Comparing the eating attitudes test (EAT -26) and disorder examination questionnaire (EDE-Q) as screening tools for eating disorders among young adults: A population-specific analysis.

BackgroundEating Disorders pose a serious health risk to individuals. Often, eating disorder symptoms are overlooked when assessing obesity risk. The current cross-sectional study was focused on the search of association between disordered eating behaviors evaluated by Eating Attitudes Test 26 (EAT-26) and obesity in a large cohort of Russian-speaking adults seeking online assistance with medical weight correction.MethodsThe web-based cross-sectional study evaluated the data of online Eating Attitudes Test 26 (EAT-26) completed by 13,341 registered adult visitors of weight loss clinic website. The EAT-26 provides an overall score for potential eating disorders risk, as well as scores for three subscales: Bulimia, dieting, and oral control. Additional self-reported information about sex, weight, height, and age of respondents was used for analysis. The nonparametric analysis of variance and binominal logistic regression modeling were applied to search for an association between obesity and EAT-26 total score and subscales scores. The critical level of the significance was considered as α = 0.05.ResultsWomen (94%) had lower BMI values but higher EAT-26 total score than men, which was indicated as statistically significant by a Wilcoxon Signed-Ranks Test (Z = − 11.80, p < 0.0001). Logistic regression for the whole cohort revealed that Bulimia subscale score was associated with higher risk of obesity (OR = 1.03, 95% CI 1.02–1.05) whereas higher score of EAT-26 oral control subscale was associated with decreased risk of obesity (OR = 0.93, 95% CI 0.91–0.95). Separate analysis for men and women showed that in men higher obesity risk was associated with higher oral control subscale scores (OR = 1.08, 95% CI 1.06–1.11); while in women both dieting and bulimia subscales scores were associated with higher obesity risk (OR = 1.02, 95% CI 1.01–1.03 and OR = 1.03, 95% CI 1.02–1.05, respectively). Older age was associated with obesity risk for both women and men.ConclusionsIn a large cohort of individuals seeking medical weight correction assistance, the risk of obesity was associated with the higher EAT-26 scores, age, and sex. Moreover, different eating disorder risk profiles were associated with obesity in men and women. Higher oral control subscale score was associated with decreased risk of obesity in women, but with higher risk in men. Older age was a shared obesity risk factor for both sexes. Therefore, the use of EAT-26 would facilitate individual diagnostic assessment for specific eating disorders in different sub-cohorts. Further assessment of separate EAT-26 subscales may be important to predict sex-/age-specific risks of obesity that implies their study in the future.Plain English summaryObesity is a significanthealth problem. Different factors (e.g. social, biological, and behavioral) areimportant for their successful treatment. Abnormal eating behaviors may be oneof the most likely predictors of increased body weight. This study aims todetermine whether there is a significant association between obesity and scoreson the eating behavior questionnaire-Eating Attitudes Test-26 (EAT-26)-in alarge cohort of adults seeking medical weight correction assistance at a privateweight loss clinic web-site. According to the study results, the associationwas shown for the male sex, older age, and higher Bulimia scores as measured onthe EAT-26. Moreover, different EAT-26 scales were associated with obesityrisks in women and men subgroups, while older age was a shared risk factor forobesity in both sexes. The findings may suggest sex-/age-specific diagnosticapproach and treatment strategies for individuals with obesity.

