Psychometric Properties of The 26-Item Eating Attitudes Test (EAT-26): An Application of Rasch Analysis

Background: The 26-item Eating Attitudes Test (EAT-26) is a commonly used tool to assess eating disorder risk. The purpose of this study was to examine the psychometric properties of the EAT-26 with a sample of adults (n=469; age=36.17±17.83 years; female =72.5%; white=66.3%; obese BMI category=58%).Methods: Rasch analysis of the EAT-26 assessed model-data fit, an item-person map to evaluate relative distribution items and persons, item difficulty, and person’s eating disorder (ED) risk level, differential item functioning (DIF), and rating scale functioning. Results: A total of 7 misfit items were removed from the final analysis due to unacceptable Infit and Outfit mean square residual values. The item-person map showed that the items were biased toward participants with moderate to high levels of ED risk and did not cover those who had low risk for having an ED (< -1 logits). The DIF analyses results showed that none of the items functioned differently across sex, but 5 items were flagged based on obesity status. The six-category Likert-type rating scale did not function well indicating a different response format may be needed.Conclusion: Several concerns were identified with the psychometric evaluation of the EAT-26 that may question its utility in assessing ED risk. Because the EAT-26 is a frequently used screening tool for nonclinical populations, future work should focus on developing screening tools that are more effective at assessing ED risk in people with overweight and obesity.

Influencia de la ansiedad e insatisfacción corporal sobre conductas alimentarias de riesgo en una muestra de mujeres adolescentes de México

La insatisfacción corporal (IC) es un predictor importante de conductas alimentarias de riesgo (CAR), aunque la IC comúnmente se presenta con sintomatología de ansiedad, se desconoce si esta modera la relación entre la IC y las CAR en población adolescente. Objetivo: analizar el efecto moderador de la sintomatología de ansiedad en la relación entre la IC y las CAR. Método: Estudio transversal explicativo. Muestreo no probabilístico n = 500 mujeres adolescentes escolarizadas, edades entre los 14 y 19 años (M = 16.81, DE = 1.33). Las participantes respondieron el Eating Attitudes Test-26, Body Shape Questionnaire-8D y Hospital Anxiety and Depression Scale. Se obtuvo consentimiento informado de padres/tutores y asentimiento informado de participantes. Resultados: la sintomatología de ansiedad moderó la relación entre la IC y las CAR, asociación más fuerte en niveles altos de ansiedad (b = .51, p < .001) que en bajos niveles (b = .32, p < .001). Análisis post-hoc mostraron que las pendientes de sintomatología de ansiedad alta vs baja fueron significativamente diferentes (t = 2.90; p < .001). Discusión: La ansiedad modera la relación de dos predictores de trastornos alimentarios, influyendo en el aumento del riesgo a desarrollarlos. Se discuten implicaciones prácticas a nivel de prevención y tratamiento de los trastornos alimentarios.

Conductas alimentarias de riesgo e interiorización del modelo estético corporal en participantes de certámenes de belleza

Los concursos de belleza, se han visto como medios potencialmente favorecedores de la emisión de estándares de belleza, que pueden asociarse con la adopción de conductas alimentarias de riesgo (CAR) que comprometan la salud (física y mental) de quienes son partícipes de estos certámenes. Por lo que, el objetivo del presente trabajo fue analizar las relaciones existentes entre las CAR, la insatisfacción corporal, la interiorización del modelo estético corporal y la autoestima de 133 mujeres de entre 15 y 27 años (M = 20.70, DE = 2.50), a quienes se les aplicaron: un cuestionario sociodemográfico, el Eating Attitudes Test, el Body Shape Questionnaire, el cuestionario de Influencias del Modelo Estético Corporal, así como la Escala de Autoestima de Rosenberg. Los resultados de la prueba de correlación mostraron la existencia de asociaciones significativas entre la mayoría de variables evaluadas, teniendo una mayor fuerza la relación de las CAR con la insatisfacción corporal (rs = .57, p < .001) y de esta segunda con la interiorización del modelo estético corporal (rs = .76, p < .001). Estos hallazgos evidencian la necesidad de contemplar a la satisfacción corporal como una de las vías estratégicas preventivas de las CAR, al igual que la estrecha relación que guarda la insatisfacción corporal con la interiorización del modelo estético corporal de las participantes de certámenes de belleza.

