Validity, Reliability and Feasibility of the Eating Behavior Pattern Questionnaire (EBPQ) among Iranian Female Students

Effect of age and gender on dietary patterns, mindful eating, body image and confidence

The emergence of 'Diet Culture' came into existence with the era of pop culture, which emphasized the idea of body improvement by embracing the portrayal of unrealistic beauty standards set by the thin-ideal media. This growing and trending culture gained its popularity in India with the COVID pandemic and the imposed lockdown, wherein the prevalence of obesity and binge eating resulted from counter-regulatory eating behaviors and restrictive food intake to a greater extent of skipping meals to achieve the desired body type. The present empirical investigation focuses on understanding the gender and age-based differences (between the ages 18 to 55) among Indian population on dietary patterns, body image, mindful eating and physical appearance confidence using 2 × 3 factorial design. The tools used were Eating Behavior Pattern Questionnaire (EBPQ) [43], Body Self- image Questionnaire (BSIQ) [40], Mindful Eating Questionnaire (MEQ) [18] and Personal Evaluation Inventory (PEI) [44] were administered on a sample size of 120, selected using convenience sampling technique. The collected data was analyzed using SPSS Version 20.0. Results of the study reveal non-significant age and gender differences for mindful eating and appearance confidence. Significant age- differences were observed for Snacking and convenience F(2,114) = 6.22, p < .05; social dependence F(2,114) = 3.87, p < .05 and height dissatisfaction F(2,114) = 8.79, p < .05. And, significant gender differences were observed for Meal Skipping F(1,114) = 6.46, P < .05; snacking and convenience F(1,114) = 4.19, p < .05; fatness evaluation F(1,114) = 5.94, p < .05 and fitness evaluation F(1,114) = 5.33, p < .05. The only significant interaction effect observed was for social dependence dimension F(2, 114) = 3.96, p < .05. Thus, high exposure to social media and diet-related content contributed significantly to changing dietary patterns, and how they look, feel or perceive their body.

Modified-Malay Eating Behavior and Pattern Questionnaire (Malay-EBPQ): translation and validation among Malaysian women

BACKGROUND

Eating behavior primarily depends on eating patterns which are largely influenced by interactions between physiology, environment, psychology, culture and socio-economic status. This study was designed to translate and validate the Eating Behavior Pattern Questionnaire (EBPQ) among Malaysian women.

METHODS

A cross-sectional study involving translation and validation of the English version of EBPQ. The original questionnaire, contained 51 items extracted into six domains was translated in Malay using forward and backward translation, pre-tested and validated among conveniently sampled female healthcare personnel. Vegetarians, pregnant ladies and women in confinement were excluded due to special daily dietary plans. Construct validity, reliability and feasibility were analyzed using Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA).

RESULTS

During translation, item modifications were made and subjected to field testing among 394 women. The original questionnaire was used as a reference to identify the positioning of items in constructs. Fifteen items were removed due to poor correlation with items within constructs. Seven factors were extracted using Varimax rotation with Kaiser-Meyer-Olkin (KMO) value range from 0.725-0.872 and significant Bartlett's test of Sphericity (p < 0.001). The item-loading of the items within the constructs ranged between 0.415-0.812 (explained variation = 62.7%). Cultural and lifestyle behavior was relabeled to lifestyle and behavioral eating, and snacking on sweets was relabeled as snacking pattern. Emotional eating was divided into two sub-factors as snacking behavior and emotional influence. CFA resulted with an acceptable fit with no presence of floor and ceiling effects. Intra-class correlation coefficient (ICC) for all the constructs were reported good and excellent. The overall internal consistency was reported as good.

CONCLUSION

The modified 36-item Malay-EBPQ had moderate internal consistency, reliable and fit with multi-dimensional measures of eating behaviors and dietary patterns among women in the multi-racial population with cultural diversity.

