Online Screening for Eating Disorders

Man using online screening IOI-S to check for signs of an eating disorder

Research shows that when individuals with eating disorders seek professional help in the early stages of their illness, they are two times more likely to achieve remission [1]. Conversely, the longer a person has ED symptoms before seeking intervention and treatment, the more likely they are to experience a chronic course and suffer from medical complications [2]. In other words, the sooner an eating disorder is detected and treated, the better the chances are of recovery, meaning early screening tools, now particularly online screening, and detection are a critical part of ED intervention and treatment.

Unfortunately, current ED screening tools are typically designed to be carried out by an expert in an in-person setting and are seldom approved for online use. And with more and more people turning to digital healthcare and online resources for mental health help (due in large part to COVID-19), there is an ever-increasing need for online screening for eating disorders.

The InsideOut Institute for Eating Disorders (IOI) at the University of Sydney recently developed a 6-item online screening tool designed to “start a conversation” and encourage those who may have an ED or may be struggling with early-onset ED symptomatology to seek professional help in a timely manner [3].

The Need for Online Eating Disorder Screening

In light of the current circumstances surrounding COVID-19, more and more people are turning to telehealth and digital resources for medical and mental health help. One report found that while only 11 percent of consumers in the US used telehealth in 2019, 46 percent are using telehealth in 2020 [4].

Unfortunately, most screening tools for eating disorders are validated for in-person use only and must be administered by an expert. This means many people no longer have safe or easy access to eating disorder detection tools and intervention.

Further, current ED screening tools are typically designed to identify traditional cases of Anorexia Nervosa (AN) and Bulimia Nervosa (BN), instead of uncovering broad eating disorder risk and early stages of ED symptomatology.

This means traditional ED screening tests may fail to detect many newly specified eating disorders in the DSM-5 (Atypical AN, Avoidant Restrictive Food Intake Disorder, Binge Eating Disorder, Other Specified Feeding or Eating Disorder, etc.).

Additionally, many current ED screening tools are designed to determine only whether a person is ill or healthy instead of identifying possible ED risk/early symptomatology. This means at-risk individuals or those in the earliest stages of an ED may fail to get the help they need.

The IOI Online Screening for Eating Disorders Test

Girl using online screening tool IOI-S to check for eating disorder symptomsIn an effort to address these gaps in current eating disorder screening tools, the InsideOut Institute for Eating Disorders at the University of Sydney created a 6-item online screening test for eating disorders called the InsideOut Institute Screener (IOI-S).

Unlike other eating disorder screening tools, IOI-S for eating disorders was

1) designed specifically for autonomous online use, and

2) is intended to uncover broad eating disorder risk and early-onset ED symptomatology.

The test-developers drew upon scientific literature for existing screening tools and consulted clinical research and expert experience to develop an online test that uses non-intrusive language. The IOI-S’s purpose is not to diagnose or treat but simply to “start a conversation” and encourage at-risk individuals to seek professional help right away [5].

The IOI-S test involves the following six questions. Participants are prompted to pick the answer that best describes them from a scale of 1 to 5.

1. How is your relationship with food?

2. Does your weight, body, or shape make you feel bad about yourself?

3. Do you feel like food, weight, or your body shape dominates your life?

4. Do you feel anxious or distressed when you are not in control of your food?

5. Do you ever feel like you will not be able to stop eating or have lost control around food?

6. When you think you have eaten too much, do you do anything to make up for it?

After test-takers complete this short, 6-item questionnaire, they receive a score of between 6 and 30 points, with 6 being the lowest degree of ED risk and 30 being the highest. If the test-taker receives a score of moderate to high risk, the IOI directs them to their database of eating disorder professionals, where they can find more information and treatment options.

The Effectiveness of the IOI-S

Since the IOI-S is a relatively new online screening tool for eating disorders, little research exists around its statistical reliability and accuracy. However, a recent paper published in the Journal of Eating Disorders reveals an extensive study is underway to establish the credibility of the IOI-S [6].

While the study’s results are not yet determined, the researchers acknowledge the importance of tailoring ED screening tools for online use and state that online screening tools like the IOI-S “may become the first step to seeking care” [7].


[1] Bryant, E., Miskovic-Wheatley, J., Touyz, S. et al. Transitioning to digital first line intervention – validation of a brief online screener for early identification of a suspected eating disorder: study protocol. J Eat Disord 8, 60 (2020).

[2] ibid.

[3] ibid.

[4] Bestsennyy, O., Gilbert, G., Harris, A., & Rost, J. (2020, June 1). Telehealth: A quarter-trillion-dollar post-COVID-19 reality? McKinsey & Company.

[5] Bryant, E., Miskovic-Wheatley, J., Touyz, S. et al. Transitioning to digital first line intervention – validation of a brief online screener for early identification of a suspected eating disorder: study protocol. J Eat Disord 8, 60 (2020).

[6] ibid.

[7] ibid.

About the Author:

Sarah Musick PhotoSarah Musick is a freelance writer who specializes in eating disorder awareness and education. After battling with a 4-years long eating disorder, she made it her mission to help others find hope and healing in recovery.

Her work has been featured on numerous eating disorder blogs and websites. When she’s not writing, Sarah is off traveling the world with her husband.

The opinions and views of our guest contributors are shared to provide a broad perspective on eating disorders. These are not necessarily the views of Eating Disorder Hope, but an effort to offer a discussion of various issues by different concerned individuals.

We at Eating Disorder Hope understand that eating disorders result from a combination of environmental and genetic factors. If you or a loved one are suffering from an eating disorder, please know that there is hope for you, and seek immediate professional help.

Published December 15, 2020, on
Reviewed & Approved on December 15, 2020, by Jacquelyn Ekern MS, LPC

About Baxter Ekern

Baxter is the Vice President of Ekern Enterprises, Inc. He is responsible for the operations of Eating Disorder Hope and ensuring that the website is functioning smoothly.