The Eating Attitudes Test (EAT-26): Psychometric Characteristics and Factor Structure in Nonclinical Sample of 876 Female University Students

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Abstract

The Eating Attitudes Test (EAT-26) is widely used all over the world, including Russia, for screening eating disorders, however, the psychometric characteristics and factorial structure of the questionnaire have not yet been studied on Russian non-clinical samples. This study involved 876 female students aged 17–26 (M=20.11±1.79) from three cities (Moscow, Ryazan, and Arkhangelsk). All respondents were asked to fill out an adapted Russian version of EAT-26. To assess the retest reliability, 48 students from Ryazan filled out the questionnaire twice with an interval of one month. To assess construct validity, 293 female students from Ryazan filled out the Body Appreciation Scale (BAS) to assess a positive attitude towards the body, 281 students from Arkhangelsk filled out the Hospital Anxiety and Depression Scale (HADS). As a result, descriptive statistics of the total score and responses to individual items of EAT-26 were obtained. In accordance with the critical value of EAT-26 (≥20), the risk group for eating disorders included 13.5% of the respondents. The high internal consistency (Cronbach's alpha — 0.883) and retest reliability (r=0.865) of the EAT-26 total were shown. The confirmatory factor analyses failed to confirm the three-factor structure originally proposed by the authors of the questionnaire. Confirmatory factor analysis confirmed a five-factor model (χ2=226.584, df=81, p<10-6, CFI=0.970, RMSEA=0.046, 90% CI [0.038; 0.052] with 15 items included (EAT-15), which has high rates of internal consistency and retest reliability (Cronbach's alpha — 0.840; r=0.861). Psychometric characteristics and indicators of reliability and validity of EAT-26, EAT-15, and the five selected scales are given.

General Information

Keywords: eating disorders, EAT-26, Russian non-clinical population, female students, screening, diagnostics, psychometrics, factor analysis

Journal rubric: Diagnosis of Personality Disorders and Conditions

Article type: scientific article

DOI: https://doi.org/10.17759/cpse.2023120104

Received: 09.11.2022

Accepted:

For citation: Meshkova T.A., Mitina O.V., Shelygin K.V., Aleksandrova R.V., Nikolaeva N.O. The Eating Attitudes Test (EAT-26): Psychometric Characteristics and Factor Structure in Nonclinical Sample of 876 Female University Students [Elektronnyi resurs]. Klinicheskaia i spetsial'naia psikhologiia = Clinical Psychology and Special Education, 2023. Vol. 12, no. 1, pp. 66–103. DOI: 10.17759/cpse.2023120104. (In Russ., аbstr. in Engl.)

