lacey, J. H. (2010). SCOFF, the development of an eating disorder screening questionnaire. International Journal of Eating Disorders, 43, 344351.
Lähteenmäki, S., Aalto-Setälä, T., Suokas, J. T, Saarni, S. E., Perälä, J., Saarni, S. I., …, & Suvisaari, J. M. (2009). Validation of the Finnish version of the SCOFF questionnaire among young adults aged 20 to 35 years. BMC Psychiatry, 9.
Luck, A. J., Morgan, J. F., Reid, F., O’Brien, A., Brunton, J., Price, C., …, & Lacey, J. H. (2002). The SCOFF Questionnaire and clinical interview for eating disorders in general practice: Comparative study. British Medical Journal, 325, 755756.
Macaskill, P. (2004). Empirical Bayes estimates generated in a hierarchical summary ROC analysis agreed closely with those of a full Bayesian analysis. Journal of Clinical Epidemiology, 57, 925932.
Mond, J. M., Myers, T. C., Crosby, R. D., Hay, P. J., Rodgers, B., Morgan, J. F., …, & Mitchell, J. E. (2008). Screening for eating disorders in primary care: EDE-Q versus SCOFF. Behaviour Research and Therapy, 46, 612622.
Morandé, G., Celada, J., & Casas, J. J. (1999). Prevalence of eating disorders in a Spanish school age population. Journal of Adolescent Health, 24, 212219.
Morgan, J. F., Reid, F., & Lacey, J. H. (1999). The SCOFF questionnaire: Assessment of a new screening tool for eating disorders. British Medicine Journal, 319, 14671468.
Muro-Sans, P., Amador-Campos, J. A., & Morgan, J. F. (2008). The SCOFF-C: Psychometric properties of the Catalan version in a Spanish adolescent sample. Journal of Psychosomatic Research, 64, 8186.
Ogg, E. C., Millar, H. R., Pusztai, E. E., & Thom, A. S. (1997). General practice consultation patterns preceding diagnosis of eating disorders. International Journal of Eating Disorders, 22, 8993.<89::AID-EAT12>3.0.CO;2-D
Pannocchia, L., Di Fiorino, M., Giannini, M., & Vanderlinden, J. A. (2011). Psychometric exploration of an Italian translation of the SCOFF questionnaire. European Eating Disorders Review, 19, 371373.
Parker, S. C., Lyons, J., & Bonner, J. (2005). Eating disorders in graduate students: Exploring the SCOFF questionnaire as a simple screening tool. Journal of American College Health, 54, 103107.
Pérez-Gaspar, M., Gual, P., De Irala-Estévez, J., Martínez-González, M. A., Lahortiga, F., & Cervera, S. (2000). Prevalencia de trastornos de la conducta alimentaria en las adolescentes Navarras. [Prevalence of eating disorders in a representative sample of female adolescents from Navarra-Spain] Medicina Clínica-Barcelona, 114, 481486.
Review Manager (2008). Version 5.0. Copenhagen, Denmark: The Nordic Cochrane Centre, The Cochrane Collaboration.
Rojo, L., Livianos, L., Conesa, L., Garcia, A., Domínguez, A., Rodrigo, G., …, & Vila, M. (2003). Epidemiology and risk factors of eating disorders: A two-stage epidemiologic study in a Spanish population aged 12–18 years. International Journal of Eating Disorders, 34, 281291.
Rueda, G. E., Díaz, L. A., Campo, A., Barros, J. A., Avila, G. C., Oróstegui, L. T.,..., & Cadena, L. P. (2005). Validation of the SCOFF questionnaire for screening of eating disorders in university women. Biomédica, 25, 196202.
Rueda, G. E., Díaz, L. A., Ortiz, D. P., Pinzón, C., & Rodrigues, J. (2005). Validación del cuestionario SCOFF para el cribado de los trastornos del comportamiento alimentario en adolescentes escolarizadas. [Validation of the SCOFF questionnaire for screening the eating behavior disorders of adolescents in school] Atención Primaria, 35, 8994.
Ruíz-Lazaro, P. M., Alonso, J. P., Velilla, J. M., Lobo, A., Martín, A., Paumard, C., & Calvo, A. I. (1998). Estudio de prevalencia de trastornos de la conducta alimentaria en adolescentes de Zaragoza. [Study of the prevalence of eating disorders in adolescents in Zaragoza] Revista de Psiquiatría Infanto-Juvenil, 3, 148162
SAS Institute Inc. (2008). The SAS System for Windows. Version 9.2. Cary, NC: SAS Institute Inc.
Steinhausen, H. C., Winkler, C., & Meier, M. (1997). Eating disorders in adolescence in a Swiss epidemiological study. International Journal of Eating Disorders, 22, 147151.<147::AID-EAT5>3.3.CO;2-I
Zamora, J., Abraira, V., Muriel, A., Khan, K., & Coomarasamy, A. (2006). Meta-Disc: A software for meta-analysis of test accuracy data. BMC Medical Research Methodology, 6.
Zweig, M. H., & Campbell, G. (1993). Receiver-operating characteristic (ROC) plots: A fundamental evaluation tool in clinical medicine. Clinical Chemistry, 39, 561577.



Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed