SCOFF Questionnaire
The SCOFF questionnaire is a five-question screening test for eating disorders: two or more yes answers means the person needs proper assessment before any weight-loss plan continues.
Plain English
Patient-Friendly Explanation
SCOFF is five short questions designed to raise suspicion of an eating disorder in a few seconds. The letters stand for Sick, Control, One stone, Fat and Food: do you make yourself sick because you feel uncomfortably full; do you worry you have lost control over how much you eat; have you recently lost more than about six kilograms in three months; do you believe you are fat when others say you are thin; would you say that food dominates your life. Each yes scores one point. A score of two or more does not mean the person has an eating disorder - it means they should be assessed properly by someone who specialises in them. In the original study, two or more yes answers identified every woman with anorexia or bulimia, at the cost of about one false positive in eight healthy women, so it is a sensitive sieve rather than a precise one. The questions matter in a weight clinic because eating disorders occur at every body size, and a strict diet or an appetite-suppressing medicine given to someone with an untreated eating disorder can make things considerably worse. A negative screen is not a guarantee either: SCOFF was built around anorexia and bulimia and does not reliably pick up binge eating disorder, so clinical judgement still counts.
Medical
Clinical Definition
The SCOFF was developed by Morgan, Reid and Lacey and published in the British Medical Journal in 1999, derived from focus groups of patients with eating disorders and of specialists. It comprises five binary items covering self-induced vomiting, loss of control over eating, weight loss of more than one stone (about 6.35 kilograms) in three months, body image distortion and food preoccupation. In the original validation, which involved 116 women with anorexia or bulimia and 96 controls and was administered orally, a threshold of two or more positive answers gave 100% sensitivity (95% confidence interval 96.9 to 100) for anorexia and bulimia separately and combined, with specificity of 87.5% (79.2 to 93.4). A later meta-analysis of diagnostic accuracy reported lower pooled sensitivity, as expected when a case-control validation is applied to unselected populations. The instrument does not screen for binge eating disorder or avoidant restrictive food intake disorder and performs less well in men and in some translated non-Western populations. Its role in obesity practice is as a first-line safety check before prescribing restrictive diets, very low energy diets or appetite-suppressing medication, and as a prompt for referral to an eating disorder service or psychologist. A positive result is a reason to look further, never a diagnosis, and a negative result does not exclude an eating disorder.
Key Insight
Why It Matters
Five questions can change the whole plan - an unrecognised eating disorder combined with a strict diet or appetite-suppressing medicine is a bad combination, and eating disorders are not visible from someone's weight.
Sources
Reviewed against standard medical references.
Medically reviewed by
Family Physician & Registered Acupuncturist, Accord Medical Clinic. MBBS (NUS), Graduate Diploma in Family Medicine (NUS), Graduate Diploma in Acupuncture (Singapore College of TCM).
Last reviewed: September 2026
This page is general health education, not medical advice. Whether any treatment is appropriate for you is a decision made in consultation after assessment.
