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Int J Eat Disord. 2019 Mar 2. doi: 10.1002/eat.23062. [Epub ahead of print]

Assessment of eating attitudes and dieting behaviors in healthy children: Confirmatory factor analysis of the Children's Eating Attitudes Test.

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Department of Epidemiology, Biostatistics, and Occupational Health, Faculty of Medicine, McGill University, Montreal, Quebec, Canada.
Department of Psychology, Faculty of Science, McGill University Montreal, Quebec, Canada.
Department of Pediatrics, Faculty of Medicine, McGill University Montreal, Quebec, Canada.
Bristol Medical School: Population Health Sciences, Faculty of Health Sciences, University of Bristol, Bristol, United Kingdom.
Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, United Kingdom.
University Hospitals Bristol National Health Service Foundation Trust, National Institute for Health Research Bristol Biomedical Research Centre, University of Bristol, Bristol, United Kingdom.
Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts.
Harvard Pilgrim Health Care Institute, Boston, Massachusetts.



The Children's Eating Attitudes Test (ChEAT) is a self-report questionnaire that is conventionally summarized with a single score to identify "problematic" eating attitudes, masking informative variability in different eating attitude domains. This study evaluated the empirical support for single- versus multifactor models of the ChEAT. For validation, we compared how well the single- versus multifactor-based scores predicted body mass index (BMI).


Using data from 13,674 participants of the 11.5 year-follow-up of the Promotion of Breastfeeding Intervention Trial (PROBIT) in the Republic of Belarus, we conducted confirmatory factor analysis to evaluate the performance of 3- and 5-factor models, which were based on past studies, to a single-factor model representing the conventional summary of the ChEAT. We used cross-validated linear regression models and the reduction in mean squared error (MSE) to compare the prediction of BMI at 11.5 and 16 years by the conventional and confirmed factor-based ChEAT scores.


The 5-factor model, based on 14 of the original 26 ChEAT items, had good fit to the data whereas the 3- and single-factor models did not. The MSE for concurrent (11.5 years) BMI regressed on the 5-factor ChEAT summary was 35% lower than that of the single-score models, which reduced the MSE from the null model by only 1%-5%. The MSE for BMI at 16 years was 20% lower.


We found that a parsimonious 5-factor model of the ChEAT explained the data collected from healthy Belarusian children better than the conventional summary score and thus provides a more discriminating measure of eating attitudes.


Republic of Belarus; adiposity; attitude; child; eating; factor analysis; psychology; statistical


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