# Evidence-based assessment/Instruments/Eating Attitudes Test

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The Eating Attitudes Test (EAT, EAT-26), created by David Garner, is a widely used self-report questionnaire 26-item standardized self-report measure of symptoms and concerns characteristic of eating disorders. The EAT has been a particularly useful screening tool to assess "eating disorder risk" in high school, college and other special risk samples such as athletes. Screening for eating disorders is based on the assumption that early identification can lead to earlier treatment, thereby reducing serious physical and psychological complications or even death. Furthermore, EAT has been extremely effective in screening for anorexia nervosa in many populations.
The EAT-26 can be used in a non-clinical as well as a clinical setting not specifically focused on eating disorders. It can be administered in group or individual settings and is designed to be administered by mental health professionals, school counselors, coaches, camp counselors, and others with interest in gathering information to determine if an individual should be referred to a specialist for evaluation for an eating disorder. It is ideally suited for school settings, athletic programs, fitness centers, infertility clinics, pediatric practices, general practice settings, and outpatient psychiatric departments. It is designed for adolescents and adults.
The EAT-26 is rated on a six-point scale based on how often the individual engages in specific behaviors. The questions may be answered: Always, Usually, Often, Sometimes, Rarely, and Never. Completing the EAT-26 yields a "referral index" based on three criteria: 1) the total score based on the answers to the EAT-26 questions; 2) answers to the behavioral questions related to eating symptoms and weight loss, and 3) the individual’s body mass index (BMI) calculated from their height and weight. Generally a referral is recommended if a respondent scores "positively" or meets the "cut off" scores or threshold on one or more criteria.

## Psychometrics
### Reliability

The internal consistency reliability of the Eating Attitudes Test is good. Data from David Garner and Paul Garfinkel produced alpha coefficients of 0.79 for the anorexia nervosa subjects and 0.94 for the pooled sample.

### Validity

According to a research study on the instrument by David Garner and Paul Garfinkel, the total EAT score significantly correlated with criterion group membership (r = 0.87, p < 0.001), suggesting a high level of concurrent validity.

## Development and history

The EAT was developed in response to a National Institute of Mental Health consensus panel that recognized a need for screening large populations to increase early identification of anorexia related symptoms. Additionally, the NIMH wanted a measure that could be used to examine the social and cultural factors involved in the development and maintenance of eating disorders. The original version of the EAT was published in 1979, with 40 items each rated on a 6-point likert scale. In 1982, Garner and colleagues modified the original version to create an abbreviated 26-item test. The items were reduced after a factor analysis on the original 40-item data set revealed there to be only 26 independent items. Since that time, the EAT has been translated into many different languages and has gained widespread international as a tool to screen for eating disorders. Both the original paper and the subsequent 1982 publication are 3rd and 4th on the list of the 10 most cited articles in the history of the journal Psychological Medicine a prominent peer-reviewed journal in the fields of psychology and psychiatry.
The EAT-26 should be used as the first step in a two-stage screening process. Accordingly, individuals who score higher than a 20 should be referred to a qualified professional to determine if they meet the diagnostic criteria for an eating disorder. The EAT-26 is not designed to make a diagnosis of an eating disorder and should not be used in place of a professional diagnosis or consultation. The EAT should only be used as a screener for general eating disorders, as research has not shown it to be a valid instrument in making specific diagnoses.
Permission to use the EAT-40 or EAT-26 can be obtained from David Garner through the EAT-26 website or the River Centre Clinic [ [3]]. Instructions and scoring information can be obtained from the EAT-26 website for no charge.

## Impact

* This assessment is useful in evaluating a range of target behaviors found in Anorexia Nervosa. Clinicians are able to use this assessment and get results in a timely manner. W

## Use in other populations

* It has been used in various parts in China (ex: Shenzen, Hong Kong, and Hunan) and in Mexico.
* There is a translation of the EAT-40 in Spanish.
* There is also a translation of the EAT in Zulu.
* There was also a study done for children.

## Scoring and Interpretation

There are three parts to this 26 question test, each part assessing a different dimension of the respondent's attitude towards eating. Part A deals with age, weight, and other physical attributes of the respondent. Part B screens for the respondent's attitude towards their height, weight, and shape. Part C asks about behavioral tendencies of the respondent over the past six months. It is important to note that results from EAT-26 should not take the place of an expert medical opinion.

### Scoring

A respondent's score is often used in addition to the BMI norms for their age. The responses for Part A are also taken into consideration.
Dieting scale items: 1, 6, 7, 10, 11, 12, 14, 16, 17, 22, 23, 24, and 26
Bulimia and food preoccupation scale: 3, 4, 9, 18, 21, and 25
Oral Control Scale: 2, 5, 8, 13, 15, 19, and 20
The sum of questions 1-26 yield the total score.
Always: 3 points
Usually: 2 points
Often: 1 point
Sometimes, Rarely, Never: 0 points
Question 26 scored as
Always, usually, often: 0points
Sometimes: 1 point
Rarely: 2 points
Never: 3 points
The behavioral questions are scored as follows:
2-3 times a month for question A: positive screen
Once a month or less for question B and C: positive screen
Once a day or more for question D: positive screen
Yes for question E: positive screen

### Interpretation

A score of 20 or more on questions 1-26 suggests a high risk for an eating disorder. It is recommended that the respondent be referred to a professional for further diagnosis. Any behavioral question that yields a "positive screen" indicates that the respondent should seek evaluation from a professional.