Psychometric properties and measurement invariance of the Weight Self-Stigma Questionnaire and Weight Bias Internalization Scale in children and adolescents

Background/ObjectiveGiven the negative consequences of weight bias, including internalized weight stigma, on health outcomes, two instruments—the Weight Self-Stigma Questionnaire (WSSQ) and Weight Bias Internalization Scale (WBIS)—have been developed. However, their psychometric properties are yet to be tested for Asian pediatric populations. Method:Participants aged 8 to 12 years (N = 287; 153 boys) completed the WSSQ and the WBIS, and they were classified into either a group with overweight or a group without overweight based on self-reported weight and height. Results:Both WSSQ and WBIS had their factor structures supported by confirmatory factor analyses (CFAs). The measurement invariance of two-factor structure was further supported for WSSQ across gender and weight status. The measurement invariance of single-factor structure was supported for WBIS across gender but not across weight status. Conclusions:WSSQ and WBIS were both valid to assess the internalization of weight bias. However, the two instruments demonstrated different properties and should be applied in different situations.     

Food Cravings Questionnaire–Trait (FCQ–T) Discriminates Between Obese and Overweight Patients With and Without Binge Eating Tendencies: The Italian Version of the FCQ–T

Food craving (FC) might play an important role in the course of eating disorders and obesity. The question of its measurement has particular importance in relation to the dramatic growth in obesity rates and its relevance for public health. The aim of this study was to investigate the psychometric properties of the Italian version of the Food Cravings Questionnaire–Trait (FCQ–T) in overweight and obese patients who were attending weight loss programs, and its efficiency in discriminating patients with binge eating. Participants were 497 (411 women, 86 men) overweight and obese patients in treatment with low-energy diet therapy. We used structural equation modeling to compare 3 factor models tested in previous studies (a 6-factor model, an 8-factor model, and a 9-factor model), which indicated that the 9-factor model has a better fit over the competing models. The FCQ–T had good internal consistency (Cronbach's α of.96 for the total score, and between.76 and.92 for subfactors), and was able to discriminate patients with clinical-level binge eating from those with probable and without binge eating with an efficiency of.74 (sensitivity =.64, specificity =.78). FCQ–T scores were sensitive to changes associated with treatment only for patients who started dietary restriction between the baseline and the follow-up assessment, but not for patients who were already observing dietary restrictions at the time of the baseline assessment. These results suggest that the FCQ–T could be a potentially useful measure for the screening of binge eating problems in overweight and obese patients while in treatment.     

Body-image thought processes: The development and initial validation of the Assessment of Body-Image Cognitive Distortions

No measures exist that specifically assess cognitive distortions related to body image per se, despite their theoretical and clinical significance. Most cognitive-distortion scales pertain to depression, anxiety, or eating disorders. Accordingly, the 37-item Assessment of Body-Image Cognitive Distortions (ABCD) was developed and validated in this study with a sample of 263 college women. The ABCD samples eight types of distorted thinking related to how persons process information about their physical appearance. Two 18-item parallel forms of the unidimensional measure were also constructed. All forms were highly internally consistent and relatively free from socially desirable responding. Convergent validity for all ABCD forms was established using several standardized measures of body image and eating attitudes. Multiple regression analysis showed that the ABCD was predictable from body-image evaluation, investment, and overweight preoccupation. The ABCD uniquely predicted body-image quality of life and disturbed eating attitudes above and beyond other body-image predictors. Heavier women and White women were more prone to body-image cognitive distortions than were thinner women and Black women. Finally, limitations of this preliminary study, directions for future research, and clinical implications are discussed.     

The effect of autonomous and controlled motives on eating dysregulation: Implications for individuals classified as underweight,overweight or obese

IntroductionControlled and autonomous motivational factors from self-determination theory have previously been highlighted as key factors in eating regulation. The present study examined controlled motives as an overarching motivational factor in eating dysregulation and examined its effects on dieting behaviour for those who are underweight, overweight or obese.ObjectiveTo examine whether the influence of controlled motives on dieting behaviour would be moderated by body mass index (BMI). Specifically, it was hypothesised that controlled motives would be associated with high levels of dieting behaviour in underweight individuals and low levels of dieting behaviour in individuals classified as overweight or obese.MethodOne hundred and thirty-seven participants completed the measures of height, weight, and motivation and intentions towards watching their diet and subsequently completed a measure of dieting behaviour two weeks later.ResultsModerated regression and simple slopes analyses provided support for the hypothesised effects at underweight, overweight, and obese range BMIs.ConclusionThe effect of controlled motives on dieting behaviour is dependent upon BMI and therefore varies across underweight, overweight, and obese individuals. The implications of controlled motives and external pressures to watch one's diet are discussed.     

