The EAT-26 has three subscales:

1. Dieting
2. Bulimia and Food Preoccupation
3. Oral Control

The measure can be used with adolescents (13+) and adults. It has also been validated in samples at high risk of eating problems such as female athletes and fashion models.

The EAT-26 is a useful screening tool in cosmetic settings for patients seeking body contouring procedures in particular, including liposuction, breast surgery and abdominoplasty.

It is estimated that there is a 5% lifetime prevalence of eating disorders in patients seeking aesthetic treatments, with the most common treatments undertaken being breast augmentation, rhinoplasty and liposuction. Around 11% of patients undertaking breast augmentation meet criteria for anorexia nervosa, and around 13% of liposuction patients meet criteria for bulimia nervosa. Individuals with eating disorders are at 4 times higher risk of experiencing a complication in the 30 days following a cosmetic surgery, when compared to the general patient population (Spataro et al., 2021).

Eating disorders can be associated with distorted body perception, low self-esteem and a heightened need for control which can increase the risk of dissatisfaction with a cosmetic procedure and experiencing greater challenges during recovery. Further, eating disorders can be associated with a range of physical health problems which may place the patient at greater risk of medical complications from a cosmetic surgery (Barone et al., 2024; D’Souza et al., 2020). Patients seeking body contouring surgery following bariatric surgeries have also been found to display higher rates of body image related distress, and eating disorder pathology (Bennett et al., 2021).

Some studies have demonstrated improvements in eating disorder pathology in patients following breast surgeries (both reductions and augmentations) as well as liposuction, while others have demonstrated negative patient outcomes. As such, if eating disorder risk is identified preoperatively, an individualised assessment is recommended to determine the suitability of the procedure (Barone et al., 2024). This may require additional specialist support from the patient’s GP or mental health professional.

Results consist of a total score and three subscales scores:

1) Dieting

2) Bulimia

3) Food Preoccupation and Oral Control

Higher scores indicate greater risk of an eating disorder and total scores 20 or above are considered to be in the clinical range.  In addition to the raw scores the results are presented as a percentiles based on a healthy female sample (n = 140) and a sample of anorexia nervosa patients (n = 160: Garner et al., 1982). A percentile of about 50 is typical in comparison to the anorexia nervosa group for someone suffering from an eating disorder.

The four behavioural questions (questions 27, 28, 29, 30 and 31) are not included in the calculation of the above scores, but are major risk factors important to the health of people with an eating disorder.

While developing the scale Garner et al. (1982) validated the long version (EAT-40) and short version (EAT-26) with 160 females with anorexia nervous and compared the results to a sample of 140 healthy females. It was able to discriminate between these groups and the subscales were found to have high internal consistency. The normative data from this research can be used to compute percentile comparisons.

The EAT-26 is well-validated with female samples, with scores on the EAT-26 being highly predictive of scores on the original EAT-40 and other validated measures (Garner et al., 1982). The scale can be used in men however comparison groups are not available at this time.

The EAT-26 has been validated against the Short Form – 36 questionnaire in adolescents seeking reduction mammaplasty, with higher EAT-26 scores associated with poorer mental health on the SF-36 (McNamara et al., 2023). Following reduction mammaplasty in adolescents, eating disorder symptoms on the EAT-26 improved, except in young people with anxiety (White et al., 2023). Similar improvements in EAT-26 scores have been observed in adults following breast reduction surgery (Losee et al., 2004).