References

  1. Altukhova N.Yu., Bryukhin A.E., Demenina S.N. Skriningovyi metod diagnostiki rasstroistv pishchevogo povedeniya pri pomoshchi ispol'zovaniya testa EAT-26 [Screening method for the diagnosis of eating disorders using the EAT-26 test]. In N.G. Neznanov et al. (eds.), «Zhenskoe psikhicheskoe zdorov'e: mezhdistsiplinarnyi status»: materialy Vserossiiskogo nauchno-prakticheskogo kongressa s mezhdunarodnym uchastiem, posvyashchennogo 100-letiyu kafedry psikhiatrii Pervogo Sankt-Peterburgskogo gosudarstvennogo meditsinskogo universiteta im. akad. I.P. Pavlova = Proceedings of the Russian Scientific and Practical Congress with international participation dedicated to the 100th anniversary of the Department of Psychiatry of the I.P. Pavlov First St. Petersburg State Medical University. "Women's mental health: Interdisciplinary status", Saint-Petersburg: Al'ta Astra Publ., 2018, pp. 8–9. URL: https://psychiatr.ru/download/3826?view=1&name=18-10-08_WPH_abstr.pdf (Accessed: 11.03.2023). (In Russ.).
  2. Andryushchenko A.V., Drobizhev M.Yu., Dobrovol’skii A.V. Sravnitel’naya otsenka shkal CES-D, BDI i HADS v diagnostike depressii v obshchemeditsinskoi praktike [Comparative evaluation of CES-D, BDI and HADS scales in the diagnosis of depression in general medical practice]. Zhurnal Nevrologii i Psikhiatrii im. Korsakova = Korsakov Journal of Neurology and Psychiatry, 2003, no. 5, pp. 11–18. (In Russ.).
  3. Kelina M.Yu., Marenova E.V., Meshkova T.A. Neudovletvorennost' telom i vliyanie roditelei i sverstnikov kak faktory riska narushenii pishchevogo povedeniya sredi devushek podrostkovogo i yunosheskogo vozrasta [Body dissatisfaction and influence of parents and peers as risk factors for eating disorders among girls of adolescent and young age]. Psikhologicheskaya nauka i obrazovanie = Psychological Science and Education, 2011, vol. 16, no 5, pp. 44–51. (In Russ., abstr. in Engl.).
  4. Kibitov A.A., Kasyanov E.D., Rukavishnikov G.V. et al. Semeinaya otyagoshchennost' rasstroistvami nastroeniya assotsiirovana s vyrazhennost'yu angedonii i simptomov rasstroistv pishchevogo povedeniya u patsientov s depressiei [Family history of mood disorders is associated with the severity of anhedonia and eating disorders symptoms in patients with depression]. Sotsial'naya i klinicheskaya psikhiatriya = Social and Clinical Psychiatry, 2022, no. 2, pp. 5–11. URL: https://cyberleninka.ru/article/n/semeynaya-otyagoschennost-rasstroystvami-nastroeniya-assotsiirovana-s-vyrazhennostyu-angedonii-i-simptomov-rasstroystv-pischevogo (Accessed 11.03.2022). (In Russ. in Engl.).
  5. Meshkova T.A., Nikolaeva N.O. Opyt primeneniya testa pishchevykh attityudov (EAT-26) na vyborke studentok Moskvy [Eating Attitude Test (EAT-26) on a sample of students in Moscow]. Psikhiatriya = Psychiatry (Moscow), 2017, no. 73 (01), pp. 34–41. (In Russ., abstr. in Engl.).
  6. Mitina O.V. Osnovnye idei i printsipy strukturnogo modelirovaniya [Basic ideas and principles of structural modeling]. In B.S. Bratus', E.E. Sokolova (eds.), Uchenye zapiski kafedry obshchei psikhologii MGU imeni M.V. Lomonosova = Scientific notes of the Department of General Psychology of Lomonosov Moscow State University. Moscow: Smysl, 2006. Issue 2, pp. 272–296. (In Russ.).
  7. Nikolaeva N.O., Kukina A.A. Neudovletvorennost' svoim telom kak faktor riska narushenii pishchevogo povedeniya [Body dissatisfaction as a risk factor for eating disorders]. «Korrektsiya i profilaktika narushenii povedeniya u detei s ogranichennymi vozmozhnostyami zdorov'ya». Materialy I Vserossiiskoi nauchno-prakticheskoi konferentsii = Proceedings of the First Russian Scientific and Practical Conference «Correction and prevention of behavioral disorders in children with disabilities», October 17–18, 2011. Moscow, MSUPE, 2011. (In Russ.)
  8. Shloido D.E., Grandilevskaya I.V. Individual'no-psikhologicheskie osobennosti studentov s narusheniyami pishchevogo povedeniya [Psychological Features of Students with Disordered Eating Behaviors]. Peterburgskii psikhologicheskii zhurnal = Peterburgskij psihologičeskij žurnal, 2020, no. 30, pp. 138–166. (In Russ., abstr. in Engl.).
  9. Ahmadi S., Moloodi R., Zarbaksh M.R. et al. Psychometric properties of the Eating Attitude Test-26 for female Iranian students. Eating and Weight Disorders, 2014, vol. 19, pp. 183–189. DOI: 10.1007/s40519-014-0106-7
  10. Alhaj O.A., Fekih-Romdhane F., Sweidan D.H. et al. The prevalence and risk factors of screen-based disordered eating among university students: A global systematic review, meta-analysis, and meta-regression. Eating and Weight Disorders, 2022, vol. 27, pp. 3215–3243. DOI: 10.1007/s40519-022-01452-0
  11. Ambrosi-Randić N., Pokrajac-Bulian A. Psychometric properties of the eating attitudes test and children’s eating attitudes test in Croatia. Eating and Weight Disorders, 2005, vol. 10, e76–e82. DOI: 10.1007/BF03327495.
  12. Avalos L., Tylka T.L., Wood-Barcalow N. The Body Appreciation Scale: Development and psychometric evaluation. Body Image, 2005, vol. 2, pp. 285–297. DOI: 10.1016/j.bodyim.2005.06.002
  13. Ayala C.O., Scarpatto C., Garizábalo-Davila C.M. et al. Assessing eating disorder symptoms in low and middle-income countries: A systematic review of psychometric studies of commonly used instruments. Journal of Eating Disorders, 2022, vol. 10, article 124. DOI: 10.1186/s40337-022-00649-z
