Children's Eating Attitudes Test Research Articles

A 2-year longitudinal study of eating attitudes, BMI, perfectionism, asceticism and family climate in adolescent girls and their parents

The aim of this longitudinal study of 383 Swedish adolescent girls (11 and 13 years old at year 1) and their parents was to examine changes in eating attitudes over a two-year period, and to investigate the predictive value of eating attitudes, perfectionism, asceticism, family climate and body mass index (BMI) for the development of disturbed eating attitudes. The following self-report questionnaires were used: Children's Eating Attitudes test, Eating Attitudes Test, Eating Disorder Inventory for Children, Eating Disorder Inventory 2, I Think I Am and The Family Climate. The frequency of disturbed eating attitudes increased with increased age in the girls. Children's eating attitudes, higher BMI than peers, the girls rating of a less healthy relation to family and their fathers' eating attitudes at year 1 contributed most to the prediction of disturbed eating attitudes for the girls 2 years later. The results suggest that early signs of disturbed eating attitudes and higher BMI than peers may be important predictors for the development of more serious eating disturbances among adolescent girls.

Attitudes to food, eating and dieting behaviour in 11 and 14-year-old Swedish children.

All students in grades 5 and 8 of three randomly chosen schools in Uppsala (n = 236) were eligible, and 197 participated. The survey included a Swedish version of the Children's Eating Attitudes Test (ChEAT) and a demographic and dieting questionnaire. In total, 47% of the children (girls 70%, boys 25%) wanted to be thinner and 25% had tried to lose weight. In the 5th grade, 49% of the girls reported that they wanted to be thinner and in the 8th grade 83%. Fifty-three percent of the girls in the 8th grade reported that they had tried to lose weight; 36% admitted that they felt too fat but only 5% reported that other people found them too fat. The methods used were caloric restriction and exercise. Compared with US data, the Swedish students dieted less often and showed lower ChEAT scores. Compared with earlier data, our results show that weight concerns begin at an earlier age among Swedish children today.

Structure analysis of the Children's Eating Attitudes Test in overweight and at-risk for overweight children and adolescents

BackgroundIn school-based samples of children, the Children's Eating Attitudes Test (ChEAT) has a four-factor structure; however, previous studies have not examined its factor structure in samples restricted to overweight youth. MethodsThe ChEAT was administered to 220 overweight (BMI≥95th percentile) and 45 at-risk for overweight (BMI 85th–<95th percentile) children and adolescents. Factors were identified by a principal component analysis with varimax rotation. ChEAT factor scores of children with BMI≥85th percentile were contrasted with those of 152 non-overweight (BMI 5th to <85th percentile) children and adolescents. ResultsFactor analysis generated four subscales described as ‘body/weight concern,’ ‘food preoccupation,’ ‘dieting,’ and ‘eating concern.’ ChEAT total score, body/weight concern, and dieting subscale scores were positively related to BMI-Z and body fat mass (p's<.05). Compared to non-overweight children, overweight and at-risk for overweight children had higher ChEAT total (9.9±7.4 vs. 6.6±7.8, p<.001), body/weight concern (3.2±3.1 vs. 1.3±3.0, p<.001), and dieting (1.8±2.2 vs. .8±2.3, p<.001) subscale scores. ConclusionsThe previously elucidated factor structure of the ChEAT was primarily supported in a sample of overweight children. The emergence of separate body/weight concern and dieting subscales may relate to these children's experiences with attempted weight reduction.

Epidemiology of eating disorders

The aims of this study were to determine the prevalence of eating disorders (ED) in a representative school population of early adolescents of both sexes and to evaluate persistence and incidence after two years. An initial sample of 1336 (mean age = 11.37) was assessed in a two-phase design. The Children Eating Attitudes Test was used to select 258 participants (T1) from the initial sample who were followed-up two years later (T2; n = 200). Diagnoses of ED were obtained using the Diagnostic Interview for Children and Adolescents- Children and Parent Version (DICA-C and DICA-P) at T1, and Adolescent Version (DICA-A) at T2. At T2, participants were also assessed with the Eating Attitudes Test, the Bulimic Investigatory Test, and the Eating Disorders Inventory. The Body mass index (BMI) was obtained for all participants. The estimated prevalence of any ED according to DICA-C (T1) and DICA-A was 3.44% and 3.81%, respectively. The most frequent diagnoses were syndromes that were not full-blown. Biannual incidence of any ED was 2.02%. Amongst those with an ED, 52.17% persisted. Females showed a higher incidence and persistence of any ED than males. Participants who had the highest BMI were those who had a persistent diagnosis of ED. ED that began at early ages in less severe forms and in females often persisted with increasing severity.

