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December 26, 2018

Eating Disorder Testing in Arabian Young Women

Arabian woman taking Eating Disorder Test

Disordered eating attitudes and behaviors (DEAB), are those behaviors that are associated with an increased risk of eating disorders and obesity [1].

While various cultures differ in respect to many diverse beliefs, governmental systems, cultural expectations, etc., DEAB is known to be a global phenomenon and can include behaviors such as “dieting, fasting, abusing laxatives or diuretics, self-induced vomiting or binge eating [1].”

However, just because these behaviors occur globally does not mean they display the same way or be measured using the same testing instruments.

A recent study published in the Journal of Eating Disorders considered this aspect and addressed the question of whether or not one of the most widely-used measures of DEAB is accurate in the screening of disordered eating in young, Arabic-speaking, females [1].

The Test in Question

The test that this study examined is the Eating Attitudes Test, often referred to as EAT.

This test was originally 40 questions but has been shortened to 26 over time, hence the “26” in “EAT-26.”

Each of these 26 questions falls into one of the three subscales being measured:

  1. Dieting (items related to “avoidance of fattening foods and preoccupation with being thinner [1].)”
  2. Bulimia and Food Pre-occupation
  3. Oral Control

All the items an individual scores for are added up to help the test administrator determine an individual’s risk in each area.

The test does not yield an eating disorder diagnosis; however, it is often used as a two-factor screening process indicating those individuals that should be examined by an eating disorder professional to determine whether a diagnosis is fitting.

The Debate

The EAT-26 has been translated into multiple languages and contexts and tested with English and Non-English speaking individuals, however, the measures’ subscales have created challenges in using the tests in other countries.

Many cultures vary in the number of factors they believe are represented in the test.

In fact, most English-speaking countries report more than the three factors the test has, and indicate it is likelier 4 or 5 [1].

Non-English speaking countries report, on average, 4 to six factors [1].

One study examined one of the most ethnically diverse populations ever used to study the EAT-26 and found six factors: Fear of Getting Fat, Eating-Related Control, Eating-Related Guilt, Food Preoccupation, Vomiting-Purging Behavior, and Social Pressure to Gain Weight [1].

The number of factors was inconclusive in studies done in the Middle East as well, with one researcher determining the EAT-26 is helpful to screen for dieting and weight-related concerns but not bulimic symptoms [1].

The discrepancies in each of these cultures have led to debate as to whether the EAT-26 is a useful screening tool to be used globally.

The Results

The aim of the study was to determine the factorial structure of the EAT-26 in young, female, Arab students.

Arabian Young Woman

One of the important findings of the study was that it supported other studies that have found a five-factor, 19 item version of the EAT to be reliable in measuring disordered eating behaviors in young Arab women [1].

However, one aspect raised red flags.

The study found that “even when levels on the DEAB construct are identical, young Arab females belonging to different BMI-groups would still score higher or lower on the different items, giving the false impression of higher or lower levels of DEAB [1].”

This led researchers to conclude that the EAT-26, or other, shortened versions, pose measurement challenges in screening for disordered eating in young Arab women of varying body weight.

What’s the Point?

Among the complicated research terms and processes, the bottom line is that the EAT-26, or shortened versions, score as “close but no cigar” when it comes to measuring disordered eating behaviors in young Arab women.

Cultures vary on so many levels including societal expectations, beliefs, and languages. As such, it will be difficult to find one eating disorder screening that can be adapted to all of them.

The EAT-26 comes close, but researchers in all countries are continually researching and learning the most reliable screenings for their cultures.


[1] Khaled, S. M. Kimmel, L., Trung, K. L. (2018). Assessing the factor structure and measurement invariance of the eating attitude test (EAT-26) across language and BMI in young Arab women. Journal of Eating Disorders, 6:14.

Image of Margot Rittenhouse.About the Author: 

Margot Rittenhouse, MS, PLPC, NCC is a therapist who is passionate about providing mental health support to all in need and has worked with clients with substance abuse issues, eating disorders, domestic violence victims, and offenders, and severely mentally ill youth.

As a freelance writer for Eating Disorder Hope and Addiction Hope and a mentor with MentorConnect, Margot is a passionate eating disorder advocate, committed to de-stigmatizing these illnesses while showing support for those struggling through mentoring, writing, and volunteering. Margot has a Master’s of Science in Clinical Mental Health Counseling from Johns Hopkins University.

The opinions and views of our guest contributors are shared to provide a broad perspective of eating disorders. These are not necessarily the views of Eating Disorder Hope, but an effort to offer a discussion of various issues by different concerned individuals.

We at Eating Disorder Hope understand that eating disorders result from a combination of environmental and genetic factors. If you or a loved one are suffering from an eating disorder, please know that there is hope for you, and seek immediate professional help.

Published on December 26, 2018.
Reviewed & Approved on December 26, 2018, by Jacquelyn Ekern MS, LPC

Published on EatingDisorderHope.com

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