  14. Azzeh M., Peachey G., Loney T. Prevalence of high-risk disordered eating amongst adolescents and young adults in the Middle East: A scoping review. International Journal of Environmental Research and Public Health, 2022, vol. 19, article 5234. DOI: 10.3390/ ijerph19095234
  15. Doninger G., Enders C., Burnett K. Validity evidence for Eating Attitudes Test scores in a sample of female college athletes. Measurement in Physical Education and Exercise Science, 2005, vol. 9, no. 1, pp. 35–49. DOI: 10.1207/s15327841mpee0901_3
  16. Douka A., Grammatopoulou E., Skordilis E. et al. Factor analysis and cut-off score of the 26-item eating attitudes test in a Greek sample. Journal Biology of Exercise, 2009, vol. 5, no. 1, pp. 51–67. DOI: 10.4127/jbe.2009.0025
  17. Elran-Barak R., Goldschmidt A.B. Differences in severity of eating disorder symptoms between adults with depression and adults with anxiety. Eating and Weight Disorders, 2021, 26, pp. 1409–1416. DOI: 10.1007/s40519-020-00947-y
  18. Ernst M., Werner A.M., Tibubos A.N. et al. Gender-dependent associations of anxiety and depression symptoms with eating disorder psychopathology in a representative population sample. Frontiers in Psychiatry, 2021, vol. 12, article 645654. DOI: 10.3389/fpsyt.2021.645654
  19. Fekih-Romdhane F., Daher-Nashif S., Alhuwailah A.H. et al. The prevalence of feeding and eating disorders symptomology in medical students: An updated systematic review, meta-analysis, and meta-regression. Eating and Weight Disorders, 2022, vol. 27, no. 6, pp. 1991–2010. DOI: 10.1007/s40519-021-01351-w
  20. Fekih-Romdhane F., Obeid S., Malaeb D. et al. Validation of a shortened version of the Eating Attitude Test (EAT-7) in the Arabic language. Journal of Eating Disorders, 2022, v 10, article 127. DOI: 10.1186/s40337-022-00651-5
  21. Fornell C., Larcker D.F. Evaluating structural equation models with unobservable variables and measurement error. Journal of Marketing Research, 1981, v 18, no. 1, pp. 39–50. DOI: 10.1177/002224378101800104
  22. Garfinkel P., Newman A. The eating attitudes test: Twenty-five years later. Eating and Weight Disorders, 2001, vol. 6, no. 1, pp. 1–21. DOI: 10.1007/BF03339747
  23. Garner D.M., Garfinkel P.E. The eating attitudes test: An index of the symptoms of anorexia nervosa. Psychological Medicine, 1979, vol. 9, no. 2, pp. 273–279. DOI: 10.1017/S0033291700030762
  24. Garner D.M., Olmsted M., Bohr Y. et al. The Eating Attitude Test: Psychometric features and clinical correlates, Psychological Medicine, 1982, vol. 12, no. 4, pp. 871–878. DOI: 10.1017/S0033291700049163
  25. Gleaves D.H., Pearson C.A., Ambwani S. et al. Measuring eating disorder attitudes and behaviors: a reliability generalization study. Journal of Eating Disorders, 2014, vol. 2, article 6. DOI: 10.1186/2050-2974-2-6
  26. Goldschmidt A.B., Wall M.M., Loth K.A. et al. Risk factors for disordered eating in overweight adolescents and young adults. Journal of Pediatric Psychology, 2015, vol. 40, no. 10, pp. 1048–1055. DOI: 10.1093/jpepsy/jsv053
  27. Gorrasi I.S.R., Ferraris C., Degan R. et al. Use of online and paper-and-pencil questionnaires to assess the distribution of orthorexia nervosa, muscle dysmorphia and eating disorders among university students: Can different approaches lead to different results? Eating and Weight Disorders, 2022, v 27, pp. 989–999. DOI:10.1007/s40519-021-01231-3
  28. Hoteit M., Mohsen H., Bookari K. et al. Prevalence, correlates, and gender disparities related to eating disordered behaviors among health science students and healthcare practitioners in Lebanon: Findings of a national cross sectional study. Frontiers in Nutrition, 2022, vol. 9, article 956310. DOI: 10.3389/fnut.2022.956310
  29. Jahrami H., Saif Z., Faris M.A. et al. The relationship between risk of eating disorders, age, gender and body mass index in medical students: A meta-regression. Eating and Weight Disorders, 2019, vol. 24, pp. 169–177. DOI: 10.1007/s40519-018-0618-7
  30. Jacobi C., Hayward C., de Zwaan M. et al. Coming to terms with risk factors for eating disorders: Application of risk terminology and suggestions for a general taxonomy. Psychological Bulletin, 2004, vol. 130, pp. 19–65. DOI: 10.1037/0033-2909.130.1.19
  31. Kang Q., Chan R.C.K., Li X. et al. Psychometric properties of the Chinese version of the eating attitudes test in young female patients with eating disorders in Mainland China. European Eating Disorders Review, 2017, vol. 25, no. 6, pp. 613–617. DOI: 10.1002/erv.2560
  32. Khaled S.M., Kimmel L., Le Trung K. Assessing the factor structure and measurement invariance of the eating attitude test (EAT-26) across language and BMI in young Arab women. Journal of Eating Disorders, 2018, vol. 6, article 14. DOI: 10.1186/s40337-018-0199-x
  33. Koslowsky M., Scheinberg Z., Bleich A. et al. The factor structure and criterion validity of the short form of the Eating Attitudes Test. Journal of Personality Assessment, 1992, vol. 58, no. 1, pp. 27–35. DOI: 10.1207/s15327752jpa5801_3
  34. Maïano C., Morin A.J.S., Lanfranchi M.C. et al. The Eating Attitudes Test-26 Revisited using exploratory structural equation modeling. Journal of Abnormal Child Psychology, 2013, v 41, pp. 775–788. DOI: 10.1007/s10802-013-9718-z
