What is the EAT-26 (Eating Attitudes Test-26) form?

The EAT-26 (Eating Attitudes Test-26) Form

The EAT-26 is a standardized self-report screening tool used to identify individuals at risk for eating disorders by measuring symptoms and concerns characteristic of eating disorders. 1

Purpose and Development

The EAT-26 is an abbreviated version of the original 40-item Eating Attitudes Test (EAT-40), developed through factor analysis to provide a more economical assessment tool while maintaining high correlation (r = 0.98) with the original version. 1 It serves as an objective measure to identify individuals who may require further clinical evaluation for eating disorders.

Structure and Scoring

The EAT-26 consists of 26 questions that assess:

• Dieting behaviors
• Bulimia and food preoccupation
• Oral control

These three factors form subscales that relate to:

• Bulimic behaviors
• Weight concerns
• Body image issues
• Psychological symptoms associated with eating disorders 1

Scoring uses a 6-point Likert-type scale, with scores ≥20 traditionally indicating elevated risk for an eating disorder. However, optimal cut-off scores may vary by population:

• In Japan, a cut-off score of 17 has been identified as optimal with sensitivity and specificity values of 0.866 and 0.868, respectively 2
• For obese patients attending nutritional services, a lower cut-off of 11 has been suggested to improve diagnostic accuracy 3

Clinical Applications

The EAT-26 is widely used in various settings:

1. Clinical screening: Helps identify individuals who may need comprehensive evaluation for eating disorders

2. Research: Used in epidemiological studies to assess prevalence of eating disorder risk

3. School-based screening: Employed in educational settings to identify adolescents at risk for eating disorders 4

4. Treatment monitoring: Can track changes in eating attitudes during treatment

Limitations and Considerations

Recent psychometric evaluation using Rasch analysis has identified several concerns with the EAT-26:

• The test appears biased toward detecting moderate to high levels of eating disorder risk but may not adequately identify those with low risk
• Seven items showed misfit in statistical analysis
• The six-category rating scale did not function optimally
• Five items functioned differently based on obesity status, though no items showed differential functioning based on sex 5

Integration with Comprehensive Assessment

The EAT-26 should be part of a broader assessment approach that includes:

• Medical evaluation including vital signs, height, weight, BMI assessment
• Laboratory tests (complete blood count, comprehensive metabolic panel)
• Cardiac evaluation with ECG when indicated
• Psychological assessment for comorbidities 6

For a comprehensive nutritional assessment in patients with suspected eating disorders, the EAT-26 should be complemented with evaluation of:

• Current eating patterns
• Food restrictions and rules
• Compensatory behaviors
• Weight history
• Body image concerns
• Menstrual history in females
• Bone health 7

Clinical Significance

Early identification of eating disorders is crucial as they can lead to serious medical complications affecting multiple organ systems, including cardiovascular, gastrointestinal, metabolic, and hematologic systems. 6 The EAT-26 provides a valuable first-line screening tool that can facilitate timely intervention and potentially reduce morbidity and mortality associated with eating disorders.