CPG for Eating Disorders

However, there is a need for a guide adapted to the Spanish population using the bestpossible methodology and based on the best available evidence.Recently, other important actions related with eating disorders have been carried out in ourcontext, such as: NAOS and PAOS programme for the prevention of obesity in children and ahealthy diet; the Social Pact of the Madrid for the prevention of eating disorders; Image andSelf-Esteem Foundation, and pacts between user federations (FEACAB and ADANER) and theMSC.Magnitude of the problemEstimations on the incidence and prevalence of eating disorders vary depending on the studiedpopulation and assessment tools employed. Therefore, in order to compare data from differentnational and international sources it is essential that the study design be the same. The study in“two phases” is the most appropriate methodology for the detection of cases in the community.The first phase consists of screening using self-report symptom questionnaires. In the secondphase, assessment is carried out by means of clinical interviews that are conducted withindividuals who obtained scores above the cut-off point in the screening questionnaire (“at risk”subjects), meaning only a subsample of the total initially screened sample is interviewed.Within the studies that use correct two-phase methodology, very few perform randomsampling of participants who score below the cut-off point of the screening questionnaire tointerviews, which leads to a subestimation of the prevalence of eating disorders by not takingfalse negatives into account 21-23 . An additional problem is the use of different cut-off points inscreening questionnaires.In spite of these methodological difficulties, the increased prevalence of eating disorders issignificant, especially in developed or developing countries, while it is nearly inexistent in thirdworldcountries. Increased prevalence is attributable to increased incidence and duration andchronicity of these clinical pictures.Based on two-phase studies conducted in Spain (Tables 1 and 2) on the highest risk population,women ranging from 12 to 21 years of age, a prevalence of 0.14% to 0.9% is obtained for AN,0.41% to 2.9% for BN and 2.76% to 5.3% in the case of EDNOS. In total, we would be lookingat an eating disorder prevalence of 4.1% to 6.41%. In the case of male adolescents, even thoughthere are fewer studies available, a prevalence of 0% for AN, 0% to 0.36% for BN and 0.18% to0.77% for EDNOS is obtained, with a total prevalence of 0.27% to 0.90% 21-29 .These numbers are similar to those presented in the NICE CPG (2004), where prevalence inof EDNOS, BN and AN in women ranges from 1% to 3.3%, 0.5% to 1.0% and 0.7%,respectively, and also to those in the Systematic Review of Scientific Evidence (SRSE) (2006)which reports prevalence in Western Europe and the United States (0.7% to 3% of EDNOS inthe community, 1% of BN in women and 0.3% of AN in young women).CLINICAL PRACTICE GUIDELINE FOR EATING DISORDERS35