Eating disturbances in a school population of preteen girls: Assessment and screening

To assess the utility of the Children's Eating Attitudes Test (cEAT) questionnaire in screening for interview-ascertained eating disturbances. A total of 409 girls, 9-13 years of age, completed a cEDE interview and cEAT questionnaire. 14.7% of girls reported eating disturbances in the past month on the cEDE. Mean cEDE score was 0.3 +/- 0.6 and mean cEAT score was 5.9 +/- 5.9. The cEAT demonstrated low sensitivity but high specificity at a cutoff score of 20, and poor positive predictive value when lower cutoff scores were used. Eating disturbances were common but mild in this preteen group. The cEAT was not an efficient screening tool for interview-ascertained mild eating disturbances in preteen girls.

Calcium and Body Fat in Peripubertal Girls: Cross‐sectional and Longitudinal Observations

The objective was to investigate whether calcium intake is independently associated with body fat in peripubertal girls. A total of 45 healthy premenarcheal girls (initially 10.5 +/- 0.6 years of age) completed a 2-year prospective observational study. Percent body fat and trunk fat (by DXA), height, weight, maturational stage, and eating attitudes (children's Eating Attitudes Test [EAT]) were measured at baseline and at 1 and 2 years. Physical activity (by questionnaire) and calcium intake (by calcium-specific food frequency questionnaire and 3-day food records) were assessed at 6-month intervals. Girls with 2-year mean calcium intake below and above the median had similar age, height, lean mass, and maturational stage at baseline, but girls below the median had significantly higher baseline percentage body fat (29.3 +/- 10.3% vs. 22.0 +/- 6.8%, p < 0.01) and trunk fat (24.2 +/- 10.6% vs. 15.8 +/- 6.8%, p < 0.01). However, differences were no longer significant when covariates (most notably children's EAT dieting score) were considered. Regression analysis revealed that dieting score was a consistent positive predictor of percentage body and trunk fat at all cross-sectional time-points, accounting for >20% of the variance, but did not predict 2-year change in percentage fat. Calcium intake did not enter longitudinal regression equations for 2-year change in percentage fat. In this group of girls, an inverse cross-sectional association between calcium intake and body fat appeared to result from avoidance of foods high in calcium by girls who were concerned about their body weight or shape. Calcium intake was not associated with change in fat over time.

Reformulation of the Children’s Eating Attitudes Test (ChEAT): Factor structure and scoring method in a non-clinical population

The primary aims of this study were to empirically test the factor structure of the Children's Eating Attitudes Test (ChEAT) through both exploratory and confirmatory factor analyses and to interpret the factor structure of the ChEAT within the context of a new scoring method. The ChEAT was administered to 728 children in the 2nd through 6th grades (from five schools) at two different time points. Exactly half the students were male and half were female. To the best of our knowledge, this is the first study to empirically test the merits of an alternative 6-point scoring system as compared to the traditionally used 4-point scoring system. With the new scoring procedure, the skewness for all factor scores decreased, which resulted in increased variance in the item scores, as well as the total ChEAT score. Since the internal consistency of two factors in a recently proposed model was not acceptable (<0.60), this model did not adequately fit our data. Thus, exploratory and confirmatory factor analyses were conducted. A 6-factor solution based on a 20-item version was found to best fit the data and have the best internal reliability. The six factors were labeled: 1) overconcern with body size, 2) dieting, 3) food preoccupation, 4) social pressure to gain weight, 5) vomiting, and 6) caloric awareness and control. The obtained factor solution had considerable overlap with the original factor analysis performed on the 26-item Eating Attitudes Test and with the factor structure of the ChEAT reported by previous investigations. Intercorrelations among the factors suggested three higher order constructs. These findings indicate that the ChEAT subscales may be sufficiently stable to allow use in non-clinical samples of children.

