The New Zealand eating behavior questionnaire - Validation study for a novel assessment tool to describe actionable eating behavior traits

Ole Schmiedel; Melissa Ivey; Amy Liu; Rinki Murphy

doi:10.1016/j.appet.2023.107066

The New Zealand eating behavior questionnaire - Validation study for a novel assessment tool to describe actionable eating behavior traits

Appetite. 2023 Oct 16:191:107066. doi: 10.1016/j.appet.2023.107066. Online ahead of print.

Authors

Ole Schmiedel¹, Melissa Ivey², Amy Liu³, Rinki Murphy³

Affiliations

¹ Department of Diabetes, Te Toka Tumai, Te Whatu Ora, New Zealand; University of Auckland, New Zealand. Electronic address: oles@adhb.govt.nz.
² Ivey Public Health Partners, LLC, New Zealand.
³ Department of Diabetes, Te Toka Tumai, Te Whatu Ora, New Zealand; University of Auckland, New Zealand.

PMID: 37852374
DOI: 10.1016/j.appet.2023.107066

Abstract

Individualised management of obesity remains challenging and, to date, most treatment is based on clinical judgement. This study aimed to develop and validate a novel questionnaire-based tool to identify three pre-defined eating behavior (EB) traits, emotional eating, reduced satiety (constant hunger) and reduced satiation (feasters) that may predict selective medication response given their targeted actions. We recruited 977 individuals from a tertiary academic diabetes clinic to participate in this two-phase validation study. Participants self-reported weight management activities and were asked to self-assess their EB characteristics. The initial questionnaire included 42 visual analogue scale questions. In Phase I, 729 participants completed the questionnaire, including Māori (11.8%) and Pacific peoples (19.3%). After random division of the study sample, Exploratory Factor Analysis (EFA) confirmed a three-factor model as the best fit. Stepwise removal of items with inadequate factor loading retained 27 of 42 items, which accounted for 96% of the variance. Confirmatory Factor Analysis (CFA), performed on the second half of the sample, demonstrated good model fit with the final 27-item questionnaire. Internal consistency was high for factor (α = 0.82-0.95) and demographic subgroups, and similar to those obtained in the EFA. Test-retest reliability in a subset of 399 participants who repeated the questionnaire after a four-week interval (Phase II) showed moderate to good reliability. Participants classified into one of three EB types based on the highest median score among the factors. Test-retest reliability was robust for emotional eaters (71.25%) and constant hunger (68.9%). The correlation between aggregate EB score (sum of three EB scores) and BMI was significant (Spearman rho = 0.314, P = .0005). The questionnaire reliably identified three distinct EB traits, which may be informative for precision medicine applications for obesity management.

Keywords: Eating behavior; Emotional eating; Obesity; Personalized medicine; Pharmacotherapy; Questionnaire.