Eating Attitudes Test-26 (EAT-26)

Abstract

The Eating Attitudes Test-26 (EAT-26) is a widely utilized self-report screening instrument designed to identify the presence of psychological and behavioral markers associated with an elevated risk of developing an eating disorder. The core measure consists of 26 items assessing general eating attitudes, feelings, and symptomatic behaviors. These items are supplemented by five additional behavioral questions (Questions 27–31) that evaluate specific high-risk actions such as binge eating and compensatory behaviors, although these supplemental questions are scored separately from the main scale total.

The EAT-26 is a streamlined version of the original EAT-40 and is suitable for administration across various populations, including adolescents, adults, and specific high-risk groups such as athletes. Its primary function is clinical screening, helping practitioners determine if further, more comprehensive diagnostic evaluation is warranted. The scale organizes symptoms into three distinct factors: Dieting, Bulimia and Food Preoccupation, and Oral Control.

Keywords

Eating Attitudes Test, EAT-26, Eating disorder risk, Screening tool, Anorexia nervosa, Bulimia, Dieting behavior, Food preoccupation, Psychological assessment.

Authors

Garner, D. M., Olmsted, M. P., Bohr, Y., Garfinkel, P. E.

Purpose

The principal purpose of the EAT-26 is to serve as an efficient screening measure for detecting attitudes, feelings, and behaviors that are characteristic of, or predictive of, clinical eating disorders. It is explicitly designed to quantify the severity of these disordered eating patterns, thereby identifying individuals who may require professional intervention or full diagnostic assessment.

The brevity of the 26-item structure makes it highly practical for use in large-scale research studies, primary care settings, and educational environments where rapid preliminary screening is necessary. The scale aims to capture the cognitive and behavioral preoccupation with weight, shape, and control over food intake, which are central features of conditions like Anorexia nervosa and Bulimia nervosa.

Construct

The EAT-26 measures the broad psychological construct of Disordered Eating Attitudes and Behaviors. It focuses not merely on weight status, but on the cognitive and emotional distress surrounding food, weight, and body image. The scale operationalizes this construct through three primary subscales:

• Dieting: Measures pathological avoidance of fattening foods and concern with body shape and weight loss.
• Bulimia and Food Preoccupation: Assesses behaviors indicative of bulimic tendencies, such as binge eating episodes and subsequent compensatory actions (like vomiting or laxative use), along with constant preoccupation with thoughts about food.
• Oral Control: Reflects extreme control over food intake, including slow eating, cutting food into small pieces, and feeling uncomfortable when eating sweets.

Collectively, these factors provide a comprehensive, multidimensional view of the psychological distress and behavioral patterns associated with eating disorders.

Validity

The EAT-26 demonstrates robust empirical validity, established during its development by Garner et al. (1982). The validation study compared scores from 160 female patients diagnosed with Anorexia nervosa against a control sample of 140 healthy females. This differential validation confirms the scale’s ability to discriminate between clinical and non-clinical populations.

Furthermore, the EAT-26 exhibited high concurrent validity, as scores obtained on this abbreviated version were highly predictive of scores achieved on the original, longer 40-item version (EAT-40). This finding supports the notion that the EAT-26 retains the essential measurement properties of its predecessor while offering a more efficient administration format. The scale’s strong psychometric features suggest it is a valid instrument for clinical and research applications, particularly within female samples where it was initially validated.

Reliability

The EAT-26 exhibits high reliability, particularly concerning its internal consistency. Garner et al. (1982) reported strong indices of internal consistency, indicating that the individual items within the scale measure the same underlying construct of disordered eating attitudes. High internal consistency ensures that the various items consistently contribute to the total score, providing a cohesive and dependable measure of risk.

While the original validation primarily focused on internal consistency, subsequent research across diverse populations and cultural settings has generally reaffirmed the EAT-26’s stability and consistency, supporting its continued use as a reliable screening tool in psychological and medical contexts.

