Psychometric evaluation of disordered eating measures in bariatric surgery patients

Development and validation of a healthy diet and physical activity tool based on health action process approach among patients undergone bariatric surgery

Background

The purpose of this study was to develop and evaluate the validity and reliability of a healthy diet and physical activity assessment tool among patients one year after bariatric surgery based on Health Action Process Approach.

Methods

We compiled 53 items based on healthy diet and physical activity behaviors among patients undergone bariatric surgery through reviewing the literature. Using quantitative and qualitative methods, and a panel of experts, we evaluated the face and content validities of the tool. The reliability was evaluated by Intra-class correlation coefficient and Cronbach's alpha.

Results

The content validity ratio and the content validity index were 0.62 and 0.79, respectively. Exploratory factor analysis showed seven factors, including risk perception, outcome expectations, task self-efficacy, coping, recovery self-efficacy, action planning, coping planning, and behavioral intentions. The Intra-class correlation coefficient was between 0.8 and 0.91; and Cronbach's alpha for different constructs was between 0.8 and 0.95.

Conclusion

The findings showed that the constructs of the Health Action Process Approach tool regarding healthy diet and physical activity had adequate validity and reliability in bariatric surgery patients.

Emotional Eating and Uncontrolled Eating as Risk Predictors for Disordered Eating Attitudes in Candidates for Bariatric Surgery Treated at a Public Hospital in the Amazon

This study analyzes the eating behavior and factors associated with the presence of disordered eating attitudes in patients undergoing bariatric surgery. It is a cross-sectional, descriptive, and analytical study conducted at a hospital in the Amazon region of Brazil. The Disordered Eating Attitude Scale reduced version (DEAS-s) was used to assess the risk of eating disorders and the Three-Factor Eating Questionnaire (TFEQ-R21) was used to characterize eating behavior. A total of 205 patients participated, with a mean age of 37.5 ± 8.6 years. The majority of participants were female (93.7%; p < 0.001), and the mean BMI was 45.3 ± 6.7 kg/m2. It was found that cognitive restraint had the highest mean (52.6 ± 19.9; p < 0.001). As for the DEAS-s, the question with the highest mean response was "spending one or more days without eating or consuming only liquids to lose weight" (2.80 ± 1.99). Female participants had a higher score for emotional eating (p = 0.016). Disordered eating attitudes showed a correlation with emotional eating and uncontrolled eating. These results suggest that candidates for bariatric surgery may have susceptibility to eating disorders. The importance of a multidisciplinary team conducting monitoring during the preoperative period is highlighted.

Patients' Pre and Post-Bariatric Surgery Experience of Dieting Behaviours: Implications for Early Intervention

PURPOSE

Bariatric surgery works, in part, by surgically changing signals of hunger and satiety to achieve weight loss. Not all patients experience optimal outcomes. One potential explanation is that post-surgery dieting may subvert the ability to identify physiological cues of hunger and fullness. Dieting behaviours (e.g. restriction/cognitive restraint) are correlated with disordered eating, and disordered eating implicated in poor outcomes. This study examines the experience of dieting after bariatric surgery.

METHOD

Seventeen adult participants who had undertaken bariatric surgery and residing in Australia participated in semi-structured interviews. Surgeries occurred in 2021 (n = 8), 2020 (n = 4), 2019 (n = 2), and one participant each had surgery in 2014, 2009, and 2004. Thematic analysis elicited themes related to post-operative dieting.

RESULTS

All participants reported chronic pre-surgery dieting. Lifestyle change was the overarching post-surgical theme comprising (i) flexibility (e.g. allowing food, intuitive eating), and (ii) control, comprising surgery control (e.g. set portions, surgery instilled control) and dieting control (e.g. discipline, restriction/restraint). Descriptions of lifestyle change often mirrored pre-surgery descriptions of dieting.

CONCLUSION

Post-surgery lifestyle change appears to encompass a tension between flexible/adaptive approaches to eating and the need to maintain control. Control may emerge as practices that mirror pre-surgery dieting with the potential to interfere with adaptive eating behaviours or promote disordered eating. Dieting behaviours may be a precursor to the development of disordered eating. Health care practitioners should regularly assess dieting behaviour post-surgery to enable early intervention where warranted. Future research should consider how post-surgery re-emerging dieting may be identified and measured to aid in intervention.