  35. Matusik A., Grajek M., Szlacheta P. et al. Comparison of the prevalence of eating disorders among dietetics students and students of other fields of study at selected universities (Silesia, Poland). Nutrients, 2022, vol. 14, article 3210. DOI: 10.3390/nu14153210
  36. Mazzeo S.E., Bulik C.M. Environmental and genetic risk factors for eating disorders: What the clinician needs to know. Child and Adolescent Psychiatric Clinics of North America, 2009, vol. 18, pp. 67–82. DOI: 10.1016/j.chc.2008.07.003
  37. McCabe M., Alcaraz-Ibanez M., Markey C. et al. A longitudinal evaluation of a biopsychosocial model predicting BMI and disordered eating among young adults. Australian Psychologist, 2023. DOI: 10.1080/00050067.2023.2181686
  38. McEnery F., Fitzgerald A., McNicholas F. et al. Fit for purpose, psychometric assessment of the Eating attitudes test-26 in an Irish adolescent sample. Eating Behaviors, 2016, vol. 23, pp. 52–57. DOI: 10.1016/j.eatbeh.2016.07.006
  39. McLean C.P., Kulkarni J., Sharp G. The 26-Item Eating Attitudes Test (EAT-26): psychometric properties and factor structure in vegetarians and vegans. Nutrients, 2023, vol. 15, no. 2, p. 297. DOI: 10.3390/nu15020297
  40. Nasser M. The EAT speaks many languages: Review of the use of the EAT in eating disorders research. Eating and Weight Disorders, 1997, vol. 2, pp. 174–181. DOI: 10.1007/BF03339972
  41. Ocker L.B., Lam E.T.C., Jensen B.E. et al. Psychometric Properties of the Eating Attitudes Test. Measurement in Physical Education and Exercise Science, 2007, vol. 11, no. 1, pp. 25–48. DOI: 10.1080/10913670709337010
  42. Orbitello B., Ciano R., Corsaro M. et al. The EAT-26 as screening instrument for clinical nutrition unit attenders. International Journal of Obesity, 2006, vol. 30, no. 6, pp. 977–981. DOI: 10.1038/sj.ijo.0803238
  43. Oshio A., Meshkova T. Eating disorders, body image, and dichotomous thinking among Japanese and Russian college women. Health, 2012, vol. 4, no. 7, pp. 392–399. DOI: 10.4236/health.2012.47062
  44. Papini N., Jung M., Cook A. et al. Psychometric properties of the 26-item eating attitudes test (EAT-26): An application of rasch analysis. Journal of Eating Disorders, 2022, vol. 10, article 62. DOI: 10.1186/s40337-022-00580-3
  45. Park J., Beaudet M.P. Eating attitudes and their correlates among Canadian women concerned about their weight. European Eating Disorders Review, 2007, vol. 15, no. 4, pp. 311–320. DOI: 10.1002/erv.741
  46. Pereira A.T., Maia B., Bos S. et al. The Portuguese short form of the Eating Attitudes Test-40. European Eating Disorders Review, 2008, vol. 16, pp. 319–325. DOI: 10.1002/erv.846
  47. Piran N. New possibilities in the prevention of eating disorders: The introduction of positive body image measures. Body Image, 2015, vol. 14, pp. 146–157. DOI: 10.1016/j.bodyim.2015.03.008
  48. Puccio F., Fuller-Tyszkiewicz M., Youssef G. et al. Longitudinal Bi-directional Effects of Disordered Eating, Depression and Anxiety. European Eating Disorder Review, 2017, vol. 25, no. 5. pp. 351–358. DOI: 10.1002/erv.2525
  49. Richter F., Strauss B., Braehler E. et al. Psychometric properties of a short version of the Eating Attitudes Test (EAT-8) in a German representative sample. Eating Behaviors, 2016, vol. 21, pp. 198–204. DOI: 10.1016/j.eatbeh.2016.03.006
  50. Rivas T., Bersabé R., Jiménez M. et al. The Eating Attitudes Test (EAT-26): Reliability and validity in Spanish female samples. The Spanish Journal of Psychology, 2010, vol. 13, no. 2, pp. 1044–1056. DOI: 10.1017/s1138741600002687
  51. Rogoza R., Brytek-Matera A., Garner D.M. Analysis of the EAT-26 in a non-clinical sample. Archives of Psychiatry and Psychotherapy, 2016, vol. 18, no. 2, pp. 54–58. DOI: 10.12740/APP/63647
  52. Rukavishnikov G.V., Verbitskaya E.V., Vekovischeva O.Yu. et al. The association of obesity with eating disorders risk: Online survey of a large cohort of Russian speaking individuals seeking medical weight correction assistance. Journal of Eating Disorders, 2021, vol. 9, article 100. DOI: 10.1186/s40337-021-00456-y
  53. Sander J., Moessner M., Bauer S. Depression, anxiety and eating disorder-related impairment: moderators in female adolescents and young adults. International Journal of Environmental Research and Public Health, 2021, v 18, article 2779. DOI: 10.3390/ijerph18052779
  54. Sidor A., Baba C.O., Marton-Vasarhelyi E. et al. Gender differences in the magnitude of the associations between eating disorders symptoms and depression and anxiety symptoms. Results from a community sample of adolescents. Journal of Mental Health, 2015, vol. 24, no. 5, pp. 294–298. DOI: 10.3109/09638237.2015.1022250
  55. Spivak-Lavi Z., Peleg O., Tzischinsky O. et al. Differences in the factor structure of the Eating attitude test-26 (EAT-26) in different cultures in Israel: Jews, Muslims, and Christians. Nutrients, 2021, vol. 13, article 1899. DOI: 10.3390/nu13061899
  56. Tsekoura E., Kostopoulou E., Fouzas S. et al. The association between obesity and the risk for development of eating disorders – A large-scale epidemiological study. European Review for Medical and Pharmacological Sciences, 2021, vol. 25, pp. 6051–6056. DOI: 10.26355/eurrev_202110_26883
  57. Zigmond A.S., Snaith R.P. The hospital anxiety and depression scale. Acta Psychiatrica Scandinavica, 1983, vol. 67, pp. 361–370. DOI: 10.1111/j.1600-0447.1983.tb09716.x

