 The adequacy of the four abilities model was challenged along these lines by Tan, Hope, Stewart and colleagues in a series of articles exploring the results of a small empirical study of patients with anorexia nervosa (Tan, Hope, &amp; Stewart 2003a,b; Tan, Stewart, Fitzpatrick, &amp; Hope 2006a,b; Tan, Stewart, &amp; Hope 2009). Ten young women with the illness were interviewed at length about their own understanding of their illness, why they pursued extreme weight loss, how they felt about treatment and what might lead them to refuse treatment. In addition, the women were all assessed for decision-making capacity using the MacCAT-T. They all scored very well on the MacCAT-T, demonstrating high levels of understanding and reasoning ability, with scores basically equivalent to healthy controls (Tan, Stewart, et al. 2006a: 270). By the typical, purely cognitive criteria of capacity assessment, they were all (or mostly all, depending on how much emphasis one places on appreciation)  competent.[3]  Yet most of them also clearly intended to keep trying to lose weight. The extremely high value they placed on being thin led them to downplay other values that had once been more central to them. As they explained to interviewers, thinness was more important to them than family, friends, education, work, and even life itself. In the words of one participant, 