Management of eating disorders for people with higher weight: clinical practice guideline

INTRODUCTION

The prevalence of eating disorders is high in people with higher weight. However, despite this, eating disorders experienced by people with higher weight have been consistently under-recognised and under-treated, and there is little to guide clinicians in the management of eating disorders in this population.

AIM

The aim of this guideline is to synthesise the current best practice approaches to the management of eating disorders in people with higher weight and make evidence-based clinical practice recommendations.

METHODS

The National Eating Disorders Collaboration Steering Committee auspiced a Development Group for a Clinical Practice Guideline for the treatment of eating disorders for people with higher weight. The Development Group followed the 'Guidelines for Guidelines' process outlined by the National Health and Medical Research Council and aim to meet their Standards to be: 1. relevant and useful for decision making; 2. transparent; 3. overseen by a guideline development group; 4. identifying and managing conflicts of interest; 5. focused on health and related outcomes; 6. evidence informed; 7. making actionable recommendations; 8. up-to-date; and, 9. accessible. The development group included people with clinical and/or academic expertise and/or lived experience. The guideline has undergone extensive peer review and consultation over an 18-month period involving reviews by key stakeholders, including experts and organisations with clinical academic and/or lived experience.

RECOMMENDATIONS

Twenty-one clinical recommendations are made and graded according to the National Health and Medical Research Council evidence levels. Strong recommendations were supported for psychological treatment as a first-line treatment approach adults (with bulimia nervosa or binge-eating disorder), adolescents and children. Clinical considerations such as weight stigma, interprofessional collaborative practice and cultural considerations are also discussed.

CONCLUSIONS

This guideline will fill an important gap in the need to better understand and care for people experiencing eating disorders who also have higher weight. This guideline acknowledges deficits in knowledge and consequently the reliance on consensus and lower levels of evidence for many recommendations, and the need for research particularly evaluating weight-neutral and other more recent approaches in this field.

Interrater reliability and internal consistency of the eating disorder examination in the longitudinal assessment of bariatric surgery study

BACKGROUND

Psychometric studies of eating disorder measures within bariatric surgery populations are limited.

OBJECTIVES

To examine the interrater reliability and internal consistency of the Eating Disorder Examination (EDE) among patients before and after bariatric surgery.

SETTING

Three clinical centers of the Longitudinal Assessment of Bariatric Surgery Research Consortium.

METHODS

The EDE-Bariatric Surgery Version was administered and audio-recorded by trained interviewers before and at annual assessments after bariatric surgery. Approximately 20% of interviews were randomly selected for rating by a second interviewer. Reliability of the original and brief EDE subscales was examined.

RESULTS

Interrater reliability of the EDE subscales ranged from .86-.97 for the original subscales and .83-.95 for brief subscales before surgery, and .90-.98 for the original subscales and .92-.97 for brief subscales after bariatric surgery. Interrater agreement (based on kappa) was almost perfect for overeating and binge-eating behaviors and substantial for loss-of-control eating before surgery. Similar interrater agreements (based on kappa) were observed after surgery for subjective overeating and binge-eating episodes. Internal consistency of the subscale and global scores was variable, ranging from .41-.97.

CONCLUSION

Findings provide support of the interrater reliability of the EDE, albeit with variable internal consistency, before and after bariatric surgery. Despite support for trained raters to reliably assess EDE constructs, variability in internal consistency suggests that further psychometric testing and rigorous scale development of disordered eating may be needed for the bariatric surgery population.

Structural validity of the Eating Disorder Examination-Questionnaire: A systematic review

OBJECTIVE

The main aim was to perform a systematic literature review of studies investigating the factor structure of the Eating Disorder Examination-Questionnaire (EDE-Q), a widely used measure of eating pathology. Secondary aims were to summarize the quality of reporting of latent variable (factor) analyses in these studies and review support for different factor solutions.