Clarifying the construct of perfectionism

The construct of perfectionism is related to many important outcome variables. However, the term perfectionism has been defined in many different ways, and items comprising the different existing scales appear to be very different in content. The overarching aim of the present set of studies was to help clarify the specific unidimensional personality constructs that contribute to perfectionistic behavior. First, trained raters reliably sorted items from existing measures of perfectionism into nine dimensions. An exploratory factor analysis, followed by a confirmatory factor analysis on an independent sample, resulted in a 9-scale, 61-item measure, called the Measure of Constructs Underlying Perfectionism. The nine scales were internally consistent and stable across time, and they were differentially associated with relevant measures of personality in theoretically meaningful ways.     

Psychometric properties of a scale measuring negative attitudes toward overweight individuals.

This study examined the psychometric properties of the Anti-fat Attitudes Scale (AFAS), a 5-item instrument developed by the authors to measure negative attitudes toward overweight individuals. A total of 4 studies were conducted among Canadian adolescents (n = 1,452) and university students (n = 424). Results suggested that the AFAS possessed a unidimensional factor structure and satisfactory reliability for both men and women. As predicted, men obtained higher scores than women on the AFAS, and antifat attitudes were positively associated with authoritarianism, homonegativity, and political conservatism. Participants who were overweight had lower scores on the AFAS than participants who were thin or average weight. Responses on the AFAS did not appear to be contaminated by social desirability bias.     

A bias-corrected exploratory and confirmatory factor analysis of right-wing authoritarianism: Support for a three-factor structure

The factor structure of right-wing authoritarianism (RWA) remains a contentious issue. Although designed to measure three underlying attitude clusters, aggression, submission and conventionalism, many items are deliberately double- or triple-barrelled, to capture the covariation of the three clusters in a unidimensional scale. Additionally, although the scale is balanced, there is an item wording direction bias in the clusters; aggression items are pro-trait, and conventionalism items are con-trait. Sub-scale structure is therefore potentially confounded with acquiescence bias. Although RWA as a unitary construct has been an effective tool for exploring prejudice, it would be useful in many cases to measure its underlying components directly. Proposed solutions to this problem include creating short-form scales as subsets of the original scale, or modifying items to simplify and un-confound the structure. We present convergent evidence of an underlying factor structure by considering one-, two- and three-factor solutions to the uncorrected scale and then using an indirect method to correct for acquiescence bias. Before and after correction, factor analysis supported a three-factor solution. Confirmatory factor analyses also support a three-factor solution compared to a one-factor solution.     

A scenario-based dieting self-efficacy scale: the DIET-SE

The article discusses a scenario-based dieting self-efficacy scale, the DIET-SE, developed from dieter's inventory of eating temptations (DIET). The DIET-SE consists of items that describe scenarios of eating temptations for a range of dieting situations, including high-caloric food temptations. Four studies assessed the psychometric properties of the 11-item DIET-SE. Exploratory factor analysis (N = 392) and confirmatory factors analysis (N = 124) revealed three internally consistent and reliable factors representing challenges to adhere to a diet (high-caloric food temptations [HCF], social and internal factors [SIF], negative emotional events [NEE]). Convergent validity is established with other measures of dieting self-efficacy, as well as measures of eating disinhibition, susceptibility to hunger, and weight loss competency. Criterion-related validity is provided through the assessment of goal adherence, and predictive validity is established for dieters' actual food intake (N = 68). The DIET-SE represents a short, reliable, and valid scenario-based measure of dieting self-efficacy.     