PurposeWidely used eating disorder (ED) measures, such as the Eating Disorder Examination-Questionnaire (EDE-Q) or the Eating Attitudes Test-26 (EAT-26), were originally developed and standardized in young White women, leading to poor performance, unclear factor structures, and inconsistent measurement invariance across diverse groups. As ED prevalence rises among middle-aged women, the need for age-appropriate and psychometrically sound assessment tools has become increasingly important. This study evaluated the factor structure, measurement invariance, and internal consistency of the EDE-Q and EAT-26 when administered online across two developmentally relevant age groups: emerging adults and middle-aged women.MethodA sample of 829 women from across the U.S. (emerging adults: 419; middle-aged: 410) completed the EDE-Q and EAT-26 through an online survey platform. We tested the original factor structures and two alternative models for each measure through confirmatory factor analysis. Measurement invariance analyses were conducted on good-fitting models.ResultsThe original EDE-Q model failed to converge, while the original EAT-26 model demonstrated poor fit. The alternative factor models—Grilo et al.’s (2013) EDE-Q model, and Bazo Perez et al.’s (2023) EAT-26 model—demonstrated best fit and measurement invariance across both age groups. The EDE-Q subscales exhibited good internal consistency, while the EAT-26 showed acceptable to good internal consistency.ConclusionThese findings emphasize the need for developmentally sensitive tools to improve diagnostic accuracy, early detection, and treatment of EDs across the lifespan. Because the factor structure and measurement invariance results reflect online administration, they should be interpreted within this context and motivate continued evaluation of these instruments across administration formats. Addressing a critical gap in ED research and clinical practice, this work underscores the need to refine ED assessment methods, to ensure equitable, accurate, and developmentally appropriate identification of ED risk in women beyond early adulthood.Level of evidence: V, descriptive (cross-sectional) study.

BackgroundVarious well-validated interview and self-report instruments are available to assess eating disorder symptomatology. However, most psychometric studies have been conducted in high-income countries. The aim of the present study was to systematically review the available psychometric studies conducted in low- and middle-income countries on well-known measures for assessing eating disorder symptoms.MethodsPsychometric studies with the following instruments were included: the Eating Disorder Examination (EDE), the Eating Disorder Examination Questionnaire (EDE-Q), the Eating Disorder Inventory (EDI), the Eating Attitudes Test (EAT), and the Children’s Eating Attitudes Test (ChEAT). Searches were conducted on August 30, 2021, in the following databases: MEDLINE, EMBASE, LILACS, Web of Science, PsycINFO, and CABI. The methodological quality of the studies was assessed using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN). The studies were considered to have conducted the minimum psychometric evaluation if they assessed at least the three types of validity (content, criteria, and construct) or diagnostic performance. The psychometric properties were also evaluated considering the cut-off points described in the literature for each of the analysis methods used to evaluate validity and reliability and two reviewers independently selected the studies and evaluated the quality criteria.ResultsA total of 28 studies were included. The studies were conducted in 13 countries (10 middle income and 3 low income). The instruments that were most used in the studies were the EAT and EDE-Q. According to the overall COSMIN assessment, in most (57%) of the studies the psychometric properties assessed were not described. Forty-three percent of the studies conducted the minimum psychometric evaluation. However, according to the described cut-off points, the results for the psychometric properties assessed showed, in general, acceptable validity and reliability.ConclusionThe results of this review suggest a lack of studies with the recommended psychometric properties in low- and middle-income countries on these commonly used instruments. With the steady increase in the prevalence of eating disorders globally, psychometric investigations of instruments for measuring eating disorder symptoms in these countries should be encouraged to promote their early detection and treatment.

Validity and reliability of eating disorder assessments used with athletes: A review

Eating disorders (ED) and plastic surgery are two areas of healthcare that have gained significant attention in recent years. The goal of this review is to provide an overview of the existing literature concerning the interplay between ED and aesthetic surgery, identifying existing questionnaires and providing suggestions for the future research on the psychological aspects of these group of patients. We conducted a systematic review on PubMed. We included studies that examined the type of ED, surgical procedure, outcome measures used, patients' motivations as well as physical and psychological outcomes of individuals with ED seeking or undergoing aesthetic surgery. Three independent reviewers examined each potential study. Eleven studies met the inclusion criteria. These studies involved 5510 patients, addressing a spectrum of ED such as Anorexia nervosa, Bulimia nervosa, and Binge eating. The primary focus was on body contouring procedures like liposuction, breast surgery, and abdominoplasty. The assessment tools employed in these studies for evaluating ED included the Eating Attitude Test (EAT), Eating Disorder Inventory (EDI), Eating Disturbance Scale (EDS), Sociocultural Attitudes Toward Appearance Questionnaire-Eating Disorder (SATAQ-ED), and the Eating Disorder Examination Questionnaire. There is a complex interplay between ED and aesthetic surgery, underscoring the significance of comprehending and dealing with the psychological and sociocultural factors that impact patients in this context. The optimal management for these patients and the most effective tool for plastic surgeons to assess their psychological condition remain unclear. It is, therefore, crucial to standardize the evaluation and approach to this patient subgroup, closely aligned with psychological support, to achieve the best outcomes. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