METHOD

Literature was identified through Scopus, Medline, PsycInfo, and ProQuest databases published up to February 23, 2022 and outreach via an international listserv. All studies published in English reporting factor analysis of the EDE-Q were included with few restrictions. Sixty studies including 63,389 participants met inclusion criteria.

RESULTS

The originally proposed four-factor solution received little empirical support, although few alternative models have been robustly evaluated. Items assessing shape and weight concerns frequently coalesce in factor solutions, suggesting that these constructs are closely related. Investigations of brief versions of the EDE-Q have produced more consistent findings, suggesting that these measures, particularly a seven-item version, might be useful alternatives to the full version. Quality of studies was reasonable, with important methodological elements of factor analysis often reported.

DISCUSSION

The findings are of relevance to practitioners and researchers, suggesting that the "original" factor structure of the EDE-Q should be reconsidered and that use of a seven-item version is to be encouraged.

PUBLIC SIGNIFICANCE

Self-report questionnaires are widely used in the assessment of disordered eating. The current study found that there is little consensus about the structure of a common measure of eating psychopathology. There is more consistent support for a brief, seven-item, version assessing dietary restraint, body dissatisfaction, and overvaluation of weight and shape.

The eating disorder examination questionnaire for adults from the Mexican general population: Reliability and validity

The Eating Disorder Examination Questionnaire is a widely used self-report questionnaire for eating disorders. An Eating Disorder Examination Questionnaire model that is not lacking in relevant content has been supported in three different samples, but existing studies on this model present shortcomings regarding generalizations to the general population. Therefore, the general purpose of the current research was to test the reliability and interpretation validity of the Eating Disorder Examination Questionnaire 6.0 scores in adults of both sexes from the Mexican general population. After translating, adapting, and assessing the Eating Disorder Examination Questionnaire 6.0 in the target population through three pilot studies, we conducted two independent studies. In Study 1, 684 women and 433 men aged 18–83 participated, whereas in Study 2, 591 women and 382 men aged 18–86 did it. They answered the Eating Disorder Examination Questionnaire 6.0 and a measure of either body dissatisfaction (Study 1) or self-esteem (Study 2). According to confirmatory factor analyses, the 14-item Eating Disorder Examination Questionnaire model that we tested fit acceptably for the four samples (two female, two male) and was invariant across sex. All 14-item Eating Disorder Examination Questionnaire 6.0 scores were reliable according to Cronbach’s alpha and McDonald’s omega, except for only one factor score in men. Pearson’s correlations of the 14-item Eating Disorder Examination Questionnaire 6.0 scores with body dissatisfaction and self-esteem were positive and negative, respectively. This new Latin American Spanish translation of the Eating Disorder Examination Questionnaire 6.0 works broadly as expected and provides evidence to extend the generalization of previous studies to the general population. Thus, the present translation of the Eating Disorder Examination Questionnaire 6.0 may be a valuable tool in the field of eating disorders for researchers and practitioners studying or serving Latin American Spanish speakers of either sex from the general population.

Relationships Among Childhood Maltreatment, Limbic System Dysfunction, and Eating Disorders in College Women

The mechanisms linking childhood maltreatment and eating pathology are not fully understood. We examined the mediating role of limbic system dysfunction in the relationships between three forms of childhood maltreatment (parental psychological maltreatment, parental physical maltreatment, and parental emotional neglect) and eating disorder symptoms. A convenience sample of college women (N = 246, M age = 19.62, SD = 2.41) completed measures of maltreatment (Parent-Child Conflict Tactics Scales and the Parental Bonding Instrument), limbic system dysfunction (Limbic System Questionnaire), and eating pathology (Eating Disorder Examination Questionnaire). We hypothesized that there would be an indirect effect of each type of childhood maltreatment on eating disorder symptoms via limbic system irritability. Results generally supported the hypotheses. Examination of the individual paths that defined the indirect effect indicated that higher reported childhood maltreatment was associated with greater limbic irritability symptoms, and higher limbic irritability symptomatology was related to higher total eating disorder scores. There were no significant direct effects for any of the proposed models. Findings are in line with research supporting the role of limbic system dysfunction as a possible pathway in the maltreatment-eating disorder link. Given that limbic system dysfunction may underlie behavioral symptoms of eating disorders, efforts targeting limbic system dysfunction associated with child maltreatment might best be undertaken at an early developmental stage, although interventions for college women struggling with eating disorders are also crucial.

