Abstract
BackgroundThe objective of the study was to determine the factorial structure and test the measurement invariance of the EAT-26 in a large probability sample of young female university students in Qatar (n = 2692), a Muslim country in the Middle East.MethodsThe maximum number of factors was derived based on results from initial exploratory factor analysis (EFA) in the first-half of the randomly split sample (Sample 1). A subsequent EFA and Exploratory Structural Equation Models (ESEM) were conducted to identify the number of valid factors. A five-factor model with 19 items was identified as the optimal factor structure. This structure was further replicated using ESEM in the second-half of the sample (Sample 2). Multi-group Confirmatory Factor Analyses (CFAs) were conducted at this stage and their fit was evaluated with and without further sub-grouping by language (Arabic and English) and BMI (underweight, normal weight, and overweight/obese). Finally, measurement invariance tests were conducted in the entire sample assessing equivalence across language and BMI within the final five-factor model.ResultsThe five-factor structure of the new EAT-19 [fear of getting fat (FGF), eating-related control (ERC), food preoccupation (FP), vomiting-purging behavior (VPB), and social pressure to gain weight (SP)] provided the best fit: CFI = 0.976, TLI = 0.952, RMSEA = 0.045 (90%CI 0.039–0.051), SRMR = 0.018, CD =1.000. CFAs supported metric invariance for language and for BMI. Language and BMI-based population heterogeneity comparisons provided modest and small-to-moderate evidence for differential factor means, respectively.ConclusionAlthough the five-factor model of the EAT-19 demonstrated good item characteristics and reliability in this young female population, the lack of scalar invariance across language and BMI-categories pose measurement challenges for use of this scale for screening purposes. Future studies should develop culture- and BMI-specific cut-offs when using the EAT as a screening instrument for disordered eating in non-clinical populations.
Highlights
The objective of the study was to determine the factorial structure and test the measurement invariance of the Eating Attitudes Test (EAT)-26 in a large probability sample of young female university students in Qatar (n = 2692), a Muslim country in the Middle East
Using exploratory and confirmatory analytical approaches in randomly half-split samples, we evaluated the theoretical structure of Disordered Eating Attitudes and Behaviors (DEAB) measured by the EAT-26 and the same structure holds across two languages (Arabic and English) and three Body Mass Index (BMI)-based groups in a large representative sample of undergraduate female students of predominantly Arab ethnicity
Factor Structure Assessment using exploratory factor analysis (EFA) in Sample 1: The scree plot (Fig. 1) suggests factors beyond the first six account for little variability in the 26 items, the factor structure was fixed to a maximum of six factors in a second EFA (Table 1)
Summary
Disordered Eating Attitudes and Behaviors (DEAB) are a global phenomenon with high prevalence among young adults in English- and non-English speaking cultures. Examples of DEAB include dieting, fasting, abusing laxatives or diuretics, self-induced vomiting, and binge eating. These behaviors are associated with increased risk of eating disorders and obesity, and are a serious public health concern [1, 2]. In a Muslim and Arabic-speaking country like Qatar, as in many of the Gulf countries, young women constitute a high-risk population for obesity and DEAB [5,6,7]. There are currently limited screening tools for identifying young women who are at high risk of DEAB and eating disorders in this unique cultural setting
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