Atitudes alimentares e insatisfação corporal em estudantes de nutrição de uma instituição particular de ensino superior, matriculados em diferentes períodos do curso

O comportamento alimentar sofre influência de diversos fatores, sejam psicológicos e emocionais, ou socioeconômicos, onde o estilo de vida norteia a alimentação. O ingresso na vida acadêmica universitária aflora ainda mais essas emoções, devido à pressão para a adequação do corpo dentro dos padrões impostos, somado às expectativas de um bom desempenho profissional, principalmente em estudantes da área da nutrição. O objetivo deste trabalho foi analisar mudança comportamental dos acadêmicos de nutrição com o decorrer do curso, em relação aos hábitos alimentares e estilo de vida. Foram avaliados 37 estudantes de nutrição, de uma instituição privada, na cidade de Pindamonhangaba – São Paulo, matriculados em diferentes períodos. Foram aplicados os questionários Eating Attitudes Test - EAT-26 e Body Shape Questionnaire – BSQ, para análise de transtornos alimentares e distorção da imagem corporal, respectivamente, bem como, um questionário de frequência de consumo alimentar e outro contendo questões pessoais, sobre o perfil social e estilo de vida. Fez-se análise descritiva e estatística dos resultados, para verificar associação da mudança comportamental dos hábitos alimentares e estilo de vida dos acadêmicos de nutrição com o decorrer do curso. Apesar de encontrar transtorno alimentar leve e distorção da imagem corporal em todos os períodos, não houve diferença significativa entre as turmas avaliadas e nem presença significativa destes transtornos no grupo. No entanto, os hábitos alimentares, e consequentemente, o estado nutricional da maioria destes universitários se encontram adequados, fato que pode ter sido influenciado pela aquisição de novos conhecimentos na área.

The association of obesity with eating disorders risk: online survey of a large cohort of Russian-speaking individuals seeking medical weight correction assistance

Background Eating 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. Methods The 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. Results Women (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. Conclusions In 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 summary Obesity is a significant health problem. Different factors (e.g. social, biological, and behavioral) are important for their successful treatment. Abnormal eating behaviors may be one of the most likely predictors of increased body weight. This study aims to determine whether there is a significant association between obesity and scores on the eating behavior questionnaire-Eating Attitudes Test-26 (EAT-26)-in a large cohort of adults seeking medical weight correction assistance at a private weight loss clinic web-site. According to the study results, the association was shown for the male sex, older age, and higher Bulimia scores as measured on the EAT-26. Moreover, different EAT-26 scales were associated with obesity risks in women and men subgroups, while older age was a shared risk factor for obesity in both sexes. The findings may suggest sex-/age-specific diagnostic approach and treatment strategies for individuals with obesity.

Prevalencia de la Ortorexia Nerviosa en estudiantes universitarios españoles: relación con la imagen corporal y con los trastornos alimentarios