Comparison of two questionnaires for assessment of emotional eating in people undergoing treatment for obesity

PURPOSE

Emotional eating may contribute to weight gain and difficulty with weight loss. Questionnaires are currently the primary method used to identify this behaviour but there is no gold standard for detecting emotional eating, making it difficult to know which questionnaire to use for this purpose. This study assesses two questionnaires validated for assessment of emotional eating in patients with obesity, with the aim of investigating their interchangeability in the clinical setting.

METHODS

387 adult participants were recruited from the obesity treatment service at a tertiary metropolitan hospital. Responses were obtained for the 25-item Emotional Eating Scale (EES) and the 4-item coping subscale of the Palatable Eating Motives Scale (PEMS). Agreement was analysed using quadratically weighted Cohen's κ scores. Substantial agreement was defined as κ 0.61-0.80.

RESULTS

The median (interquartile range) body mass index and age of participants was 42.1 kg/m² (36.4-48.9 kg/m²) and 51.6 years (41.1-61.4 years), respectively, and 70.5% of participants were female. The EES and PEMS were found to have substantial agreement (κ 0.71; 95% CI 0.65-0.76). Agreement remained substantial when analysing responses from men (0.61; 95% CI 0.47-0.73), women (0.73; 95% CI 0.67-0.79) and post-bariatric surgery patients (0.72; 95% CI 0.62-0.82) separately.

CONCLUSION

Despite focusing on different elements of emotional eating behaviour, the substantial agreement between the EES and PEMS coping subscale suggests that they identify respondents' susceptibility to emotional eating with consistency, including in people who have undergone bariatric surgery.

LEVEL V

Opinions of respected authorities, based on descriptive studies, narrative reviews, clinical experience, or reports of expert committees.

CLINICAL TRIAL REGISTRATION

This observational study has not been registered as a clinical trial.

Psychometric properties of the adapted Malay Eating Disorder Examination-Questionnaire 6.0 (EDE-Q 6.0) among university students in Malaysia

The "Eating Disorder Examination-Questionnaire" (EDE-Q) is a cost-effective eating disorder (ED) screening tool that has a significant relationship with the gold standard "Eating Disorder Examination" (EDE) interview. Though it has been widely used for clinical and research purposes, there is a dearth of effort to establish psychometric properties of the latest EDE-Q 6.0 in the Malaysian sample. The extant study adapted and validated EDE-Q 6.0 on Malaysian university's student population (N = 595) from a public university in the Klang Valley, Malaysia. Four factors of Restraint, Shape and Weight Concerns, Eating Concerns, and Shape/Weight Overvaluation were constituted from exploratory factor analysis. Still, they failed to indicate apparent replication of the original English EDE-Q 6.0. Malay EDE-Q 6.0 exhibited high internal consistency reliability (α = 0.93), acceptable test-retest reliability over 14 days, and acceptable equivalence reliability of its items with the original English version items. The Malay EDE-Q 6.0 global and subscales scores attained acceptable validity with the global scores of Malay EAT-26 (another ED scale) as evidence of convergent validity and with quality of life (QoL) scale for divergent validity. Accordingly, the adapted EDE-Q 6.0 Malay version is considered a valid and reliable instrument for assessing eating disorder psychopathology among Malaysian university students.

The Development of Feeding and Eating Disorders after Bariatric Surgery: A Systematic Review and Meta-Analysis

Background: Patients in the postoperative period following bariatric surgery are at risk of developing eating disorders. This study aims to analyze the relation between bariatric surgery and the development and recurrence of eating disorders. Material and methods: A literature review was carried out on 15 November 2020. Fourteen studies that met the eligibility criteria were included for qualitative synthesis, and 7 studies for meta-analysis. Results: The prevalence of eating disorders in the postoperative period was 7.83%, based on the 7 studies in the meta-analysis. Binge eating disorder alone was 3.81%, which was the most significant factor, and addressed in 6 of these studies. Conclusion: The investigated studies have significant methodological limitations in assessing the relation between bariatric surgery and eating disorders, since they mostly present data on prevalence. PROSPERO CRD42019135614.