Association of depression with Body Mass Index, sedentary behavior, and maladaptive eating attitudes and behaviors in 11 to 13-year old children

We examined the relation of different behavioral dimensions of depression with weight-related variables (BMI percentile, sedentary behavior, eating attitudes, and weight control behaviors) in children aged 11 to 13 years. Depression was assessed using the Children's Depression Inventory (CDI). Sedentary behavior was measured in 45 sixth grade students (23 boys and 22 girls) using a validated 24-hour recall instrument, the Self-Administered Physical Activity Checklist. BMI was calculated directly from measured height and weight (kg/m2). The Children's Eating Attitudes Test (ChEAT) was used to measure eating attitudes and weight control behaviors. There were not significant gender differences in reported minutes (142 vs. 91 minutes for boys vs. girls; p=0.25) of sedentary behavior (i.e., television watching and video game playing). The major finding of this study was that certain aspects of depression (i.e., interpersonal problems and feelings of ineffectiveness) were correlated with higher levels of sedentary behavior in children aged 11 to 13. A factor analysis of the study variables indicated that most dimensions of depression, sedentary behavior, and body size represent distinct but correlated behavioral dimensions. This study provides support for a link between specific aspects of depression (i.e., interpersonal problems and feelings of ineffectiveness) and sedentary behavior in children.

Social and family correlates of eating problems and muscle preoccupation in young adolescents

This study examined the unique contribution of a number of social and familial factors to body change strategies and eating problems in youths. A sample of non-clinical adolescents aged 10 to 16 years ( N = 405) completed a modified version of the Children's Eating Attitudes Test (ChEAT) and questionnaires for measuring various social and familial factors that may play a role in the etiology of eating problems and muscle preoccupation. Regression analyses indicated that specific eating disorder-related factors (such as the encouragement of peers and parents to lose weight or to become more muscular) and more general factors (such as negative parental rearing behaviors and insecure attachment) made independent contributions to problem eating and muscle preoccupation in youths.

Children with early refusal to eat: Follow‐up in adolescence

To describe the adolescent outcome of infant refusal to eat (RTE) and to investigate early predictors of adolescent outcomes. 19 of 25 children with RTE and 35 of 42 controls were assessed at age 16. The participants rated eating attitudes and self-perceptions with a Swedish version of the Children's Eating Attitudes Test (ChEAT) and a Swedish self-perception measure. Weight and height were assessed through self-reports, and body mass index (BMI) was computed. Child and family variables measured from infancy through age 4 were used as predictors. RTE and controls did not differ with regard to disturbed eating attitudes, BMI or self-perceptions. There were no relations between early predictors and adolescent disturbed eating for the whole sample, but breastfeeding problems and social adversity in the early years predicted negative self-perceptions, and weight at 4 y predicted adolescent BMI. For the RTE group, low birthweight predicted higher levels of disturbed eating attitudes and less positive self-perceptions. For the control group, social adversity predicted high BMI. RTE does not seem to constitute a risk factor for adolescent disturbed eating. Further, there may be different risk factors for adolescent disturbed eating for children with and without RTE.

Domains of Childhood Teasing and Psychopathological Symptoms in Dutch Adolescents

This study examined relations between memories for childhood teasing and symptoms of social anxiety, depression, and eating disorders in 130 Dutch adolescents. Participants completed the Teasing Questionnaire-Revised which measures how much people recall having been teased during childhood, as well as the Social Anxiety Scale for Children, the Child Depression Inventory, and the Children's Eating Attitude Test. Analysis yielded significant positive correlations between self-reported recollections of childhood teasing and various symptoms. Furthermore, some evidence indicated specific domains of teasing were associated with specific types of psychopathological symptoms.

Correlates of Children's Eating Attitude Test Scores among Primary School Children

A total of 107 Malay primary school girls (8-9 yr. old) completed a set of measurements on eating behavior (ChEAT, food neophobia scales, and dieting experience), the Rosenberg Self-Esteem Scale, body shape satisfaction, dietary intake, weight, and height. About 38% of the girls scored 20 and more on the ChEAT, and 46% of them reported dieting by reducing sugar and sweets (73%), skipping meals (67%), reducing fat foods (60%) and snacks (53%) as the most frequent methods practiced. In general, those girls with higher ChEAT scores tended to have lower self-esteem (r=.39), indicating they were more unwilling to try new foods (food neophobic) (r=.29), chose a smaller figure for desired body size (r=-.25), and were more dissatisfied with their body size (r=.31).