Worry and Pathological Worry in Patients with Psoriasis: Cross Sectional and Longitudinal Analyses of the Penn State Worry Questionnaire (PSWQ) in Four Samples of Patients

The purpose of the present study was to examine the psychometric properties of the Penn state Worry Questionnaire (PSWQ) in patients with psoriasis. A series of cross-sectional and longitudinal studies were undertaken to assess the reliability, stability and validity of the measure. Patients with psoriasis from four samples (consecutive attendees, anxious patients, depressed patients, and 6-month follow-up of consecutive attendees) completed the PSWQ and measures assessing related constructs of anxiety and depression (HADS) and coping (COPE). The clinical severity of patients psoriasis was also assessed by dermatologists using the Psoriasis Area and Severity Index (PASI). Exploratory factor analysis was undertaken and receiver operator characteristic (ROC) analyses were used to examine the clinical utility of the PSWQ cut-off score for normal and pathological worry. Exploratory factor analysis suggested that the PSWQ is essentially unidimensional in patients with psoriasis. Intraclass correlation demonstrated that, over a 6-month period, the reproducibility of the PSWQ total scale was good in patients with anxiety and moderate in patients with depression. ROC analysis suggested that the optimum cutoff differentiating pathological worry was > 60, which is commensurate with findings in adult mental health more generally. The PSWQ cutoff for pathological worry showed a lower specificity for depression than anxiety. The PSWQ is an appropriate measure of pathological worry in patients with psoriasis. The cutoff on the scale for pathological worry demonstrates appropriate conceptual overlap with subordinate distress categories of anxiety and depression.     

Loss of control over eating in obese youngsters

OBJECTIVE: To investigate loss of control over eating in a sample of obese youngsters seeking treatment. METHOD: Obese youngsters (aged 10-16) were categorized into those having experienced loss of control (LC) and those who had not (NoLC) using the child version of the Eating Disorder Examination. Furthermore, the LC group was subdivided into an objective binge eating (OBE) and a subjective binge eating (SBE) group. The groups were compared on psychological measures. RESULTS: LC subjects (17.9%) showed more concern about eating, weight and shape. They also reported more emotional and external eating behaviors and more depression. Youngsters who report SBE show resemblances to both NoLC and OBE subjects. DISCUSSION: LC subjects are characterized by more eating-related psychopathology and higher levels of depression. Especially obese youngsters with OBE turned out to be a pathological group.     

Overvaluation of shape and weight in binge eating disorder and overweight controls: refinement of a diagnostic construct

Debate continues regarding the nosological status of binge eating disorder (BED) as a diagnosis as opposed to simply reflecting a useful marker for psychopathology. Contention also exists regarding the specific criteria for the BED diagnosis, including whether, like anorexia nervosa and bulimia nervosa, it should be characterized by overvaluation of shape/weight. The authors compared features of eating disorders, psychological distress, and weight among overweight BED participants who overvalue their shape/weight (n=92), BED participants with subclinical levels of overvaluation (n=73), and participants in an overweight comparison group without BED (n=45). BED participants categorized with clinical overvaluation reported greater eating-related psychopathology and depression levels than those with subclinical overvaluation. Both BED groups reported greater overall eating pathology and depression levels than the overweight comparison group. Group differences existed despite similar levels of overweight across the 3 groups, as well as when controlling for group differences in depression levels. These findings provide further support for the research diagnostic construct and make a case for the importance of shape/weight overvaluation as a diagnostic specifier.     

On the Discriminant Validity of Burnout,Depression and Anxiety: A Re-examination of the Burnout Measure

We investigated the discriminant validity of the frequently used Burnout Measure (BM) (Pines et al ., 1981), in relation to depressive symptomatology and anxiety. Following Russell's (1980) work on the multidimensional space of affective states, BM's items were hypothesized to reside in three separate regions of that space, labeled anxiety, depression, and wornout, with wornout representing a combination of physical and emotional exhaustion. Respondents were 704 senior army officers, who completed a questionnaire that included BM items, standard measures of depression and anxiety, and measures of military-related stresses. Their responses to the BM items and to the depression and anxiety scales were subjected to multidimensional scaling analysis. Excepting an unexpected finding related to a fourth construct, loss of vigor, the results were supportive of the hypothesis and led to the construction of three unidimensional measures, respectively gauging anxiety, depression, and wornout. The correlations of the three measures with the stress measures supported their discriminant validity. We suggest that future research using the BM should focus on the set of items that were found to load on the dimension of wornout, to the exclusion of items tapping depression and anxiety.     