Disordered eating following bariatric surgery: a review of measurement and conceptual considerations

Eating disorders are associated with significant medical morbidity and mortality and serious psychological impairment. Individuals seeking bariatric surgery represent a high-risk group for evidencing disordered eating and eating disorders, with some patients experiencing the persistence or onset of disordered eating postsurgery. This review synthesizes the available literature on problematic or disordered eating in the bariatric field, followed by a review of measurement and conceptual considerations related to the use of eating disorder assessment tools within the bariatric population.

Psychosocial interventions to reduce eating pathology in bariatric surgery patients: a systematic review

Bariatric surgery is the most effective treatment for severe obesity; however, a subset of patients experience suboptimal outcomes. Psychosocial interventions that address eating pathology may ameliorate negative consequences, although their efficacy has not been examined. Thus, a systematic review to evaluate the impact of psychosocial randomized controlled trials (RCTs) on eating pathology in adults pre and post-bariatric surgery was conducted. Six scientific databases were searched for psychosocial trials assessing eating pathology as an outcome. Ten RCTs representing seven distinct interventions were identified (i.e., four preoperative and six postoperative). Trials utilized cognitive-behavioral therapy, mindfulness-based approaches, acceptance-based treatment, motivational interviewing, and psychoeducational interventions. Findings provide initial support for reducing eating pathology pre and postoperatively in the short-term (i.e., 6 months); however, the small number of RCTs and heterogeneity among postoperative trials made it difficult to draw conclusions. Additional longitudinal studies are needed to determine the long-term impact of psychosocial interventions that address eating pathology in bariatric surgery patients endorsing significant eating pathology.

Interrater reliability of the Eating Disorder Examination among postbariatric patients

BACKGROUND

Clinical assessment of eating behaviors with patients who undergo bariatric surgery is challenging because of the complexity of symptom presentation postoperatively. The Eating Disorder Examination (EDE) is a widely-used semistructured clinical interview of eating-disorder psychopathology, yet no studies have examined the interrater reliability among postoperative bariatric surgery patients.

OBJECTIVES

The present study aimed to examine the interrater reliability of the EDE, and an alternative classification of size-specific thresholds of binge-eating episodes in a postoperative bariatric surgery sample.

SETTING

University School of Medicine, United States.

METHODS

Participants interviewed were a randomly selected subset (n = 20) from a consecutive series of adults seeking treatment for eating concerns after bariatric surgery. Audio-taped interviews were rated independently by 1 of 4 expert raters. Interrater reliability was assessed using intraclass correlation coefficients (ICC) and kappa statistic.

RESULTS

ICCs for the original 4 EDE subscales were excellent, ranging from .88 to .98. ICCs for the alternative brief 3 subscales were also excellent, with a range of .78 to .97. ICCs for bariatric loss-of-control eating episodes were in the good to excellent range, with a range of .66 to .99. Kappa agreement for bariatric overeating episodes was moderate (.60).

CONCLUSIONS

These findings, based on 4 expert raters, suggest that complex eating-disorder psychopathology, as well as the newly proposed eating behavior with size thresholds relevant to bariatric patients, can be reliably assessed. To our knowledge, this is the first study to provide initial evaluation and support for the interrater reliability of the original EDE with additional modified eating categories developed for postbariatric surgery patients.

Quality of Life One Year After Bariatric Surgery: the Moderator Role of Spirituality

BACKGROUND

This study aimed to assess quality of life in obese patients 1 year after bariatric surgery taking into consideration the influence of socio-demographic, clinical, and psychological variables.

METHODS

A sample of 90 patients undergoing bariatric surgery was assessed in two moments: before surgery and 1 year after surgery.

