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Sick, Control, One Stone, Fat, Food (SCOFF)
Screen eating-disorder concerns with the five-item SCOFF, see the 0-to-5 score, 2+ cut-point, cue groups, and follow-up notes.Screen snapshot
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Vomiting/weight-loss cue present
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Assessment result details
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Share result
Share this result page with someone you trust to review your answers and result.
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Threshold gauge
What this result suggests
The interpretation stays tied to the original 2+ SCOFF cut-point and the endorsed item pattern.
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Scoring caution
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Cut-point context
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Recommended next actions
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Top signal items
These are the yes answers carrying the current screen signal.
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No yes items were endorsed on this run.
Higher/lower cue comparison
Pair the endorsed cues with the quieter ones so the current pattern is easy to brief.
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When to seek support sooner
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Answer review
Response ledger
Export the item-level answers as a simple follow-up record.
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Eating-disorder concerns often start as scattered signs: meals becoming harder to manage, a sudden change in weight, distress about shape, secret vomiting, or food taking over more of the day. A brief screener cannot explain the whole picture, but it can turn a vague worry into a small set of warning signs that are easier to discuss.
SCOFF is built for that first-pass conversation. Its five questions ask about self-induced vomiting after feeling too full, loss of control over eating, losing more than one stone in 3 months, feeling fat when others say you are too thin, and whether food dominates daily life. Each item is deliberately direct because the aim is not to measure every eating-disorder symptom. The aim is to raise suspicion when several high-signal cues appear together.
The name is a memory aid for the five item themes: Sick, Control, One stone, Fat, and Food. Those words are short, but the situations behind them are not minor. Vomiting and rapid weight loss can carry medical risk. Loss of control and food preoccupation can show that eating is becoming harder to interrupt. Feeling fat despite being told too thin points toward body-image distortion, not a normal preference about appearance.
The usual SCOFF cut-point is 2 or more yes answers. That boundary is useful because it is easy to remember and has been studied as a primary-care screening threshold, especially in adults. It should still be read as a prompt for fuller assessment, not as a diagnosis. A person can have a positive screen without meeting diagnostic criteria, and a person can need help even when a five-item screen is below the cut-point.
Several mistakes can make SCOFF results too reassuring or too alarming. One mistake is treating the total as a severity score. Another is ignoring which item was endorsed, even though vomiting and rapid recent weight loss can matter medically. A third is using a low score to dismiss eating, body-image, or weight concerns that fall outside these five questions.
Good screening language stays modest: it names a concern, keeps the answer pattern visible, and points toward the next conversation. For eating disorders, that conversation may need medical review, mental-health assessment, nutritional support, and attention to safety. The score is only the opening note.
How to Use This Tool:
Answer the five items in one sitting, then read the total together with the exact yes answers.
- Select Begin assessment and answer each SCOFF question with Yes or No.
- Keep the same recent-months frame across the full screen. Do not mix an old weight-loss period with a current food-preoccupation answer.
- Use the question navigator and progress label to find any missing item. The Screen snapshot appears only after all five answers are complete.
- Read the Screen snapshot for the 0 to 5 score, the positive-screen status, the top cue area, and the Follow-up lane.
- Check the Threshold gauge and Cut-point context to see whether the score is below, at, or above the usual 2+ boundary.
- Review Top signal items, Higher/lower cue comparison, and Response ledger before copying or exporting anything. These sections show what is driving the score.
- Use the context and follow-up emphasis controls to adjust the wording of next steps. They do not change the yes/no answers, total score, or cut-point.
Interpreting Results:
The most important result is whether the total reaches 2 or more yes answers. A score of 2 to 5 is a positive SCOFF screen and should lead to fuller assessment rather than repeated self-screening. The total does not identify anorexia nervosa, bulimia nervosa, binge eating disorder, avoidant/restrictive food intake disorder, or any other specific diagnosis.
A score of 1 is below the usual cut-point, but the endorsed item can still be important. Vomiting after feeling full and rapid recent weight loss are shown as medical cues because they can deserve prompt review even when the total is only 1. A score of 0 means these five cues were not endorsed on this run, not that eating-disorder concern has been ruled out.
- 2 to 5 yes: positive screen; use the item pattern as notes for fuller clinical assessment.
- 1 yes: below the formal cut-point; read the endorsed item directly, especially if it involves vomiting or rapid weight loss.
- 0 yes: no SCOFF items endorsed; continue to take persistent eating, weight, or body-image distress seriously.
- Medical cue present: do not let the total hide vomiting, rapid weight change, fainting, dehydration, electrolyte concerns, or feeling unsafe.
Technical Details:
SCOFF is a categorical screening instrument. Each item is scored from a yes/no response, with no item weighting, no reverse scoring, and no subscale that changes the formal total. The third item preserves the original one-stone wording, equivalent to about 6.35 kg or 14 lb in 3 months.
The score is a count of endorsed warning signs. That makes the screen quick to apply, but it also compresses very different clinical cues into the same total. A total of 2 can come from food preoccupation plus loss of control, or from vomiting plus rapid weight loss. Those two patterns have the same formal score and can need different follow-up priorities.