Psychological validation of the Rosenberg Self-Esteem Scale (RSES) in South Africa: Method effects and dimensionality in black African and white university students

The study examined the factor structure and cross-cultural validity of the Rosenberg Self-esteem Scale (RSES) in a sample of South African students (N = 862; black African = 67%, female = 71.5%). Alternative a priori CFA models (unidimensional, bi-dimensional and unidimensional models comprising either latent method factor or correlated residuals) were evaluated. Results indicated that the RSES in black and white South African university students is represented by a unidimensional model with correlated residuals of negatively and positively phrased items. Findings also suggested method effects on black African students to be significantly associated with negatively worded items compared to white students. Method bias effects appear to show for some RSES items and this may have important implications for the cross-cultural utility of the RSES in South Africa.     

Validation of the Dutch Eating Behavior Questionnaire (DEBQ) in a sample of Chinese adolescents

We sought to validate the Dutch Eating Behavior Questionnaire (DEBQ) in a sample of Chinese adolescents and investigate differences in eating behaviors among Chinese normal weight, overweight, and obese adolescents. Chinese middle and high school students completed the DEBQ, Eating Disorder Inventory-1, and the Self-Control Scale. Result showed that the DEBQ had good internal consistency, test–retest reliability and criterion validity. Furthermore, the obese and overweight adolescents scored significantly higher than normal weight adolescents on three subscales. The DEBQ is effective for assessing eating behaviors in Chinese adolescents.     

Overweight or obesity management by therapists of the obesity and overweight think thank group (G.R.O.S.). Pilot study comparing its effects with standard nutritional management

IntroductionCurrently, international recommendations for obese and overweight people that explicitly target weight loss and are based on qualitative and/or quantitative nutritional counseling and increased physical activity do not appear to be effective in the long term. In contrast, intuitive eating seems to be an interesting alternative to dieting. The G.R.O.S., a French non-profit organization, offers tri-axial management that would enable overweight or obese individuals to acquire this flexible and adaptive behavior that consists of eating naturally according to one's physiological and emotional needs.ObjectiveAfter describing the three axes of management by G.R.O.S., a pilot study is presented to evaluate the efficacy of this management type in overweight or obese subjects compared to a standard diet (DIET).MethodThirty-five subjects were divided into two groups (G.R.O.S. and DIET), and their weight, body mass index, cognitive restraint scores, emotional eating, intuitive eating, and depressive symptomatology were measured at the beginning of the study and three months later.ResultsThis pilot study showed the positive effect of weight management, body mass index, intuitive eating, and emotional eating compared with standard dietary management, which only affects the depressive symptomatology.ConclusionsThe G.R.O.S. management style seems to be an interesting and effective alternative to slimming diets. However, this study presented a number of limitations, including the sample size, nonrandomization of subjects in groups, and non-standardization of care.     

Subtyping children and adolescents who are overweight based on eating pathology and psychopathology

Children and adolescents who are overweight can differ on dimensions measuring dietary restraint and psychopathology. Classifying clinical obese children and adolescents based on these psychological characteristics is shown to be useful in making differential prognoses. The present study aimed to research the validity of subtyping children and adolescents with overweight (N?=?138) in a non-clinical sample. Using cluster analysis, results revealed three subtypes: a dietary restraint/internalizing group (DR?+?IN; n?=?41), a pure internalizing group (IN; n?=?20) and a non-symptomatic group (NS; n?=?77). The DR?+?IN group outscored both other groups on measures of eating pathology, whereas the IN group outscored both other groups on measures of negative offect. Interestingly, the three groups did not differ on degree of overweight. The results seem to suggest that different psychological mechanisms can be observed in subgroups of young overweight adolescents. Further research should explore how individual psychological characteristics can be helpful when stipulating weight loss treatment programmes.     

A new measure for an important construct: the attachment and object relations inventory

This article describes the development of the Attachment and Object Relations Inventory (AORI). The AORI, a dimensional measure based on factor structure, was developed in response to the psychometric problems typical to attachment style measures that are categorical in nature. Test-retest reliability and internal consistency were high. A factor analysis of the 75 AORI items confirmed the existence of at least 6 factors and explained approximately 50% of the item variance. Convergent and discriminant validity of the AORI was supported through appropriate relationships with measures of depression, anxiety, and personality, and other measures of attachment and object relations.     

Examination of a scale to assess irritability

The Snaith scale to measure irritability, anxiety and depression was explored for its internal consistency. A factor analysis of the items showed that the scales were not factorially pure. Furthermore, the scales correlated highly with one another and with other measures of depression and neuroticism.