Information About the Authors

Tatiana A. Meshkova, PhD in Psychology, Head of the Department of Differential Psychology and Psychophysiology, Moscow State University of Psychology and Education, Leading researcher of the Laboratory of Age-related Psychogenetics of PI RAE, Moscow, Russia, ORCID: https://orcid.org/0000-0002-6018-5006, e-mail: meshkovata@mgppu.ru

Olga V. Mitina, PhD in Psychology, Leading Researcher of the Laboratory of Communication Psychology, Faculty of Psychology, Lomonosov Moscow State University, Moscow, Russia, ORCID: https://orcid.org/0000-0002-2237-4404, e-mail: omitina@inbox.ru

Kirill V. Shelygin, Doctor of Medicine, Associate Professor of the Department of Psychiatry and Clinical Psychology, Northern State Medical University, Arkhangelsk, Russia, ORCID: https://orcid.org/0000-0002-4827-2369, e-mail: shellugin@yandex.ru

Roza V. Aleksandrova, Psychologist, Research Educational Center of Applied Psychology and Psychological Services, S. Yesenin Ryazan State University, Ryazan, Russia, ORCID: https://orcid.org/0000-0003-4963-041X, e-mail: rozinca@mail.ru

Natalia O. Nikolaeva, Senior Lecturer, Differential Psychology Chair, Department of Clinical and Special Psychology, Moscow State University of Psychology and Education, Moscow, Russia, ORCID: https://orcid.org/0000-0003-4616-2868, e-mail: sp_natalia@mail.ru

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