Formula Core
Each item value is 1 for Yes and 0 for No. The total score S ranges from 0 to 5, and the usual positive-screen rule is S ≥ 2.
| Scoring part | Rule | Interpretation effect |
|---|---|---|
| Item response | Yes = 1, No = 0 | Every endorsed cue adds one point. |
| Reverse scoring | None | All five questions point in the same risk-signal direction. |
| Total range | 0 to 5 | The number counts how many of the five SCOFF cues were endorsed. |
| Positive cut-point | Total ≥ 2 | The usual boundary for moving toward fuller eating-disorder assessment. |
| Weight-loss threshold | More than 1 stone in 3 months | Preserves the original item, with 1 stone equal to about 6.35 kg or 14 lb. |
Item-level review is part of the technical reading because the same total can hide different patterns. The cue groups shown in the result are explanatory groupings, not formal SCOFF subscores. Behavioral-control cues include vomiting after fullness, loss of control over eating, and food-dominant thinking. Medical cues include vomiting and rapid weight loss. Body-image and preoccupation cues include feeling fat despite being told too thin and food dominating daily life.
| Pattern | Formal screen status | Practical reading |
|---|---|---|
| 0 yes | Below cut-point | Only limited reassurance from these five items. |
| 1 yes | Below cut-point | The total is not positive, but the endorsed cue should still be reviewed. |
| 2 to 5 yes | Positive screen | Supports fuller assessment instead of relying on the screen alone. |
| Vomiting or rapid weight loss endorsed | Not a separate SCOFF band | Raises follow-up urgency because the cue can matter medically. |
Screening accuracy also depends on who is being screened and what comparison standard is used. Evidence reviews have found adequate SCOFF accuracy for detecting eating disorders in adults, with less certain evidence in adolescents, males, and some other populations. That is one reason a completed score should be treated as a structured starting point rather than a final answer.
Responsible Use Note:
SCOFF is a brief screener, not a diagnosis, severity scale, or treatment decision. Clinical guidance warns against using screening tools alone to determine whether someone has an eating disorder. Assessment may need eating history, medical signs, weight trajectory, vital signs, laboratory concerns, mood and anxiety symptoms, self-harm risk, and the person's wider context.
Seek urgent local care when eating-related symptoms are accompanied by fainting, chest pain, severe weakness, dehydration, suspected electrolyte problems, severe restriction, repeated vomiting, signs of organ stress, self-harm risk, or feeling unsafe. For non-urgent concern, bring the score and item pattern to a qualified clinician or eating-disorder service.
Worked Examples:
A positive screen at the boundary. A person answers Yes to loss of control over eating and Yes to food dominating daily life, with the other three answers set to No. The Screen snapshot shows 2/5 and Positive screen. The useful follow-up is fuller assessment, not a conclusion that one specific eating disorder has been diagnosed.
A single medical-priority cue. Another person answers Yes only to losing more than one stone in 3 months. The Screen snapshot shows 1/5, so the formal status is below the 2+ cut-point. The Follow-up lane still points toward sooner check-in because rapid recent weight loss can matter medically.
No endorsed cues with continuing concern. Someone answers No to all five items and sees 0/5. The Response ledger confirms that no SCOFF cues were endorsed. That result does not rule out restrictive eating, binge eating, body-image distress, medical complications, or concerns that need a different assessment.
A missing result after starting. If the Threshold gauge and Cut-point context do not appear, at least one question is still unanswered or the saved response pattern is incomplete. Use the progress label and navigator to find the missing item, answer it, then recheck the Response ledger before copying or exporting a record.
FAQ:
Does 2 or more yes answers mean I have an eating disorder?
No. It means the SCOFF screen is positive and fuller assessment is warranted. Diagnosis depends on a broader clinical review, not the five-item total alone.
Why does a single yes answer still show follow-up notes?
The total may be below the cut-point, but the content of the yes item still matters. Vomiting after fullness or rapid weight loss can deserve prompt discussion even at 1/5.
What is one stone in the weight-loss question?
One stone is about 6.35 kilograms or 14 pounds. The SCOFF item asks about losing more than that amount in a 3-month period.
Why do context and follow-up emphasis not change the score?
Those controls shape the action wording only. The score always comes from the five yes/no answers, and the positive-screen cut-point stays at 2 or more yes answers.
Why is the result missing after I answered some questions?
The result appears only after all five items are answered. Use the progress label or question navigator to find the unanswered item, then complete the screen.
Are my answers private?
Scoring happens in the browser after the page loads, and responses stay there unless you choose to copy, share, or export them. Treat result links, CSV files, and DOCX briefs as sensitive health-related records.
Glossary:
- SCOFF
- A five-question eating-disorder screener using yes/no answers and a 0 to 5 total score.
- Positive screen
- A score that reaches the usual cut-point of 2 or more yes answers.
- Cut-point
- The score boundary used to mark a screen as positive or below threshold.
- Endorsed cue
- A SCOFF item answered yes, which explains what is driving the total.
- One stone
- A weight measure equal to about 6.35 kg or 14 lb.
- Follow-up lane
- A result label that combines the total score, medical cues, and selected use context into next-step wording.
References:
- The SCOFF questionnaire: assessment of a new screening tool for eating disorders, BMJ, 4 December 1999.
- Evidence Summary: Eating Disorders in Adolescents and Adults: Screening, U.S. Preventive Services Task Force, 15 March 2022.
- Eating disorders: recognition and treatment, National Institute for Health and Care Excellence, 23 May 2017.
- Resources about eating disorders, Academy for Eating Disorders.