Eating Attitudes Test (EAT-26)

Abstract

The Eating Attitudes Test (EAT-26) is a widely utilized and standardized self-report measure consisting of 26 items, designed to evaluate the symptoms, attitudes, and behaviors characteristic of disordered eating. Developed in 1982 by Garner, Olmstedt, Bohr, and Garfinkel, the EAT-26 represents a psychometrically refined, shortened version of the original 40-item EAT scale (EAT-40). Its primary function is to serve as a high-efficiency screening tool, applicable across both clinical and non-clinical populations, including adolescents and adults. The EAT-26 aids in identifying individuals who may be at elevated risk for developing a clinical eating disorder, such as anorexia nervosa or bulimia nervosa, thereby necessitating further diagnostic assessment.

Keywords

Eating Attitudes Test, EAT-26, disordered eating, eating disorder screening, anorexia, bulimia, psychological assessment, self-report measure, oral control, dieting, psychometrics.

Authors

David M. Garner, Marion P. Olmstedt, Yona Bohr, Paul E. Garfinkel.

Purpose

The central objective of the EAT-26 is to function as an efficient and standardized screening tool capable of detecting significant psychological concerns and behaviors indicative of an underlying eating disorder, particularly within non-clinical or high-risk demographics. It is crucial to note that while the EAT-26 is highly sensitive in identifying risk, it is expressly not designed to provide a formal psychiatric diagnosis.

Instead, scores meeting or exceeding the established clinical cutoff (a total score of 20 or more) mandate a subsequent, comprehensive diagnostic interview conducted by a licensed professional. This follow-up interview determines whether the individual meets established diagnostic criteria. The scale is exceptionally useful for large-scale screening efforts in diverse groups, such as school, college, and athletic populations, facilitating the early identification of pathology characteristics related to conditions like anorexia and bulimia. Furthermore, it supports research into the prevalence and characteristics of disordered eating attitudes across varied global and demographic samples.

Construct

The EAT-26 is structured to measure psychological and behavioral characteristics that are strongly associated with clinical eating disorders. Despite being significantly shorter than the original EAT-40, the scale successfully maintains the three primary factors derived from the initial conceptualization of disordered eating attitudes at the time of its development. These factors represent distinct, yet often interrelated, dimensions of pathological eating behaviors and body image concerns.

The three original factors measured by the scale are:

• Dieting: This factor includes items related to the pathological avoidance of high-calorie foods and an intense preoccupation with maintaining thinness or losing weight.
• Bulimia and Food Preoccupation: This dimension assesses behaviors and cognitions associated with binge eating episodes, subsequent feelings of guilt, and compensatory behaviors, such as self-induced vomiting.
• Oral Control: Items within this factor pertain to an individual’s perceived self-control over their eating habits and their reaction to perceived external pressure from others concerning weight gain or food intake. This factor specifically addresses the management of eating behaviors in response to internal and social stressors.

Validity

The EAT-26 has demonstrated robust psychometric properties, particularly strong concurrent validity. In validation studies, the scale correlated highly with its predecessor, the EAT-40 (r = 0.98), confirming that the refined 26-item version effectively captures the same underlying psychological construct as the longer measure. This high correlation solidifies its position as a reliable and effective substitute for the original scale in clinical and research settings.

Extensive validation efforts have been conducted globally, confirming the instrument’s robustness across diverse cultural and demographic backgrounds, including populations in Eastern and Western Europe, South America, the Middle East, and Asia (Garfinkel and Newman, 2001). While the EAT-26 remains a cornerstone in research due to its utility in differentiating between individuals with and without clinical eating disturbances, researchers must be aware of challenges regarding its internal structure. Some studies suggest that the scale’s factors may represent multiple theoretical constructs, particularly when applied to non-clinical populations, which necessitates careful consideration of its evolving psychometric properties (Ocker et al., 2007).

Reliability

The reliability of the EAT-26 is generally considered high, particularly concerning its internal consistency. In the original validation studies (Garner et al., 1982), individuals diagnosed with anorexia nervosa (AN group) showed a robust internal consistency, with a Cronbach’s alpha reported at 0.90. This indicates excellent cohesion among the items, a desirable feature maintained despite the substantial reduction in item count from the EAT-40.

The scale’s test-retest reliability, which measures the stability of scores across different time points, has also been confirmed, with coefficients generally ranging from 0.84 to 0.89 (Banasiak et al., 2001). However, some contemporary research published since 2005 has reported lower reliability coefficients. This variance suggests that the scale’s performance may be sensitive to changes in societal attitudes toward food, exercise, and body image since the EAT’s original development, emphasizing the need for temporal context when interpreting scores derived from modern samples.

Factor Analysis

The initial factor analysis conducted by Garner et al. (1983) established the three-factor structure for the EAT-26: Dieting, Bulimia and Food Preoccupation, and Oral Control. This structure provided the essential theoretical framework for score interpretation and understanding the multi-dimensionality of the scale in clinical populations.

However, subsequent cross-cultural and non-clinical research has frequently reported inconsistent findings regarding the factorial structure. Studies have documented difficulties in consistently replicating the original three-factor model, with some analyses supporting the original structure while others have identified four or more distinct factors (Periera et al., 2008; Ocker et al., 2007). A significant concern arising from these varied factor analyses, especially when conducted in non-clinical settings, is the potential for the EAT factors to conflate multiple theoretical constructs within a single dimension, which may complicate the precise measurement of specific eating disorder components outside of strictly clinical samples.