RESULTS

Social support, problem-focused coping strategies, and quality of life increased after surgery, while eating disorder behaviour and impulsiveness decreased. The presence of eating disorder behaviour predicted worse physical and mental quality of life and higher satisfaction with social support predicted better physical and mental quality of life. In addition, higher impulsiveness predicted worse mental quality of life. Spirituality moderated the relationship between impulsiveness and mental/physical quality of life.

CONCLUSIONS

Interventions should focus on promoting social support and coping strategies particularly spirituality since it played an important role in quality of life.

Pre-operative Restraint and Post-operative Hunger, Disinhibition and Emotional Eating Predict Weight Loss at 2 Years Post-laparoscopic Adjustable Gastric Banding

INTRODUCTION

A principal mechanism of action in bariatric surgery is reduction in calorie consumption due to decreased hunger and increased satiety. Patients' ability to perceive post-operative changes to their hunger is therefore central to optimal results. This study examined factors that may impact how patients perceive post-operative hunger and how perception of hunger impacts eating and subsequent weight loss after laparoscopic adjustable gastric banding (LAGB).

METHODS

Patients undertaking LAGB (n = 147) provided pre-surgery and 2-year weight loss data and pre-surgery and 12-month psychological data (perception of hunger, disinhibition related to eating, emotional eating).

RESULTS

Path analysis demonstrated that patients with lower levels of pre-surgery cognitive restraint over eating experienced significantly greater reduction in perception of hunger at 12 months post-surgery. Perceived reduction in hunger was significantly associated with lower levels of both emotional eating and disinhibited eating. Finally, reduced emotional eating at 12 months significantly predicted 9% of the variance in percentage of total weight loss (%TWL) at 2 years after surgery.

CONCLUSION

These initial findings suggest that preparation for bariatric surgery may be enhanced by psychoeducation regarding cognitive restraint over eating and its effect on hunger perception. In addition, psychological treatment that focuses on identifying and responding to changes in hunger may contribute to improved outcomes for those who have difficulty adjusting to post-operative eating behaviours.

Obesity and Eating Disturbance: the Role of TFEQ Restraint and Disinhibition

PURPOSE OF REVIEW

Literature from the past five years exploring roles of Three-Factor Eating Questionnaire (TFEQ) Restraint and Disinhibition in relation to adult obesity and eating disturbance (ED) was reviewed.

RECENT FINDINGS

Restraint has a mixed impact on weight regulation, diet quality, and vulnerability to ED, where it is related detrimentally to weight regulation, diet, and psychopathology, yet can serve as a protective factor. The impact of Disinhibition is potently related to increased obesity, poorer diet, hedonically driven food choices, and a higher susceptibility to ED. Restraint and Disinhibition have distinct influences on obesity and ED and should be targeted differently in interventions. Further work is required to elucidate the mechanisms underlying TFEQ eating behavior traits.

Systematic review of body image measures

This systematic review synthesizes and critically appraises measurement properties of influential body image measures. Eight measures that met the definition of an assessment of body image (i.e., an individual's cognitive or affective evaluation of their body or appearance with a positive or negative valence), and scored high on systematic expert priority ranking, were included. These measures were: the Body Appreciation Scale (original BAS and BAS-2), the Body Esteem Scale for Adolescents and Adults, the Body Shape Questionnaire, the Centre for Appearance Research Valence Scale, the Drive for Muscularity Scale, two subscales of the Eating Disorders Examination Questionnaire, one subscale of the Eating Disorder Inventory 3, and two subscales of the Multidimensional Body Relations Questionnaire. Articles assessing these scales' psychometric properties (N = 136) were evaluated for their methodological quality using the Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) checklist, and a best evidence synthesis was performed. The results supported the majority of measures in terms of reliability and validity; however, suitability varied across populations, and some measurement properties were insufficiently evaluated. The measures are discussed in detail, including recommendations for their future use in research and clinical practice.

Psychometric properties of the eating loss of control scale among postbariatric patients

BACKGROUND

Assessing the complexities of eating behaviors in patients who undergo bariatric surgery is challenging. The Eating Loss of Control Scale (ELOCS), a measure of loss-of-control (LOC) eating, has not yet been evaluated psychometrically among bariatric surgery patients.