Introducción: El objetivo de este estudio fue examinar la prevalencia de la ON, y analizar su relación con la imagen corporal y conductas características de los Trastornos de la Conducta Alimentaria (TCA), en estudiantes universitarios. Método. Estudio transversal en el que participaron 534 estudiantes universitarios españoles, 422 mujeres y 112 hombres, con una edad media de 22,04 años (DT = 3,41). Se administraron los siguientes instrumentos: cuestionarios variables sociodemográficas y de hábitos alimentarios, el cuestionario ORTO-11-Es, la Teruel Ortorexia Scale (TOS), el Multidimensional Body Shape Relations Questionnaire (MBSRQ-45) y el Eating Attitudes Test (EAT-26). Resultados. El 30,5% de los estudiantes presentó un alto riesgo de ON. Se observaron mayores tendencias ortoréxicas en mujeres. El grupo que presentaba alto riesgo de ON frente al de bajo riesgo mostró un IMC medio-alto, seguían en mayor medida una alimentación de tipo vegano/vegetariano y presentaban puntuaciones significativamente superiores en el MBSRQ-45 (p=,00) y el EAT-26 (p=,00) Conclusiones. Los resultados obtenidos muestran una elevada prevalencia de ON en estudiantes universitarios y su relación con una peor imagen corporal, una mayor preocupación por el aspecto físico y con conductas características de los TCA. Background. The aim of this study was to examine the prevalence of ON and analyze its relationship with self-image and ED behavior in university students. Method. Cross-sectional study with a sample of 534 Spanish university students, 422 women and 112 men with an age mean of 22,04 (SD= 3,41). Questionnaires administered: a sociodemographic and lifestyle questionnaire, the ORTHO-11-Es, the Teruel Orthorexia Scale (TOS), the Multidimensional Body Self Relations Questionnaire (MBSRQ-45) and the Eating Attitudes Test (EAT-26). Results. 30,5% of the sample were on high risk of developing ON. Higher orthorexic tendencies were observed in women. Those at high risk of ON showed higher BMI, higher proportion of veganism/vegetarianism and significantly higher scores on the MBSRQ-45 (p=,00) and EAT-26 (p=,00). Conclusions. Results showed a high prevalence of ON and its relationship with a worse self-image, concern with physical appearance and ED behaviors.

Influência do comportamento alimentar e da imagem corporal na autoestima de indivíduos

Com o passar dos anos, os hábitos alimentares e o consumo alimentar ganharam uma nova forma e passaram a impactar em novas escolhas alimentares, uma vez que o ato de se alimentar sugere um momento de prazer e nutrição, o tipo de comportamento alimentar pode se referir a um momento de escape de emoções descontroladas podendo estar associado a transtornos alimentares. Com isso, a imagem corporal, principalmente após a evolução da mídia, representa um grande reconhecimento social que leva a interpretação de felicidade, confiança e autoestima. O presente estudo teve como objetivo principal, avaliar a percepção de satisfação com a imagem corporal e comportamento alimentar correlacionado a autoestima de adultos, voltado para uma pesquisa do tipo transversal e descritiva, avaliada por meio de questionários aprovados e publicados, sendo eles BSQ (Body Shape Questionnaire), Escala de Silhueta de Kakeshita, EAT-26 (Eating Attitudes Test) e Escala de Rosenberg. A amostra foi composta por 306 participantes, onde foi constatado que 36,3% da amostra encontra-se em excesso de peso (sobrepeso e obesidade) e 52% da amostra apresentam algum grau de insatisfação corporal. O público masculino na sua maioria apresenta estado de sobrepeso/obesidade, porém não demonstram insatisfação com o corpo se comparado com o público feminino que apresentou 45,4% para algum tipo de insatisfação corporal. Observou-se neste estudo, que 88,6% de todos os adultos estão com a autoestima baixa e que apenas 11,4% apresentam a autoestima elevada. Na coleta, dos 271 participantes com autoestima baixa, 26,6% apresentam maior risco para Transtorno Alimentar de acordo com o EAT-26. Portanto, é possível concluir que existe uma relação direta entre distorção de imagem corporal e baixa autoestima, como também, há uma maior relação entre risco de transtorno alimentar no público feminino.

Concern about appearance on Instagram and Facebook: Measurement and links with eating disorders

Appearance-related use of Social Networks (SNs) exhibits a clear relationship with the risk of eating disorders (ED). To determine which components of appearance-related use are most important for the detection and prediction of ED, it is necessary to measure concern about appearance on SNs in detail. The two main objectives of this study are to develop and validate the Concern about appearance on SNs scale (CONAPP), and to analyze the relationships between concern about appearance on SNs and the risk of ED. A total of 576 Spanish women over 18 years old, with an average age of 28.88 (SD = 11.14), participated in an online survey. We evaluated the use of the two most-commonly used SNs (Facebook and Instagram), concern about appearance on SNs, and eating attitudes (the latter through the Eating Attitudes Test-26). The psychometric properties of the CONAPP questionnaire were excellent. Strong positive correlations were found between concern about appearance on SNs and risk of ED. The pattern differed between users of Facebook and Instagram. Instagram users were younger, demonstrated higher risk of EDs and higher scores in the CONAPP questionnaire. The implications of the results for the prevention of ED are discussed.