The current study fills an important gap in the literature by examining the utility of a widely used measure of thin-ideal internalization in (a) identifying individuals with and without significant eating pathology, and (b) identifying an optimal cut score on the SATAQ-4 internalization: thin/low body fat subscale to distinguish those with clinically meaningful levels of internalization. T test and AUC results suggest that higher scores on the SATAQ-4-Thin relate to higher levels of disordered eating, and that the scale has acceptable accuracy in distinguishing between individuals with and without significant eating pathology. Further, results suggest that a cutoff score of 3.78 best differentiates individuals with and without clinically significant thin-ideal internalization. These results suggest that the measure may be clinically useful for identifying individuals with elevated eating disorder symptoms and dangerous levels of internalization. Although brief-eating disorder screening instruments such as the SCOFF are readily available [18], the SATAQ-4-Thin may serve as a meaningful adjunct instrument for treatment programs that target thin-ideal internalization. To adequately reduce risk for eating disorder onset or relapse, it may be important for intervention work to actively seek to reduce internalization levels below this clinical cutoff, though future work is needed to bear this out.

Limitations of the current study suggest avenues for future research. First, although the current study utilized established clinical cutoffs on a validated measure of eating pathology to identify disordered eating status, eating disorder diagnoses were not verified through a clinical diagnostic interview, which is considered to be the gold standard. Therefore, replication utilizing diagnostic interviews (e.g., Structured Clinical Interview for DSM-5 Disorders [19]) to establish eating disorder status represents an important avenue for future work. Second, as the current study examined SATAQ-4-Thin scores among individual with and without clinically significant disordered eating, the identified cutoff is best suited for identifying healthy versus actively ill individuals. Given the promise of prevention programs targeting thin-ideal internalization to ameliorate eating disorder risk, future work should seek to quantify specific levels of internalization (e.g., a SATAQ-4-Thin cutoff) that signifies increased versus decreased risk for future eating disorder onset or increase in symptoms. Such work would have important implications for identifying at-risk individuals who are likely to benefit most from these prevention approaches. Third, examination of score cutoffs among individuals in eating disorder remission or recovery also represents a valuable goal for future research as it is possible that individuals with a history of an eating disorder may be more vulnerable to relapse at lower levels of thin-ideal internalization. Fourth, the current sample is limited in terms of demographic diversity and findings may not generalize to men, younger/older populations, or more ethnically diverse populations. Therefore, future research is needed to clarify the clinical cutoffs on the SATAQ-4 internalization: thin/low body fat subscale among more diverse samples. Finally, although the current study sought to identify a cutoff that maximized both sensitivity (0.81) and specificity (0.64), it is important to note that the identified score demonstrates greater sensitivity than specificity, which is typically preferable in clinical settings. However, it may be preferable to utilize a cutoff that emphasizes specificity in other settings (e.g., research studies).

In sum, this is the first study to conduct a ROC curve analysis to identify a clinical cutoff on the SATAQ-4 internalization: thin/low body fat subscale, a widely used measure of thin-ideal internalization. Results indicate that the scale has good accuracy in identifying individuals with clinical levels of disordered eating, supporting the measure’s utility in clinical settings. Moderate levels of thin-ideal internalization (i.e., mean score of 3.78 on a 1–5 response scale) were found to signal increased risk for clinically significant eating pathology, emphasizing the potential hazard of pursuing a thin figure. Continued work is needed to replicate these findings and examine scale scores in additional populations.