OBJECTIVE

This study presents a psychometric examination of the ELOCS in postoperative bariatric surgery patients.

SETTING

Academic medical center in the United States.

METHODS

One hundred seventy-one postbariatric treatment-seeking adults (82.5% female, 52.4% white) with LOC eating completed the ELOCS and measures assessing eating psychopathology and mood. Confirmatory factor analysis (CFA) was used to test fit for a 1-factor solution. Exploratory factor analysis (EFA) examined alternative factor structures.

RESULTS

CFA revealed poor fit for a 1-factor structure (χ² = 220.375, degrees of freedom = 135, P < .001, comparative fit index = .917, Tucker-Lewis index = .906, root mean square error of approximation = .067). EFA data suggested an alternative factor solution (χ² = 157.76, degrees of freedom = 118, P = .009, comparative fit index = .965, Tucker-Lewis index = .955, root mean square error of approximation = .047). Factor 1 (α = .88) reflected behavioral aspects and factor 2 (α = .92) reflected cognitive/emotional aspects of LOC eating. Bivariate correlations with measures of eating and other psychopathology suggested good construct validity for factors.

CONCLUSIONS

Findings suggest possible differences in the construct validity of the ELOCS among postbariatric patients. The 1-factor solution previously supported in clinical and nonclinical groups demonstrated poor fit. EFA revealed a possible alternative 2-factor solution that aligns with emerging literature, suggesting that LOC eating presents differently in postbariatric patients. Researchers interested in LOC eating among bariatric patients should consider use of the ELOCS and testing the proposed alternative factor structure.

Psychometric Characteristics of the Revised Illness Perception Questionnaire (IPQ-R) in People Undergoing Weight Loss Surgery

The Illness Perception Questionnaire-Revised (IPQ-R) has been used extensively across many health conditions to measure patient illness and treatment perceptions. The constructs have an association with treatment adaptation and adherence which, in turn, are considered core factors involved in bariatric surgery outcome. This study examines the factorial validity and internal reliability of a modified (IPQ-R) in bariatric surgery candidates. After wording modifications, participants (N = 310) completed the IPQ-R as part of standard pre-surgery assessments. After removal of two items, confirmatory factor analysis (CFA) supported the original 7-factor solution of the Beliefs scale, with good to marginal subscale internal consistency. Exploratory factor analysis (EFA), with two items removed only partially supported the original 5-factor Causal Attributions scale. Internal consistency was unacceptably low for two subscales. Further research is needed to generate new items which better fit the IPQ-R to this population before research can explore the relevance of illness perceptions.

Psychometric Properties of the Eating Disorder Examination–Questionnaire (EDE-Q): A Confirmatory Factor Analysis and Assessment of Measurement Invariance by Sex

The original, theoretically derived factor structure of the Eating Disorder Examination–Questionnaire (EDE-Q) has received limited empirical support and there is no consensus on an appropriate alternative. Moreover, there is a paucity of data on the factor structure of the EDE-Q across sexes. The goals of the current study were to evaluate models of the EDE-Q factor structure and to assess the best-fitting model for differences by sex. Twelve models were compared using confirmatory factor analysis in a sample of 940 undergraduates. Confirmatory factor analysis did not support the original factor structure. A four-factor model fit the data reasonably well with factors corresponding to themes of (a) dietary restraint, (b) preoccupation and restriction, (c) weight and shape concern, and (d) eating shame. The EDE-Q was found to be invariant by sex across all factors except Factor 3. The implications of these findings are discussed.

