Evaluation of Eating Disorders: Counselor Response to Weight Information in a National Eating Disorders Educational and Screening Program!!Eating disorders are frequently undetected and inadequately treated in clinical settings. To understand better how clinical information is either utilized or disregarded by clinicians in the assessment of eating disorders—and ultimately, to identify means of enhancing adherence to best practices—Dr. Herzog and his team investigated how weight data were used by counselors to make recommendations for need for further evaluation in the National Eating Disorders Screening Program (NEDSP).!!The first NEDSP was an educational, two-stage screening program for eating disorders held at college campuses across the nation in 1996. The program included 9,069 individuals from 409 colleges and universities across the United States. The students filled out self-report, symptom-based screening questionnaires and had the option of meeting with a counselor, who reviewed responses and made a recommendation as to whether there was sufficient concern to warrant further formal evaluation.!!The current study investigated whether the counselors used weight data appropriately in making recommendations for further care. Data comprised self-report questionnaires from 5,684 NEDSP participants who met with a counselor, as well as the associated flow sheets completed by the counselors.!!Training of the NEDSP counselors was standardized as much as possible through the advance distribution of a two-volume procedure manual. The procedure manual recommended that NEDSP staff undergo orientation one week before initiation of the program. Counselors were provided with versions of the BWAT for women and men that were developed for the NEDSP on which they were to plot the participants’ height and weight. A corresponding category describing appropriateness of weight for height (e.g., normal weight or underweight) could then be read from this tool. The categories were normal weight, underweight, very underweight and extremely underweight (<75% of expected body weight).!!Weight for height data were used in the NEDSP algorithm as follows: (1) Normal weight and above: no recommendation for further evaluation based on weight; (2) underweight: recommendation for further evaluation based on weight only if either amenorrhea or significantly disordered eating attitudes were reported; (3) very underweight: recommendation for further evaluation based on weight alone; and (4) extremely underweight: recommendation for urgent further evaluation.!!In 95% of cases, the counselors correctly used the algorithm developed for the NEDSP to assign participants to weight categories ranging from normal to extremely underweight. However, counselors were poorly adherent to the algorithm directing them to recommend urgent evaluation to all extremely underweight participants—that is, those with a weight at or below 75% of expected weight. Of the extremely underweight participants (n = 32), only 25.0% (n = 8) received an appropriate recommendation for urgent evaluation, whereas 59.4% (n = 19) received a recommendation for further (but nonurgent) evaluation, and 15.6% (n = 5) did not receive a recommendation to seek any evaluation.!!These results suggested that further specific emphasis on the health risks of extreme underweight may be helpful in training clinicians to manage patients with eating disorders.