ObjectiveThis review aimed to examine the validity of self‐report screening questionnaires for identifying eating disorder (ED) risk in adults and adolescents with overweight/obesity.MethodFive databases were searched from inception to September 2020 for studies assessing validation of self‐report ED screening questionnaires against diagnostic interviews in adolescents and adults with overweight/obesity. The review was registered with PROSPERO (https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=220013).ResultsTwenty‐seven papers examining 15 questionnaires were included. Most studies validated questionnaires for adults (22 of 27 studies), and most questionnaires (12 of 15) screened for binge eating or binge‐eating disorder (BED). The Eating Disorder Examination Questionnaire (sensitivity = .16–.88, specificity = .62–1.0) and Questionnaire on Eating and Weight Patterns (sensitivity = .07–1.0, specificity = .0–1.0) were most frequently validated (six studies each). Five studies of three questionnaires were in adolescents, with the Adolescent Binge‐Eating Disorder Questionnaire having highest sensitivity (1.0) but lower specificity (.27). Questionnaires designed to screen for BED generally had higher diagnostic accuracy than those screening for EDs in general.DiscussionQuestionnaires have been well validated to identify BED in adults with overweight/obesity. Validated screening tools to identify other EDs in adults and any ED in adolescents with overweight/obesity are lacking. Thus, clinical assessment should inform the identification of patients with co‐morbid EDs and overweight/obesity.Public SignificanceIndividuals with overweight/obesity are at increased risk of EDs. This review highlights literature gaps regarding screening for ED risk in this vulnerable group. This work presents possibilities for improving care of individuals with overweight/obesity by reinventing ED screening tools to be better suited to diverse populations.

Objective: An increase in the prevalence of many psychological problems including Eating Disorders (EDs) during COVID-19 pandemic is noteworthy. Weight change experienced by many people in this period is accompanied by a deterioration in eating attitudes and behaviors. The aim of this study is to determine how eating attitudes and behaviors differ according to gender and weight change, and the prevalence of EDs during COVID-19 pandemic. Method: Firstly, Socio-demographic-Clinical Information Form, Eating Attitude Test-26 (EAT-26), and Eating Disorder Examination Questionnaire (EDE-Q) were administered to 771 participants. Then, the Eating Disorder Assessment for DSM-5 (EDA-5) was conducted as a semi-structured online clinical interview with the participants’ at-risk group. EDA-5 is a web-based diagnostic clinical interview which scans the last three-month according to the DSM-5 Eating Disorders diagnostic criteria that is administered by a clinician specialized in EDs. Results: Research findings indicated that participants' EAT-26 and EDE-Q scores differ significantly according to gender and weight change experienced during the pandemic. The prevalence of ED was 3% (N=20). According to sub types, Binge Eating Disorder was 1.3% (N=9), Bulimia Nervosa was 0.7% (N=5), Anorexia Nervosa was 0.4% (N=3), subthreshold Binge Eating Disorder was 0.4% (N=3), and subthreshold Bulimia Nervosa was 0.14% (N=1). Although not meeting the diagnostic criteria, the number of participants with disordered eating behavior was found to be 0.29% (N=2). Conclusion: A higher prevalence rate was found compared to previous studies in Turkey which is assumed to provide evidence that the prevalence of EDs increased during the COVID-19 period.