Evidence That the Clinical Impairment Assessment (CIA) Subscales Should Not Be Scored: Bifactor Modelling, Reliability, and Validity in Clinical and Community Samples

Aim: The Clinical Impairment Assessment (CIA 3.0) is the most widely used instrument assessing psychosocial impairment secondary to eating disorder symptoms. However, there is conflicting advice regarding the dimensionality and optimal method of scoring the CIA. We sought to resolve this confusion by conducting a comprehensive factor analytic study of the CIA in a community sample ( N = 301) and clinical sample comprising patients with a diagnosed eating disorder ( N = 209). Convergent and discriminant validity were also assessed. Method: The CIA and measures of eating disorder symptoms were administered to both samples. Results: Factor analyses indicated there is a general impairment factor underlying all items on the CIA that is reliably measured by the CIA Global score. CIA Global demonstrated good convergent and discriminant validity. Conclusions: CIA Global is a reliable and valid measure of psychosocial impairment secondary to eating disorder symptoms; however, subscale scores should not be computed.

Factor analysis of the adolescent version of the Eating Disorders Examination Questionnaire (EDE-Q): results from Swedish general population and clinical samples

BACKGROUND

Although the Eating Disorder Examination Questionnaire (EDE-Q) is perhaps the single most widely used self-report measure of eating disorder (ED) symptoms, important questions remain about its validity and applicability in relation to particular groups of individuals, especially adolescents of both genders.

METHODS

The present study investigated the factor structure of the adolescent version of the Eating Disorder Examination Questionnaire (EDE-Q) in samples of Swedish girls and boys from the general population and girls with a diagnosed eating disorder. Girls (N = 239) and boys (N = 248) aged between 13 and 15 years who were attending school, and girls (N = 570) aged between 12 and 14 years who were in treatment for an eating disorder at a specialist eating disorder clinic were assessed on the adolescent version of the EDE-Q.

RESULTS

The adolescent version of the EDE-Q demonstrated satisfactory levels of internal consistency. However, confirmatory factor analysis (CFA) failed to support the four-factor model of the EDE-Q. Parallel analysis (PA) and subsequent exploratory factor analysis (EFA) suggested that the adolescent version of the EDE-Q comprises one underlying factor in young adolescent girls (both clinical and general population), centred on Dissatisfaction with Shape and Weight. In boys three factors were found: Weight-related Concerns, Body Discomfort and Restraint.

CONCLUSIONS

The EDE-Q appears to measure different underlying aspects of eating disorder psychopathology in young teenagers compared to adults. The dimensions underlying disordered eating in young girls may become increasingly differentiated with time. There appear to be important gender-based differences in the dimensions underlying the EDE-Q in young teenagers. Therapists should be alert to beliefs that girls have about the importance of shape and weight, while in boys it may be more important to be attentive to how they feel about their bodies in relation to weight.

Psychometric Analysis of the Three-Factor Eating Questionnaire-R18V2 in Adolescent and Young Adult-Aged Central Nervous System Tumor Survivors

PURPOSE

Adolescent and young adult (AYA)-aged central nervous system (CNS) tumor survivors are an understudied population that is at risk of developing adverse health outcomes, such as obesity. Long-term follow-up guidelines recommend monitoring those at risk of obesity, thus motivating the need for an eating behavior questionnaire. An abbreviated online version of the Three-Factor Eating Questionnaire (TFEQ-R18v2) has been developed, but its applicability to this population is not yet known. This study investigated the instrument's factor structure and reliability in this population.

METHODS

AYA-aged CNS tumor survivors (n = 114) aged 15-39 years completed the TFEQ-R18V2 questionnaire online. Confirmatory factor analysis was used to examine the fit of the three-factor structure (uncontrollable eating, cognitive restraint, and emotional eating [EE]) and reliability (internal consistency of the TFEQ-R18v2). Associations between the three factors and body mass index (BMI) were assessed by linear regression.

RESULTS

The theorized three-factor structure was supported in our population (RMSEA = 0.056 and CFI = 0.98) and demonstrated good reliability (α of 0.81-0.93). EE (β = 0.07, 95% CI 0.02-0.13) was positively associated with BMI, whereas the other two subscale scores were not.

CONCLUSION

The TFEQ-R18v2 instrument holds promise for research and clinical use among AYA-aged CNS tumor survivors. The instrument may be a useful tool for researchers to develop tailored weight management strategies. It also may be a valuable tool for clinicians to monitor survivors who are at risk of obesity and to facilitate referral. Our results also suggest that EE in this population should be further investigated as a potential target for intervention.