A brief screening survey to identify teens at risk for an eating disorder could lead to earlier diagnosis and help find hard-to-detect cases, which could lower overall treatment costs and improve outcomes, Boston Children's Hospital researchers reported in the American Journal of Public Health.

"Many cases of eating disorders go undetected for years. This may be because of the stereotype that the typical teen with an eating disorder is a thin, affluent, white female. In reality, eating disorders come in all shapes and sizes and both genders, and they affect people from all racial/ethnic and socioeconomic backgrounds," said Kendrin R. Sonneville, senior study author from Boston Children's Division of Adolescent Medicine.

Eating disorders — anorexia nervosa, bulimia nervosa and binge-eating disorder—are underdiagnosed and undertreated, particularly among low-income, minority, overweight and male teens. Only 3 to 28 percent of teens with eating disorders receive treatment for their condition. Moreover, interventions for eating disorders, such as residential treatment and lengthy therapy, tend to be very expensive. Teens with untreated eating disorders face medical complications, hospitalization and higher risk of early death.

The combination of underdiagnosis, undertreatment and high treatment costs has generated support for school-based screening, which could help identify teens with eating disorders. "However, the cost-effectiveness of school-based screening for eating disorders had not been demonstrated previously," said Sonneville.

In order to evaluate the cost-effectiveness of a school-based screening program, Sonneville and colleagues devised a computer simulation comparing annual screening of 10- to 17-year-olds to a no-screening scenario.

The researchers found that the five-question survey boosted detection and treatment for eating disorders. Implementing a school-based screening program is a bargain in terms of time and money; screening costs $0.35 per student, and the survey can be scored in a few minutes.

"School-based screening for eating disorders is very likely a cost-effective approach to improving the health of teens. Early diagnosis leads to early treatment, which means these youth will get better faster and oftentimes avoid the long-term damage to their health and lives that the eating disorders can cause," said Sonneville. "A simple screening for eating disorders in schools could give millions of kids a new chance for a healthy life."