This study aimed to examine the frequency of eating disorders (ED) in patients with bipolar disorder (BD) compared to healthy controls, and to investigate potential relationships between eating attitudes, quality of life, and personality traits as measured by the Behavioral Inhibition System and Behavioral Activation System (BIS/ BAS) Method: The study was designed as a cross-sectional study in the psychiatry outpatient clinic. We included 76 BD patients and 74 controls who were similar in terms of gender, age, and education level. We utilized Behavioral Inhibition System/Behavioral Activation System Scale (BIS/BASS), Night Eating Questionnaire (NEQ), Eating Attitude Test (EAT), Eating Disorders Examination Questionnaire (EDE-Q), and Quality of Life Scale Short Form (SF-36). The frequency of ED was 18.4% in participants with BD and 1.3% in the control group. Compared with the control group; the physical function subscales scores, role difficulty physical subscales scores, social function and role difficulty emotional subscale scores of SF-36 were lower in BD patients; while the BAS, the EAT, the NEQ scales and eating concern, body concern and weight concern subscales and mean scores of the EDE-Q were found to be higher. The frequency of ED is increased in BD patients. Our study is one of very few in the literature to examine the comorbidity of BD and ED, and the factor associated with the presence of ED. The data obtained will hopefullly contribute to better diagnosis and treatment Keywords: Bipolar disorder, behavioral activation systems, behavioral ınhibition system, eating attitude test, eating disorder.

The Eating Disorder Examination-Questionnaire (EDE-Q) is one of the most widely used tools to assess the core psychopathology of eating disorders (ED). However, recent empirical findings did not support the original four-factor structure. The aims of the present study were to investigate the factor structure of the EDE-Q in Japanese ED patients, to test the reliability and convergent validity of the EDE-Q, to examine group differences between various ED groups and healthy participants, and to explore the main behavioral features of Japanese ED patients using the newly developed Japanese version of EDE-Q. A total of 148 ED patients and 469 healthy participants completed the EDE-Q, Eating Attitudes Test-26 (EAT-26), and Eating Disorder Inventory-2 (EDI-2). The factor structure, reliability, and validity of the EDE-Q were assessed in ED patients. Group differences were assessed using the new Japanese version of the EDE-Q (EDE-Q-J). The EDE-Q-J had three factors. Cronbach's alphas ranged from 0.83 to 0.93. Total score and subscale scores of "Dieting" and "Bulimia and Food Preoccupation" of EAT-26 and of "Drive for Thinness," "Body Dissatisfaction," and "Bulimia" of EDI-2 correlated with the global score and three subscale scores of the EDE-Q-J. For Japanese female ED patients, the EDE-Q-J had three subscales that were not consistent with the original subscales, but were interpretable. It demonstrated sufficient reliability and validity. Japanese female patients with restricting-type anorexia nervosa (AN-R) displayed less dissatisfaction with shape and weight than healthy participants. AN-R patients in Japan might present with a non-fat-phobic symptom profile.

Background: Schema focused cognitive- behavioral model proposed that patients with eating disorders (EDs) used bulimic behaviors in order to avoid or suppress negative affects that are triggered by early maladaptive schemas. Objectives: The aim of the present study was to compare normal weight and obese women in terms of the effect of the activation of abandonment schema. Patients and Methods: This was a 2-stage approach experimental study. In the first, 81 women (41 normal weight and 40 obese) completed the eating disorder examination questionnaire (EDE-Q) and eating attitude test-26 (EAT-26). In the second, 1 week later, all participants were randomly exposed to subliminal abandonment stimuli (experimental group) or subliminal neutral stimuli (control group). The subliminal abandonment stimuli was the word loneliness and the neutral stimuli was the word gallery. Each word was presented on a visual screen for 2 milliseconds (ms). Then, the participants were instructed that they were able to eat pistachios provided by the experimenter. The weight of consumed food was recorded as the dependent variable. Results: Both obese and normal weight women exposed to abandonment themes (loneliness) consumed significantly more food than their counterparts exposed to neutral stimuli. The univariate analysis of covariance indicated that normal weight women in the control group did not differ from obese women in the control group on the amount of consumed pistachios after controlling EDE-Q, EAT-26, and body mass index (BMI). Moreover, the univariate analysis of covariance showed that the amount of food consumed by normal weight women in the experimental condition and obese women in the experimental group did not differ when BMI, EDE-Q, and EAT-26 were controlled. Conclusions: These results provide indirect support for schemata based theory of eating disorders. In other words, abandonment themes activate eating behaviors that presumably serve to avoid negative emotions.

