What does the EAT (Eating Attitudes Test) 26 screen for?

EAT-26 Screening Tool for Eating Disorders

The Eating Attitudes Test-26 (EAT-26) is a validated screening tool designed to identify individuals at risk for eating disorders, including anorexia nervosa, bulimia nervosa, and other disordered eating patterns. 1

Purpose and Clinical Utility

• EAT-26 screens for symptoms and concerns characteristic of eating disorders, serving as an early detection tool for disordered eating behaviors and attitudes 2
• The test functions as a first-line screening instrument that can prompt further clinical evaluation when scores exceed established thresholds 3
• Originally developed from the longer 40-item version (EAT-40), the EAT-26 maintains high correlation (r=0.98) with the original test while being more economical to administer 2

Structure and Scoring

• The EAT-26 consists of 26 self-rated items measuring various symptoms and concerns related to eating disorders 4
• Items are scored on a 6-point Likert scale, though research indicates this rating scale may not function optimally 4
• The traditional cut-off score is 20, though optimal thresholds may vary by population 3
• Recent research in Japan found an optimal cut-off score of 17, highlighting the need for culturally-specific validation 3
• In some populations, a cut-off score as low as 11 has demonstrated excellent sensitivity (100%) and good specificity (85.6%) 5

Factor Structure

• The EAT-26 contains three main factors that form meaningful subscales 2:
  • Dieting (related to avoidance of fattening foods and preoccupation with thinness)
  • Bulimia and food preoccupation (related to thoughts about food and bulimic behaviors)
  • Oral control (related to self-control around food and perceived pressure from others to gain weight) 2, 6
• Factor structure may differ between clinical and non-clinical populations 6

Clinical Applications

• The American Psychiatric Association recommends screening for eating disorders as part of initial psychiatric evaluations 1
• EAT-26 can be used alongside other assessment methods, including:
  • Evaluation of weight history and changes
  • Assessment of restrictive eating, food avoidance, and binge eating
  • Evaluation of compensatory behaviors (purging, excessive exercise)
  • Measurement of preoccupation with food, weight, and body shape 1

Limitations and Considerations

• The EAT-26 appears biased toward detecting moderate to high levels of eating disorder risk and may not adequately identify individuals at low risk 4
• Performance may vary based on BMI status, with some items functioning differently between individuals with and without obesity 4
• While the test does not show differential functioning based on sex, cultural factors may influence optimal cut-off scores 3, 4
• A positive screen requires follow-up clinical evaluation, as the EAT-26 alone cannot establish a diagnosis 1

Integration with Clinical Practice

• When a patient screens positive on the EAT-26, clinicians should conduct a comprehensive evaluation including medical, nutritional, and psychological assessments 1
• For patients with diabetes, the EAT-26 can help identify disordered eating that may complicate diabetes management 1
• Regular screening with validated tools like the EAT-26 is particularly important in high-risk populations, such as adolescents and young adults 1

The EAT-26 remains one of the most widely used screening tools for eating disorders, offering clinicians a validated method to identify patients who may require further assessment and intervention for disordered eating behaviors.