Date Approved

2022

Degree Type

Open Access Dissertation

Degree Name

Doctor of Philosophy (PhD)

Department or School

Psychology

Committee Member

Claudia Drossel, PhD, Chair

Committee Member

Heather Hutchins-Wiese, PhD, RD

Committee Member

Tamara Loverich, PhD

Committee Member

Thomas Waltz, PhD

Abstract

The most commonly used screening tools for disordered eating, the Eating Attitudes Test (EAT-26) and Eating Disorders Examination–Questionnaire (EDE-Q), rely on the detection of shape and weight concerns to identify potentially dangerous caloric restriction among adolescent girls and young adult women. It is unclear how accurate these measures are at detecting restriction among adults 40 years and older. These adults may be vulnerable to developing or maintaining restrictive eating patterns when healthcare providers recommend weight loss as a preventative health measure or when acute or chronic illnesses (e.g., diabetes or cancers) impact eating. The present online study (a) evaluated the accuracy of and suggested optimal cut-scores for the EAT-26 and EDE-Q in this age group and (b) examined the accuracy of a measure of restricted energy intake for health-related reasons, i.e., the Orthorexia Nervosa Inventory (ONI). Of 145 participants, 60 completed demographic and health history surveys, EAT-26, EDE-Q, and ONI, and dietary recalls to examine energy intake. Receiver operating characteristics analyses used dietary recall data as an index criterion to determine the three measures’ accuracy at detecting participants who restricted their energy intake below estimated individual requirements. Results indicated that, contrary to initial hypotheses, the number of medical conditions did not affect energy restriction. Instead, participants who restricted their energy intake below requirements (n = 18) had higher BMIs and were more likely to have a medically prescribed diet than non-restrictors (n = 42). The EAT-26 and EDE-Q performed at the level of chance for detecting individuals whose dietary recalls indicated energy restriction, and the ONI performed in the acceptable range, using the cutoff score of ≥ 30 identified in the present study. Consequently, measures emphasizing altered eating patterns because of health concerns such as the ONI should be considered in clinical practice with middle and late life adults.

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