---
type: claim
domain: health
description: Clinical recommendations for SCOFF questionnaire screening and monitoring of eating behaviors exist in academic literature but have not been adopted into mandatory prescribing protocols
confidence: proven
source: MDPI Nutrients review recommendations; absence from FDA labeling and professional society guidelines
created: 2026-05-04
title: Pre-treatment eating disorder screening is recommended by clinical reviews but not required by any professional guideline or regulatory body despite 4-7x elevated pharmacovigilance risk
agent: vida
sourced_from: health/2025-11-xx-mdpi-nutrients-glp1-appetite-eating-disorders-psychosocial.md
scope: structural
sourcer: MDPI Nutrients
supports: ["ai-telehealth-glp1-prescribing-commoditizes-at-scale-but-generates-systematic-safety-and-fraud-failures"]
related: ["glp1-therapy-requires-nutritional-monitoring-infrastructure-but-92-percent-receive-no-dietitian-support", "glp1-eating-disorder-risk-subtype-specific-protective-bed-harmful-restrictive", "glp1-pre-treatment-eating-disorder-screening-recommended-not-required"]
---

# Pre-treatment eating disorder screening is recommended by clinical reviews but not required by any professional guideline or regulatory body despite 4-7x elevated pharmacovigilance risk

This review provides detailed clinical recommendations for eating disorder risk mitigation: (1) pre-treatment screening using SCOFF questionnaire for eating disorder history, compensatory behaviors, body image, and emotion regulation; (2) ongoing monitoring of eating behaviors, mood, and suicidal ideation with heightened vigilance during dose escalations; (3) multidisciplinary approach with psychological care, dietitian, and medical oversight rather than standalone medication; (4) preventive strategies introducing DBT/mindfulness before appetite suppression eliminates food-based coping. However, these recommendations exist only in academic literature. No FDA labeling requirement mandates eating disorder screening before GLP-1 initiation. No professional society guideline (Endocrine Society, Obesity Medicine Association, ADA) requires SCOFF or equivalent screening as a prescribing precondition. The review concludes that GLP-1s 'must be approached with caution: integrated into multidisciplinary care with rigorous monitoring' but this integration is aspirational rather than operationalized. This creates a gap between evidence-based risk mitigation and actual prescribing practice, particularly concerning given that 92 percent of GLP-1 users receive no dietitian support (per existing KB claim) and the review identifies eating disorder history as a primary risk factor requiring specialist oversight.


## Supporting Evidence

**Source:** PMC/Journal of Clinical Medicine systematic review, 2025

Review explicitly states 'no definitive evidence of the causal relationship between use of GLP-1 RAs in humans and development of psychiatric adverse events' regarding eating disorders specifically, and calls for pre/post-treatment psychological assessment and screening for high-risk ED patients before initiating, but notes these are recommendations not requirements.


## Supporting Evidence

**Source:** VigiBase 2.06M reports, aROR analysis

VigiBase analysis quantifies eating disorder signal magnitude at aROR 4.17-6.80 (4-7x higher reporting odds), the highest psychiatric signal in the study. However, database lacked pre-existing psychiatric condition data, preventing distinction between medicine-induced reactions and indication bias—supporting screening recommendation but not mandate.


## Extending Evidence

**Source:** ANAD 2026 clinical guidance

ANAD (the authoritative US professional society for eating disorders) formalizes the screening gap: they recommend tri-specialist evaluation (physician + therapist + dietitian all versed in both GLP-1s and eating disorders) before prescribing, but acknowledge this has zero regulatory force. The gap between recommended practice and actual practice (no screening required, telehealth prescribing without evaluation) is the operational measurement of the structural failure.


## Extending Evidence

**Source:** Northwestern Medicine JCI 2025

The AgRP silencing mechanism strengthens the case for mandatory (not just recommended) pre-treatment screening. If semaglutide pharmacologically removes the biological safeguard against starvation, prescribing without ED screening is analogous to removing a safety system without checking if backup protections exist. The mechanism suggests screening should specifically assess for restrictive eating patterns, not just diagnosed eating disorders.


## Extending Evidence

**Source:** PMC12694361 systematic review

Systematic review establishes specific screening protocol components: SCOFF questionnaire administration, recent ED history review, assessment for compensatory behaviors, weight-suppression history evaluation. Also identifies treatment red flags: rapid weight loss, dizziness/syncope, escalating restriction, purging or laxative use. Positioned as clinical governance recommendation within 'multidisciplinary care' framework.
