The Eating Attitudes Test, created by David Garner, is a widely used self-reportquestionnaire 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 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.
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 ofthe 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 thediagnostic 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 . Instructions and scoring information can be obtained from the EAT-26 website for no charge.
Limitations
The EAT suffers from the same problems as other self-report inventories, in that scores can be easily exaggerated or minimized by the person completing them. Like all questionnaires, the way the instrument is administered can have an effect on the final score. If a patient is asked to fill out the form in front of other people in a clinical environment, for instance, social expectations have been shown to elicit a different response compared to administration via a postal survey. There are some general concerns with the EAT-26. First, varied symptoms of eating disorders and self-report instruments like the EAT measure symptoms only at that particular point in time. Therefore, considerable fluctuation is possible in some aspects of the eating disorder. Additionally, as it occurs with self-report measures generally, high scores on the EAT is typically influenced by a person's attitude. For example, a person might disclose less about their problems in order to be more socially desirable. The EAT has low positive predictive value because of denial and social desirability, as well as the possible confounding role of co-morbid factors.