Effect of Nutrition Education on Eating Attitudes Among College-Age Students

Norms and discriminative validity of the Eating Disorder Examination Questionnaire (EDE-Q)

Skin findings such as acne, hypertrichosis, and hyperpigmentation may be a clue for the diagnosis of eating disorders. There are studies on skin findings in eating disorders, but there is no study evaluating eating disorders in acne patients. We aimed to investigate eating disorders in acne patients and evaluate the effect of acne severity, quality of life, and body mass index (BMI) on eating disorders. Two hundred thirty-two acne patients and 314healthy controls were enrolled. Acne severity was detected according to Grading Acne Severity Scale (GAGS) by the dermatologists. Eating Attitude Test-40 (EAT) and Acne Quality of Life Scale (AQLS) were filled out by patients. The controls filled out EAT. Individuals scoring EAT≥30 points were considered at risk for eating disorders. The median EAT score (15 vs. 13) and the number of patients scoring EAT ≥30 (14.2% vs. 2.2%) were found to be significantly higher in the patients' group compared with control group (p: 0.005, p<0.001). There was a significant positive correlation between EAT score and AQLS score but no significant relationship between acne severity and EAT score. A significant positive correlation was found between EAT scores and BMI. Eating disorders and acne are mostly seen in adolescence, and both have high biopsychosocial morbidity. Also eating disorders can even be mortal sometimes. There are common psychopathological mechanisms in eating disorders and acne.

Eating disorders is a particular problem for university students. However, little is known about this problem among medical students who often have high stress. The aims of this study were to describe the changes in eating attitudes and eating disorders from 2006 to 2008 in a medical student sample, and to compare the gender differences of eating attitudes and body mass index (BMI, kg/m(2)) with this sample. This study was conducted in Changsha city, Mainland China. Self-reported questionnaires, including the Eating Attitudes Test (EAT) and Eating Disorders Assessment Questionnaire (CETCA), were employed to examine the changes in eating attitudes and eating disorders from 2006 to 2008 in a medical student sample (N = 500). Self-reported findings suggest that tentative eating disorders prevalence was 0.90% (anorexia nervosa (AN): 0; bulimia nervosa (BN): 4 females) in 2006 and 1.44% (AN: 1 male; BN: 1 male and 3 females) in 2008 of the full sample. The present data showed that 2.26% (2 males and 9 females) in 2006 and 2.47% (4 males and 6 females) in 2008 of all students obtained scores greater than 20 on the EAT-26 indicative of distorted eating attitudes and behaviour. Male students kept lower distorted eating attitudes and behaviours than female students, while female students kept a lower BMI than male students in both 2006 and 2008. However, there were no statistically significant changes in eating attitudes, distorted eating attitudes and CETCA in either male or female students from 2006 to 2008. The results of this study suggest that there were no statistically significant changes from 2006 to 2008 in eating attitudes, distorted eating attitudes and CETCA. However, females showed significantly higher eating disorders and distorted eating attitudes compared to males in both 2006 and 2008. This study is furthering our understanding of eating disorders in a Chinese cultural context.

What relationship between eating disorders and alexithymia among medical students?