Psychometric characteristics of the Children's Eating Attitudes Test in a Spanish sample

Objective The aim of this study was to test the psychometric properties of a Catalan adapted version of the Children's Eating Attitudes Test (ChEAT). Method With a double phase-design, 1336 Spanish students (650 girls and 686 boys) from the 5th and 6th grade answered the ChEAT and an adapted version of the Body Areas Satisfaction Scale (BASS). The Diagnostic Interview for Children and Adolescents (DICA-R) was used in the second phase to assess 258 of these students and their parents. Results A principal axis factoring analysis yielded four factors that accounted for 49.4% of the variance labelled ‘Fear and preoccupation of getting fat’, ‘Social pressure to eat’, ‘Food preoccupation’ and ‘Food restriction’. Internal reliability and test–retest reliability were satisfactory. Concurrent validity was higher for weight dissatisfaction. According to the EDNOS diagnoses obtained, the examined cutoff in the ChEAT was not very sensitive but it was very specific. Discussion Although the Catalan version of the ChEAT was reliable, it is recommended that the cutoff be lower so that the maximum number of subjects at risk of eating disorders in a school population can be detected. Copyright © 2005 John Wiley & Sons, Ltd and Eating Disorders Association.

Adolescence and the diet‐dieting disparity: Healthy food choice or risky health behaviour?

Food choice in schoolchildren was examined in relation to dieting and measures of eating psychopathology. It was predicted that dieters would make healthier food choices compared to non-dieters and that measures of eating psychopathology would be associated with food choice. A cross-sectional questionnaire design incorporating an established adapted recall method was used to assess patterns of food consumption. Questionnaires were administered in 13 state secondary schools. Measures included a food frequency questionnaire, the Children's Eating Attitudes Test (CHEAT), body satisfaction ratings, dietary restraint, and questions about dieting status. The sample consisted of 574 females and 445 males aged 11-16 years. Females made significantly more healthy food choices compared to males. Females reported dieting more than males (35% vs. 18%, respectively), and female dieters made more healthy food choices than female non-dieters. Almost a fifth (19%) of the entire sample reported skipping breakfast, with female dieters being three times more likely to do so than non-dieters. There were small but significant associations between reported food consumption and measures of eating attitudes, body dissatisfaction and restraint. For females who scored in the at-risk range on the CHEAT (8.7%), these associations were more substantial. Female dieters appear to make more healthy food choices than non-dieters and so may be tuning into healthy eating messages more effectively. Vulnerable females may use 'healthy eating' to hide risky weight reduction behaviours. Further studies are required to examine the nutritional impact of moderate and extreme dieting in this age group.

Social comparisons and negative affect as indicators of problem eating and muscle preoccupation among children

The present study examined the utilization of social comparison practices and the role of negative affect in predicting body dissatisfaction, problem eating, and muscle preoccupation among young children. Participants were 236 children aged between 8 and 10 years. Children's eating, exercising, and muscle concerns were examined using a modified version of the Children's Eating Attitudes Test (ChEAT), which included additional items pertaining to muscle bulk and exercising. Consistent with past findings, body mass index (BMI) was found to be the sole unique indicator of body dissatisfaction for both boys and girls. Utilization of social comparison practices with adults was the main unique indicator of the modified ChEAT factors for boys, while BMI was the main unique indicator of the modified ChEAT factors for girls. In addition, negative affect was associated with binging, food preoccupation, and social pressure to eat for boys and dieting and muscle preoccupation for girls. Findings are discussed in relation to previous studies with adolescents and adults.

A longitudinal study of the development of dieting among 7-17-year-old Swedish girls.

To examine the extent to which the prevalence of self-reported dieting and the wish to be thinner changed in 7-15-year-old girls over a 3-year period, and to explore potential differences between cohorts recruited in 1995 and 1999. In addition, changes in eating attitudes (Children's Eating Attitudes Test [ChEAT]) were compared between 1995 and 1999. A three-wave longitudinal study including girls (n = 1,076-1,279) in five age groups (7, 9, 11, 13, 15, the Main Cohort) and an age-matched cross-sectional sample consisting of 1,759 girls (the Societal Cohort). A marked increase of the wish to be thinner was evident in the 10-14-year-old age range and significant increases in dieting attempts occurred mainly among 9-13-year-old girls. ChEAT scores were significantly higher among 11-year-olds in 1999 than in 1995. However, more 7-year-olds scored above the ChEAT cutoff (</=15) in 1995 compared with 1999. There was an increasing trend in the wish to be thinner and in dieting attempts among 9-14-year-olds. Attitudes and behaviors associated with disturbed eating had increased between 1995 and 1999 only among the 11-year- olds.