Factor Analysis

The factor structure of the EAT-26, derived through factor analysis during its development, partitions the 26 items into three correlated subscales, reflecting distinct dimensions of disordered eating pathology. These factors help researchers and clinicians understand the specific nature of the eating distress experienced by the respondent. The three factors are:

1. Dieting: Focusing on avoidance of high-calorie foods and preoccupation with thinness.
2. Bulimia and Food Preoccupation: Capturing symptoms related to loss of control over eating (binges) and subsequent guilt or thoughts dominated by food.
3. Oral Control: Pertaining to the perceived control over food intake and the behavioral rituals associated with eating.

Although the total score is the primary metric for overall risk, the subscale scores are valuable for providing a nuanced profile of the individual’s specific problematic attitudes and behaviors.

Instrument

Test Type: Self-report screening measure

Format: 26 Likert-style items (6 response options: Always to Never) plus 5 additional behavioral questions with discrete frequency options.

Language Available: English (and widely translated into numerous other languages for international use).

Population Group: Clinical and non-clinical populations.

Age Group: Adolescents and Adults.

Population Details: Originally validated primarily on female samples (both clinical and healthy controls), but commonly used across genders and various risk samples (e.g., athletes).

Test Methodology: Respondents rate the frequency of specific attitudes and behaviors over a defined period (typically the past six months for behavioral questions). Scoring is weighted, with higher frequency responses on pathological items receiving higher scores (3, 2, 1, 0, 0, 0).

Keywords

Psychological screening, Eating disorder assessment, Garner et al. (1982), Bulimia nervosa, Internal consistency, Body image disturbance, Clinical cutoff.

Authors

Author ORCID Identifier: N/A (Information not provided in source content)

Affiliation Email addresses: N/A (Information not provided in source content)

Correspondence Address: N/A (Information not provided in source content)

Permissions & Fee and Test Year

The EAT-26 was developed and published in 1982 by Garner, Olmsted, Bohr, & Garfinkel. The scale is frequently used in research and clinical practice. While often publicly available for non-commercial research and self-assessment, commercial usage or reproduction typically requires permission from the original authors or the publishing journal/institution.

Test Year: 1982 (Publication of EAT-26)

Interpretation and Scoring

The EAT-26 yields a total score based on the 26 primary attitude items. Responses are scored using a weighted system (3, 2, 1, 0, 0, 0, with higher scores assigned to responses indicating greater pathology). The maximum possible score is 78.

• Clinical Threshold: A total score of 20 or above is generally considered to be in the clinical range, suggesting a significant risk for an eating disorder and warranting immediate clinical follow-up.
• Subscale Scores: Scores are also calculated for the three subscales (Dieting, Bulimia and Food Preoccupation, and Oral Control) to provide insight into specific symptom clusters.
• Percentile Comparison: Interpretation often includes comparing the raw score to percentiles derived from the original standardization samples—a healthy female sample (n=140) and an anorexia nervosa patient sample (n=160). A percentile score around 50 when compared to the anorexia nervosa group suggests a high likelihood of suffering from an eating disorder.
• Behavioral Questions: The five supplemental behavioral questions (Q27–Q31) are critical risk indicators but are not included in the calculation of the 26-item total score. These questions assess key diagnostic behaviors (e.g., frequency of binge eating, vomiting, laxative use, excessive exercise, and significant recent weight loss) and must be reviewed separately by a clinician.

Reference’s

Garner, D. M., Olmsted, M. P., Bohr, Y., & Garfinkel, P. E. (1982). The eating attitudes test: Psychometric features and clinical correlates. Psychological Medicine, 12(4), 871-878. doi:10.1017/S0033291700049163.

Items of the Eating Attitudes Test-26 (EAT-26)

IMPORTANT: The following scale items must be preserved in their original language and must not be changed in any way.

Instructions:

This is a screening measure to help you determine whether you might have an eating disorder. Please respond as accurately, honestly and completely as possible. There are no right or wrong answers. All of your responses are confidential.