Identifying eating disorders in adolescents and adults living with higher weight: an updated systematic review of questionnaire diagnostic accuracy

Objective: To update the evidence regarding the diagnostic accuracy of eating disorder (ED) questionnaires in adolescents and adults with higher weight. Method: Five databases were systematically searched from 2020 to November 2025 (CRD420251186115). Included studies reported on the diagnostic accuracy of self-report questionnaires against a clinical interview to identify EDs and disordered eating behaviors (DEBs) in adolescents and adults with higher weight. Narrative synthesis was conducted, and findings from new studies were synthesized alongside previously identified studies. Results: Thirty-two studies (5 new) were included, reporting on the diagnostic accuracy of 13 questionnaires in adults and 5 in adolescents. The diagnostic accuracy of questionnaires was examined to identify any ED (5 questionnaires in adults, 0 adolescents), binge-eating disorder (8 adult, 2 adolescent), DEBs (e.g., binge eating, purging) (4 adult, 1 adolescent), loss-of-control eating (1 adult, 2 adolescent), bulimia nervosa, atypical anorexia nervosa, purging disorder, and night eating syndrome (each n = 1 adult, 0 adolescent). The Eating Disorder Examination Questionnaire (7 studies; sensitivity 0.16–0.88; specificity 0.54–1.0), Binge Eating Scale (6 studies; sensitivity 0.37–0.98; specificity 0.48–0.96), and Questionnaire on Eating and Weight Patterns (6 studies; sensitivity 0.07–1.0; specificity 0.0–1.0) were most used. Discussion: Progress in evaluation of the diagnostic accuracy of ED questionnaires in people with higher weight has been limited. There remains a lack of evidence regarding the diagnostic accuracy of questionnaires in adolescents and a lack of sufficiently sensitive questionnaires to identify EDs other than binge-eating disorder. Assessing the diagnostic accuracy of questionnaires in people with higher weight remains a research priority.