Eating attitudes and habitual calcium intake in peripubertal girls are associated with initial bone mineral content and its change over 2 years.

This 2-year prospective study examined associations among bone mineral acquisition and physical, maturational, and lifestyle variables during the pubertal transition in healthy girls. Forty-five girls, initially 10.5+/-0.6 years, participated. Body composition and bone mineral content (BMC) at the spine and total body (TB) were assessed at baseline and annually thereafter using dual-energy X-ray absorptiometry (DXA). Nutrient intakes were assessed using 3-day diet records and a calcium food frequency questionnaire (FFQ), physical activity by questionnaire, sexual maturation using Tanner's stages of breast and pubic hair maturation, growth by height and weight, and eating attitudes using the children's Eating Attitudes Test (Children's EAT). Mean children's EAT subscale scores (dieting, oral control [OC], and bulimia) were stable over time. Median split of OC subscale scores was used to form high and low OC groups. Groups had similar body composition, dietary intake, activity, and Tanner stage at baseline and 2 years. Using height, weight, and Tanner breast stage as covariates, girls with low OC scores had greater TB BMC at baseline (1452+/-221 g vs. 1387+/-197 g; p = 0.030) and 2 years (2003+/-323 g vs. 1909+/-299 g; p = 0.049) and greater lumbar spine (LS) BMC at 2 years (45.2+/-8.8 g vs. 41.2+/-9.6 g; p = 0.042). In multiple regression analysis, OC score predicted baseline, 2 years, and 2-year change in TB and spinal BMC, contributing 0.9-7.6% to explained variance. Calcium intake predicted baseline, 2 years, and 2-year change in TB BMC, explaining 1.6-5.3% of variance. We conclude that both OC and habitual calcium intake may influence bone mineral acquisition.

The positive influence of maternal identification on body image, eating attitudes, and self-esteem of Hispanic and Anglo girls.

The role of maternal identification in the development of girls' body image, eating attitudes, and self-esteem was examined. Hispanic and Anglo girls (n = 410) ages 8-13 were surveyed using the Body Esteem Scale (BES), the Children's Eating Attitudes Test, the Piers-Harris Children's Self-Concept Scale, and the Child Figure Drawing task. From this sample, normal-weight girls with high or low scores on the BES were selected for the main study. Ninety-two mother-daughter pairs participated in this second phase in which mothers completed similar questionnaires and girls performed a Q-sort task measuring maternal identification. Maternal identification was positively correlated with girls' self-esteem and negatively correlated with eating problems and body dissatisfaction. Also, mothers with high self-esteem tended to have daughters with high self-esteem. The mothers of girls with low BES scores found a significantly greater discrepancy than the mothers of girls with high BES scores when contrasting their daughters' current shape with either the ideal figure for their daughter or the figure they believed boys would find attractive. Girls who aspired to be like their mothers in terms of personality traits felt better about themselves and their bodies compared with girls with low maternal identification.

Assessment of eating behaviours and attitudes to eating, dieting and body image in pre-adolescent Swedish girls: a one-year follow-up.

A 1-y follow-up of fifty 8-y-old Swedish girls was performed to assess changes in eating attitudes and dieting behaviour. Individual structured interviews using the Children's Eating Attitudes Test (ChEAT) and Body Image silhouettes were used. The question, "Have you ever tried to lose weight?" was employed to discriminate dieters from non-dieters. Dieting behaviours according to the ChEAT increased over the follow-up period. Discrimination between dieters and non-dieters on the basis of a single question is highly unstable. A classification based on repeated assessment appears to be more promising.

Assessment of eating behaviours and attitudes to eating, dieting and body image in pre‐adolescent Swedish girls: a one‐year follow‐up

A 1‐y follow‐up of fifty 8‐y‐old Swedish girls was performed to assess changes in eating attitudes and dieting behaviour. Individual structured interviews using the Children's Eating Attitudes Test (ChEAT) and Body Image silhouettes were used. The question, “Have you ever tried to lose weight?” was employed to discriminate dieters from non‐dieters. Dieting behaviours according to the ChEAT increased over the follow‐up period. Conclusion: Discrimination between dieters and non‐dieters on the basis of a single question is highly unstable. A classification based on repeated assessment appears to be more promising.