The EDE-Q is appropriate for use with adolescents and adults in primary care settings as a screener for eating disorders (Anorexia, Bulimia, Binge Eating Disorder and EDNOS).

The EDE-Q is a useful screening tool in cosmetic settings for patients seeking body contouring procedures in particular, including liposuction, breast surgery and abdominoplasty.

It is estimated that there is a 5% lifetime prevalence of eating disorders in patients seeking aesthetic treatments, with the most common treatments undertaken being breast augmentation, rhinoplasty and liposuction. Around 11% of patients undertaking breast augmentation meet criteria for anorexia nervosa, and around 13% of liposuction patients meet criteria for bulimia nervosa. Individuals with eating disorders are at 4 times higher risk of experiencing a complication in the 30 days following a cosmetic surgery, when compared to the general patient population (Spataro et al., 2021).

Eating disorders can be associated with distorted body perception, low self-esteem and a heightened need for control which can increase the risk of dissatisfaction with a cosmetic procedure and experiencing greater challenges during recovery. Further, eating disorders can be associated with a range of physical health problems which may place the patient at greater risk of medical complications from a cosmetic surgery (Barone et al., 2024; D’Souza et al., 2020). Patients seeking body contouring surgery following bariatric surgeries have also been found to display higher rates of body image related distress, and eating disorder pathology on the EDE-Q (Bennett et al., 2021) .

Some studies have demonstrated improvements in eating disorder pathology in patients following breast surgeries (both reductions and augmentations) as well as liposuction, while others have demonstrated negative patient outcomes. As such, if eating disorder risk is identified preoperatively, an individualised assessment is recommended to determine the suitability of the procedure (Barone et al., 2024). This may require additional specialist support from the patient’s GP or mental health professional.,

Scores are presented as an average score (between 0 and 6), where 0 represents “No Days” of eating disorder symptoms and 6 represents symptoms “Everyday”.

Individual items can be examined to determine the number of days a symptom or behaviour occurred.

Average scores are presented for the four subscales:

1. Restraint (items 1, 2, 3, 4, 5)
2. Eating Concerns (items 7, 9, 19, 20, 21)
3. Weight Concern (items 8, 12, 22, 24, 25)
4. Shape Concern (items 6, 8, 10 11, 23, 26, 27, 28)

Percentiles are also presented related to a normative female sample (Mond et al., 2006). A percentile of 50 represents typical eating and body image concerns among adult women while scores above the 85th percentile are considered to be of clinical significance. An Eating Disorder Percentile is also presented for the Global score, where a percentile of 50 is indicative of average scores for those independently diagnosed with an eating disorder (AN, BN, BED or EDNOS) (Aardoom, et al., 2012).

The literature indicates a Global Score clinical cut-off of 2.8 for women (Mond et al., 2015) and 1.68 for men (Schaelfer et al., 2018), however in Australia scores above 3 contributes to eligibility for eating disorder MBS items. Questions 13 to 18 do not contribute to the Global Score and should be individually examined to ascertain frequency of binging and compensatory behaviours.  

The EDE-Q has been extensively validated in female cohorts and to an acceptable degree in men. The EDE-Q can reliably discriminate between people with eating disorders (Anorexia, Bulimia, Binge Eating Disorder, EDNOS) and those without (Mond et al., 2004).

Norms for women aged 18-42 were produced by Mond et al. (2006) in a community sample of 5255 Australian women. The mean for this group was 1.52 (SD=1.25). In primary care settings a clinical cut-off of 2.80 was determined as yielding a sensitivity of 0.80 and specificity of 0.80 (Mond et al., 2008). Clinical norms were created with 935 women independently diagnosed with Anorexia, Bulimia, Binge Eating Disorder and EDNOS, which yielded an average score of 4.02 (SD=1.30; Aardoom et al., 2012). In addition, among a group of adolescents admitted to hospital for Anorexia Nervosa, the mean score was 3.98 (SD=1.65; Jennings & Phillips, 2017).

Men with eating disorders tend to score lower than women on the EDE-Q, and a lower clinical cut-off of 1.68 was recommended for men (sensitivity = 0.77, specificity = 0.77; Schaelfer et al., 2018).