Instrument

Test Type: Standardized Self-Report Screening Measure

Format: The scale comprises 26 items scored on a 6-point Likert-type scale, ranging from 1=Always to 6=Never. Specific scoring rules are applied, requiring certain items to be reverse-scored to maintain consistency in interpretation.

Language Available: The EAT-26 has been extensively translated and validated globally, with versions available in languages including Spanish and Portuguese, among many others.

Population Group: Clinical and Non-Clinical populations.

Age Group: Adolescents and Adults. A specialized version, the ch-EAT, has also been developed for use with children aged 8 to 13.

Population Details: The instrument is particularly effective for mass screening in high-risk groups, such as athletes, school populations, and college students, as well as for epidemiological research utilizing general population samples.

Test Methodology: The scale generates a “referral index” based on three distinct criteria. A referral for a professional diagnostic interview is recommended if the respondent meets the cutoff criteria on any one of these three sections:

1. The total score derived from the EAT-26 questions (a score of 20 or more suggests significant risk).
2. Responses to specific behavioral questions concerning established eating symptoms and weight loss behaviors.
3. The individual’s calculated Body Mass Index (BMI), based on reported height and weight.

Keywords

Psychological assessment, psychometrics, internal consistency, test-retest reliability, factor structure, screening tool, BMI, Garner, self-report, validity, bulimia.

Authors

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

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

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

Permissions & Fee and Test Year

The EAT-26 was published in 1982 as a refinement of the original EAT-40, which was published in 1979. The scale, along with associated scoring and interpretation guidelines, is frequently made freely available for both research and clinical screening purposes. Access to the scale is provided online via the official website: http://www.eat-26.com/. The original PDF can be downloaded here: http://ses.library.usyd.edu.au/bitstream/2123/4026/1/j-swinbourne-thesis.pdf.

Reference’s

• Garner DM & Garfinkel PE. The eating attitudes test: An index of the symptoms of anorexia nervosa. Psychological Medicine. 1979; 9: 273-279.
• Garner, D., Olmsted, M. P., Bohr, Y., & Garfinkel, P. E. (1982). The Eating Attitudes Test: Psychometric features and clinical correlates. Psychological Medicine, 12(4), 871-878.
• Garner, D. (2009). EAT-26 Self-Test. Retrieved from http://www.eat-26.com/index.php.
• Garfinkel, P. & Newman, A. (2001). The Eating Attitudes Test: Twenty-five years later. Eating and Weight Disorders — Studies on Anorexia, Bulimia and Obesity, 6(1), 1–21. http://dx.doi.org/10.1007/BF03339747.
• Gleaves, D. H., Pearson, C. A., Ambwani, S., &Morey, L. C. (2014). Measuring eating disorder attitudes and behaviors: A reliability generalization study. Journal of Eating Disorders, 2(6), 1-12. doi: 10.1186/2050-2974-2-6.
• Maloney, M.J., McGuire, J.B., Daniels, S.R. (1988). Reliability testing of a children’s version of the Eating Attitude Test. Journal of the American Academy of Children and Adolescent Psychiatry, 27, 541–543.
• Ocker, L.B., Lam, E., Jensen, B. E., Zhang, J.J. (2007). Psychometric properties of the Eating Attitudes Test. Measurement in Physical Education and Exercise Science, 11(1), 25-48.
• Pereira, A. T., Maia, B., Bos, S., Soares, M. J., Macques, M., & Macedo, A., et al. (2008). The Portuguese short form of the Eating Attitudes Test-40. European Eating Disorders Review,16, 319-325.
• Rivas, T., Bersabe, R., Jimenez, M., & Berrocal, C. (2010). The Eating Attitudes Test (EAT-26): Reliability and validity in Spanish Female Samples. The Spanish Journal of Psychology, 13(2), 1044-1056.

Items of the Eating Attitudes Test (EAT-26)

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

1=Always‚ 2= Very Often‚ 3=Often‚ 4= Sometimes‚ 5= Rarely‚ 6= Never

1. I Am terrified about being overweight.
2. I Avoid eating when I am hungry.
3. I Find myself preoccupied with food.
4. I Have gone on eating binges where I feel that I may not be able to stop.
5. I Cut my food into small pieces.
6. I Aware of the calorie content of foods that I eat.
7. I Particularly avoid food with a high carbohydrate content (i.e. bread‚ rice‚ potatoes‚ etc.)
8. I Feel that others would prefer if I ate more.
9. I Vomit after I have eaten.
10. I Feel extremely guilty after eating.
11. I Am occupied with a desire to be thinner.
12. I Think about burning up calories when I exercise.
13. I Other people think that I am too thin.
14. I Am preoccupied with the thought of ha‎ving fat on my body.
15. I Take longer than others to eat my meals.
16. I Avoid foods with sugar in them.
17. I Eat diet foods.
18. I Feel that food controls my life.
19. I Display self-control around food.
20. I Feel that others pressure me to eat.
21. I Give too much time and thought to food.
22. I Feel uncomfortable after eating sweets.
23. I Engage in dieting behavior.
24. I Like my stomach to be empty.
25. I Have the impulse to vomit after meals.
26. I Enjoy trying new rich foods.