SCOFF Questionnaire
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The SCOFF Questionnaire is a 5-item screening tool used to detect possible cases of anorexia nervosa and bulimia nervosa. It is designed for rapid use in primary care, mental health, and community health settings to help clinicians identify individuals who may require a more detailed eating disorder assessment.
Developed by Morgan, Reid, and Lacey in the UK, the SCOFF is valued for its brevity, mnemonic structure, and high sensitivity, especially in early detection scenarios.
Recommended Frequency: At intake or when disordered eating is suspected; repeat if symptoms emerge during treatment
About the SCOFF
Each of the five yes/no questions corresponds to a hallmark behavior or symptom of eating disorders. The acronym “SCOFF” comes from keywords in the questions:
- S – Do you make yourself Sick because you feel uncomfortably full?
- C – Do you worry you have lost Control over how much you eat?
- O – Have you recently lost more than One stone (≈6.35 kg / 14 lb) in a 3-month period?
- F – Do you believe yourself to be Fat when others say you are too thin?
- F – Would you say that Food dominates your life?
Each “Yes” response scores 1 point, for a total possible score of 0 to 5.
Who is the SCOFF For?
The SCOFF is suitable for adolescents (≥16) and adults, particularly when:
- Clients present with weight concern, restrictive eating, bingeing, purging, or body image distress
- You observe signs like rapid weight changes, ritualistic eating behaviors, or preoccupation with food or body shape
- Clients are in settings where time-limited screening is needed (e.g., primary care, university counseling, youth clinics)
Note: It is a screening tool, not diagnostic, and is less sensitive to binge eating disorder or ARFID. Use follow-up assessments when indicated.
The Scale
Each of the 5 items is answered Yes or No. A score of 2 or more is considered a positive screen, warranting further exploration of disordered eating.
Scoring the SCOFF
0–1: Unlikely eating disorder; monitor as appropriate
2–5: Possible eating disorder; follow up recommended
While brief, the SCOFF has demonstrated high sensitivity (~100%) and moderate specificity, making it ideal for early detection, especially in non-specialist settings.
TIP FOR PRACTICE
If a client answers “Yes” to one or more questions, don’t push for details right away. Instead say:
“That response tells me this might be something you’re dealing with—can we talk more about how food and body image have been showing up in your life lately?”
Approach with curiosity, not interrogation.
The SCOFF in Practice
Use cases include:
- Early detection in general medicine or therapy settings
- Screening prior to nutrition or weight management interventions
- Triage tool for determining whether to refer for a full eating disorder evaluation
- Short-form screen in school, college, or telehealth settings
HiBoop can display SCOFF results on intake dashboards and surface care pathways when disordered eating is flagged.
Copyright
Developed by John Morgan, Deborah Reid, and James Lacey. The SCOFF Questionnaire is in the public domain and freely available for clinical and non-commercial research use.
References
- Morgan, J. F., Reid, F., & Lacey, J. H. (1999). The SCOFF questionnaire: assessment of a new screening tool for eating disorders. BMJ, 319(7223), 1467–1468.
- Hill, L. S., Reid, F., Morgan, J. F., & Lacey, J. H. (2010). SCOFF, an effective screening tool for eating disorders.International Journal of Eating Disorders, 43(6), 550–552.
Disclaimer
The SCOFF is a screening tool, not a diagnostic assessment. A positive result should be followed by comprehensive clinical evaluation, including assessment of weight history, body image, eating behaviour, and medical stability.
Permissions
Developed by John Morgan, Deborah Reid, and James Lacey.
The SCOFF Questionnaire is in the public domain and freely available for clinical and non-commercial research use.
Frequently Asked Questions
Is it triggering?
It can be for some clients. Introduce it gently and follow with a supportive conversation.
How often should I re-administer it?
Only if there’s a significant change in behaviour or concern about relapse.
Can it detect binge eating disorder or ARFID?
Not reliably. The SCOFF is more sensitive to restrictive or purging patterns. Use additional tools for broader screening.
Is this tool appropriate for all genders?
Yes. While originally validated in women, it is now widely used across genders and identities.
Can the SCOFF diagnose eating disorders?
No. It flags risk, but a full clinical assessment is needed for diagnosis.