The association of self-efficacy and coping strategies with body mass index is mediated by eating behaviors and dietary intake among young females: A structural-equation modeling approach

Globally, around three billion people are either under- or overweight. Speculating the different roles of psychological factors in body weight between over- and underweight people, it was first hypothesized that whether or not the effects of self-efficacy and coping strategies on body mass index (BMI) is different between these two groups. We secondly predicted that their association is mediated by nutritional factors. Therefore, the present cross-sectional study was conducted to model the impact of self-efficacy and coping strategies on eating behaviors, dietary intake and BMI, using structural equation modeling in two BMI groups: low-to-normal-BMI (LBMI: BMI<21.75 kg/m2) and normal-to-high-BMI (HBMI: 21.75 kg/m2 ≤ BMI). Female participants (N = 250, aged ≥18) were included using convenience sampling method and data of self-efficacy, coping strategies, eating behaviors and dietary intake were collected via questionnaires. The model fit was evaluated and confirmed by fit indices. The analysis revealed in both groups the participants tended to adopt emotion-focused coping strategy (EFCS) more than problem-focused coping strategy (PFCS) (mean score: 61.82 (7.96) vs 49.21 (6.73)). The HBMI group tended to use EFCS more than the LBMI group (P<0.001). In the LBMI group, self-efficacy, PFCS and EFCS had positive effects on BMI. Only the direct effect of self-efficacy (β = 0.314, P<0.001) and the indirect effects of PFCS and EFCS (through increasing unhealthy eating behaviors; β = 0.127, P<0.01, β = 0.095, P<0.05, respectively) were significant. In the HBMI group, self-efficacy had negative effect on BMI (both directly (β = -0.229, P<0.05) and indirectly (β = -0.103, P<0.05) by decreasing unhealthy eating behaviors). PFCS had no effect and EFCS had an indirect, positive effect on BMI (through increasing unhealthy eating behaviors, β = 0.162, P = 0.001). In conclusion, these findings suggest that improving self-efficacy and coping-strategies seems helpful to have a healthy BMI in both BMI groups and further interventions to reduce EFCS should be limited to overweight people.

Psychometric Properties of the Persian Version of Adult Eating Behavior Questionnaire in Patients with Epilepsy

Background

Adult eating behavior questionnaire (AEBQ) is an age upward extension tool that measures appetite traits in individuals. This instrument was developed by Hunot in 2016. The present study aimed to determine the psychometric properties of the Persian version of AEBQ in adults with epilepsy.

Methods

The current research is a cross-sectional study conducted in 2019 in Iran. 700 adults with epilepsy completed the 35-item AEBQ. Qualitative face validity, qualitative content and structure validity (exploratory factor analysis [EFA], N=400, and confirmatory factor analysis [CFA], N=300) appetitive traits were evaluated. Reliability was also measured using Cronbach's alpha, Construct reliability (CR), and Intra-Class Correlation (ICC). The SPSS 26-AMOS24 software was employed to analyze the data with a significance level of 0.05.

Results

The EFA and CFA results comprised eight factors, namely enjoyment of food, emotional over-eating, food responsiveness, hunger, satiety responsiveness, emotional under-eating, food fussiness, and eating slowly. Indices of root mean square error of approximation=0.068, parsimonious normed fit index=0.644, parsimonious comparative fit index=0.671, adjusted goodness of fit index=0.618, goodness of fit index=0.911, and Chi square degree-of-freedom ratio (normalized Chi square CMIN/DF=2.842) confirmed the fitness of the final model. Convergent and divergent validity was acceptable for all the factors. The results revealed that the internal stability>0.8 and CR>0.7 of the eight extracted AEBQ structures are confirmed. The ICC was 0.899 (95% CI: 0.878-0.917; P<0.001). The results also showed that AEBQ has acceptable convergent and divergent validity.

Conclusion

The eight-factor structure of AEBQ can measure eating behavior traits and is of good validity and reliability for assessing the eating behavior of Iranian adults with epilepsy.

Prediction of the Influential Factors on Eating Behaviors: A Hybrid Model of Structural Equation Modelling-Artificial Neural Networks

