David M. Garner, Ph.D.
The interpretation of the Eating Attitudes Test (EAT-26) is based on three “referral criteria” that determine if the respondent should seek further evaluation of your risk of having an eating disorder. These are:
1) The total score on the actual EAT test items;
2) Behavioral questions indicating possible eating disorder symptoms or recent significant weight loss;
3) Low body weight compared to age-matched norms.
If the respondent meets one or more of these criteria, they/you should seek an evaluation by a professional who specializes in the treatment of eating disorders.
Additional Interpretive Information:
• EAT-26 scores: A score at or above 20 on the EAT-26 indicates a high level of concern about dieting, body weight or problematic eating behaviors. If your score is above 20, you should seek an evaluation by a qualified health professional to determine if your score reflects a problem that warrants clinical attention. However, please keep in mind that high scores do not always reflect over-concern about body weight, body shape, and eating. Screening studies have shown that some people with high scores do not have eating disorders. Regardless of your score, if you are suffering from feelings which are causing you concern or interfering with your daily functioning, you should seek an evaluation from a trained mental health professional.
• Behavioral Questions: If you answered affirmatively to any of the behavioral questions, you should seek an evaluation from a trained mental health professional specializing in the treatment of eating disorders. It is important to consider the frequency and the context of the behaviors needs to determine the degree of medical risk they represent. For example, both vomiting and using laxatives for weight control confer serious medical dangers in direct relationship to their frequency. However, less frequent use of these behaviors is still a serious reason for concern since these behaviors tend to escalate over time.
• BMI: The EAT-26 includes specific questions on height, weight and gender that can be used to compute Body Mass Index (BMI) for the purpose of determining if you are “at risk” for an eating disorder because your body weight is extremely underweight according to age-matched population norms. BMI is a formula for estimating body mass that takes both height and weight into account. It is calculated by dividing weight (in kilograms) by height in meters, and then divided again by height in meters (kg/m2). Alternatively, BMI can be calculated as weight (in pounds) divided by height in inches, then divided again by height in inches and multiplied by 703. We recommend that you seek a professional evaluation for a possible eating disorder if your body weight is “extremely underweight” according to age-matched population norms.
Although BMI is a convenient and useful weight classification tool, it does have limitations. For example, BMI can overestimate fatness for people who are athletic. Also, some races, ethnic groups, and nationalities have different body fat distributions and body compositions; therefore, the norms used are not appropriate for all groups.