EAT-26: Eating Attitudes Test

What this assessment is

EAT-26 is a self-report eating-disorder screen with a core total from 0 to 78. A total of 20 or higher is one reason for professional evaluation, but specified behavior and body-weight criteria can support evaluation below 20. No result diagnoses an eating disorder or determines medical stability.

David Garner, Marion Olmsted, Yvonne Bohr, and Paul Garfinkel developed the 26-item Eating Attitudes Test in 1982 as a shorter form of the original EAT-40. The original study established the shortened form in female anorexia nervosa and comparison samples.

Who it was designed for

The development study included 160 female patients with anorexia nervosa and 140 female comparison participants. Later studies have used EAT-26 with adolescents and adults in clinical, school, community, and research settings.

Performance can differ with age, gender, language, culture, medical history, and the reason for screening. Use a validated version and interpretation process for the population being assessed.

How it is administered

EAT-26 is self-completed. Its core section has 26 responses. The standard package also records specified behaviors and recent weight change, but those responses are not added to the core total.

Use the complete official form and scoring system. A shortened question set or changed response scale is not the EAT-26.

What it measures

The core total covers eating attitudes and behaviors associated with eating-disorder concerns. It cannot capture every presentation, current physical complication, or reason that a person may restrict, binge, purge, or experience weight change.

SCOFF is a shorter five-question suspicion screen. It uses a different response format and does not share the EAT-26 total or referral system.

How scoring works

Each core response scores from 0 to 3 under the official key. One item is keyed in the opposite direction. Add the 26 values for a total from 0 to 78.

The separate behavior and body-weight referral criteria do not add points to this total. Use the official key rather than assigning points from the visual order of the response choices.

The published total uses all 26 scored responses. No authoritative replacement or prorating rule was found, so do not treat missing responses as zero or report an incomplete form as a standard total without a validated protocol.

How to interpret an EAT-26 score

The developer's interpretation guidance identifies three separate reasons for professional evaluation:

• a core EAT-26 total of 20 or higher
• specified behavioral responses
• low body weight compared with age-matched norms

Meeting any one criterion can support evaluation. A total of 20 is not a diagnostic boundary, and a result below 20 cannot rule out an eating disorder. The standard interpretation system also does not define mild, moderate, or severe total-score bands.

Medical safety is separate from the score

EAT-26 cannot determine whether someone is medically stable. A person can have a lower total and still have serious dehydration, malnutrition, electrolyte disturbance, or another urgent complication.

The NICE eating-disorder guideline bases acute medical care on the person's physical state, including severe dehydration, severe malnutrition, severe electrolyte imbalance, or signs of organ failure, not on a screening total. Urgent symptoms need direct medical assessment regardless of the EAT-26 result.

Evidence and limitations

In the original development study, EAT-26 and EAT-40 totals correlated at 0.98. That close relationship supported shortening the form, but it did not establish one diagnostic accuracy estimate for every later population.

Translations, settings, sampling methods, and the mix of eating-disorder presentations differ across studies. Interpret the total with the separate referral criteria, current physical health, daily functioning, and a full clinical assessment.