Brief Description
The EAT-26 is among the most widely used self-report measures of disordered eating symptoms. The 26 item self-report measure serves as a useful screening tool to assess risk of disordered eating to support early identification of symptoms. The assessment is also composed of three subscales: 1) Dieting, 2) Bulimia and Food Preoccupation, and 3) Oral Control. The EAT-26 also has 5 behavioral questions that inquire about engagement in specific behaviors (e.g., bingeing, purging) within the past six months. Combined with the total score of the EAT-26, it is also recommended that providers consider body weight and the additional behavioral questions related to disordered eating symptoms and weight loss.
Assessment Administration Type
Self-report
Number of questions
26 (EAT-26), 31 (EAT-26 + Behavioral Questions)
Age Range for Administration
Adult and Adolescent
Recommended Frequency of Administration
No standardized frequency; recommend administering every 6 months or as clinically indicated.
Summary of Scoring and Interpretations
The EAT-26 consists of 26 items on a 6-point Likert scale from “Always” to “Never” (Always=3, Usually=2, Often=1, Sometimes=0, Rarely=0, Never=0). Note, Item 26 is reverse-scored. A total score is calculated by summing the item responses and ranges from 0 to 78. Scores 20 or greater indicate a high level of concern about dieting, body weight or problematic eating behaviors and it is recommended to obtain further investigation by a qualified professional. Low scores (below 20) can still be consistent with serious eating concerns (e.g., downplaying or denial of symptoms can occur with eating disorders). Results should be interpreted along with weight history, current BMI (body mass index), and percentage of Ideal Body Weight. The EAT-26 plus behavioral questions includes an additional 5 questions and positive responses as shown below may indicate a need for further evaluation and treatment in their own right, independent of the EAT-26 total score.
Behavioral Question Item | Response(s) Requiring Further Evaluation/Treatment |
27 | 2-3x/month, 1x/week, 2-6x/week, 1x/day or more |
26 | 1x/month or less, 2-3x/month, 1x/week, 2-6x/week, 1x/day or more |
28 | 1x/month or less, 2-3x/month, 1x/week, 2-6x/week, 1x/day or more |
30 | 1x/day or more |
31 | Yes |
The EAT-26 also has three subscales whose scores are calculated by summing all items assigned to that respective scale:
Subscale | Items |
Dieting | 1, 6, 7, 10, 11, 12, 14, 16, 17, 22, 23, 24, 26 |
Bulimia and Food Preoccupation | 3, 4, 9, 18, 21, 25 |
Oral Control | 2, 5, 8, 13, 15, 19, 20 |
Blueprint Adjustments
There are two versions of the EAT-26 available on the Blueprint platform. The EAT-26 includes the 26 items that result in the total score and three subscale scores. The EAT-26 plus Behavioral Questions includes the aforementioned 26 items as well as the five behavioral questions. Also, Blueprint’s platform does not support multiple responses having the same numeric value at this time (e.g., “Never” and “Rarely” cannot both be “0”); thus, Blueprint has assigned values of 0, 0.1, etc., to all responses choices that have a value of “0.” Values with a decimal are rounded to the nearest integer before scoring calculations, and thus, does not impact total and subscale scoring.
Clinical Considerations
Estimated completion time: 6-12 minutes
The goal behind early screening assumes that an eating disorder identified in its early stages can lead a person to seek earlier treatment, thereby reducing the risk of serious physical and psychological complications.
It is recommended that respondents who obtain a score of 20 or more on the EAT-26 are further evaluated to determine if they meet the diagnostic criteria for an eating disorder.
Importantly, having a score less than 20 does not rule of presence of disordered eating or an eating disorder. For example, some with Binge Eating Disorder (BED) might score below the threshold of 20 on the EAT-26 but may have a serious eating disorder.
While BMI is used to inform diagnosis, BMI is only one piece of information used to indicate presence of eating disorder symptomology. BMI has significant limitations as a measurement tool, including challenges to its validity with use among Black, Indigenous, and People of Color (BIPOC) populations (e.g., Nuttall, 2015), which could be related to underdiagnosis of eating disorders among this population.
Citation
Garner, D. M., & Garfinkel, P. E. (1979). The Eating Attitudes Test: An index of the symptoms of anorexia nervosa. Psychological Medicine, 9(2), 273-279.
Relevant Articles + Further Resources
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