The importance of eating behavior risk factors in the primary prevention of obesity has been established. Researchers mostly use the linear model to determine associations among these risk factors. However, in reality, the presence of nonlinearity among these factors causes a bias in the prediction models. The aim of this study was to explore the potential of a hybrid model to predict the eating behaviors. The hybrid model of structural equation modelling (SEM) and artificial neural networks (ANN) was applied to evaluate the prediction model. The SEM analysis was used to check the relationship of the emotional eating scale (EES), body shape concern (BSC), and body appreciation scale (BAS) and their effect on different categories of eating behavior patterns (EBP). In the second step, the input and output required for ANN analysis were obtained from SEM analysis and were applied in the neural network model. 340 university students participated in this study. The hybrid model (SEM-ANN) was conducted using multilayer perceptron (MLP) with feed-forward network topology. Moreover, Levenberg–Marquardt, which is a supervised learning model, was applied as a learning method for MLP training. The tangent/sigmoid function was used for the input layer, while the linear function was applied for the output layer. The coefficient of determination (R²) and mean square error (MSE) were calculated. Using the hybrid model, the optimal network happened at MLP 3-17-8. It was proved that the hybrid model was superior to SEM methods because the R² of the model was increased by 27%, while the MSE was decreased by 9.6%. Moreover, it was found that BSC, BAS, and EES significantly affected healthy and unhealthy eating behavior patterns. Thus, a hybrid approach could be suggested as a significant methodological contribution from a machine learning standpoint, and it can be implemented as software to predict models with the highest accuracy.

Comparison of health-promoting behaviours, eating behaviour patterns and perceived social support in normal-weight and overweight pregnant women: An unmatched case-control study

Aim

The interventions based on adopting a healthy lifestyle during pregnancy have conflicting results. This study aimed to compare health-promoting, dietary patterns and social support in normal and overweight pregnant women.

Design

An unmatched case-control design was used.

Methods

A total of 360 pregnant women were selected using multistage cluster sampling and divided into two groups of normal and overweight cases. Data were collected using demographic and obstetrics characteristics, health-promoting lifestyle, perceived social support and eating behaviour questionnaires.

Results

The evaluation of the health-promoting behaviours and dietary patterns demonstrated a significant difference between the mean of total scores and their subdomains including self-actualization, nutrition, consumption of healthy and low-fat foods, fast food and sweets, as well as emotional eating and accidental planning. There was no significant difference between the two groups about social support.

Mental health problems in relation to eating behavior patterns, nutrient intakes and health related quality of life among Iranian female adolescents

Aims

To identify the association between mental health problems, eating behavior patterns, nutrient intakes and health related quality of life (HRQoL) among Iranian female adolescents.

Materials and methods

The current cross-sectional study conducted among three high-schools randomly selected from 10-day-public high schools in the selected sub-county from Tabriz city-Iran between December 2015 through March 2016. Participants were a sample of 107 adolescent girls aged 15–17 years old. Anthropometric parameters were measured and assessments of HRQoL, mental health problems and eating behavioral patterns were performed by Short Form 36 (SF-36), Strengths and Difficulties Questionnaires (SDQ) and Eating Behavioral Pattern Questionnaire (EBPQ) respectively. Dietary intake was assessed using a semi-quantitative Food-Frequency Questionnaire (FFQ) adapted for the Iranian society. Quality of life was measured with HRQoL questionnaire. Quantitative analysis using independent sample t test was performed for comparison of continuous variables between two subgroups (unlikely, possible/probable) of each category of mental health problem. Multiple logistic regression was used to measure the potential predictors (e.g. eating patterns and HRQoL) of mental health problems in two models of crude and adjusted for age and body mass index (BMI). P values less than 0.05 were considered as statistically significant.

Results

Indicators of conduct problems and hyperactivity disorders were the most prevalent mental health problems among female adolescents (25.2% and 18.6% respectively). The prevalence of hyperactivity disorders among female adolescents was 35.5%. Female adolescents in high scores of ‘snacking and convenience’, ‘planning ahead’ and ‘meal skipping’ eating patterns were more likely to have indicators of emotional disorders (P < 0.05). Also, being in the high tertile of ‘low fat eating’ pattern made adolescents less likely to have hyperactivity disorders (P < 0.05). Moreover, according to our finding, high scores of vitality and mental health components of HRQoL were associated with reduced likelihood of emotional disorders, conduct disorders and hyperactivity disorders. No significant difference in terms of BMI and nutrient intakes in different categories of mental health problems according to SDQ scoring was identified.

Conclusions

In the current study unhealthy eating patterns including ‘snacking and convenience’, ‘planning ahead’ and ‘meal skipping’ eating patterns were positive predictors of “emotional disorders” while “low fat” eating pattern was negative predictor of hyperactivity disorders.