title: The Dutch Eating Behavior Questionnaire: Further psychometric validation and clinical implications of the French version in normal weight and obese persons.
abstract: OBJECTIVE
  This study tested the psychometric properties of the French version of the Dutch Eating Behavior Questionnaire (DEBQ) for normal weight and obese patients; determined the factors associated with each DEBQ score: emotional eating (eating in response to emotional arousal states such as fear, anger or anxiety), externality (eating in response to external food cues such as sight and smell of food), and restrained eating behavior/cognitive restraint (conscious efforts to limit and control dietary intake); and determined how to interpret the results from this scale to guide clinical practice.
  
  
  METHODS
  Between January 2009 and April 2009, we assessed non-paired normal weight persons (n=74) and all consecutive obese patients consulting in the Nutrition Ward of the University Hospital of Tours (n=75; including bariatric surgery patients) using the DEBQ. We tested the scale's factor structure using a factor analysis for ordinal data and internal consistency for each DEBQ dimension.
  
  
  RESULTS
  Our results supported a three-factor structure for both normal weight and obese patients. The Cronbach's alpha coefficients were excellent for emotional eating and externality (α≥0.90) and good for cognitive restraint (α≥0.81). The emotional eating and cognitive restraint scores were higher for women (P<0.001) and obese patients (P<0.05). Higher cognitive restraint was associated with higher current and previous BMI (P<0.01). For patients who had bariatric surgery, higher length of time since surgery was significantly associated with higher externality (ρ=0.359; P≤0.05) and marginally associated with higher cognitive restraint (ρ=0.294; P=0.10) and higher emotional eating (ρ=0.302; P=0.10).
  
  
  CONCLUSIONS
  Our results support a three-dimensional factor structure for the French version of the DEBQ for normal weight and obese patients. We propose the chance to change hypothesis to explain results for bariatric surgery patients: patients experience a beneficial but transient decrease in externality, emotionality and cognitive restraint, and this period of time gives the patient a chance for cognitive, behavioral and emotional change. This critical period should be well prepared before surgery to improve the patient's postoperative success, by tackling each factor that could diminish the chances for success as soon as possible (e.g., early screening and treatment for psychiatric disorders).
authors.affiliation: CHRU de Tours, équipe de liaison et de soins en addictologie, 37044 Tours cedex 9, France; CHRU de Tours, clinique psychiatrique universitaire, 37044 Tours cedex 9, France; Université François-Rabelais de Tours, département de psychologie, EA 2114 « psychologie des âges de la vie », 37041 Tours, France; CHRU de Tours, centre spécialisé pour la prise en charge de l'obésité sévère, 37044 Tours, France. Electronic address: paul.brunault@univ-tours.fr.
authors.forename: Paul
authors.initials: P
authors.lastname: Brunault
authors.affiliation: AP-HP, hôpital Ambroise-Paré, unité fonctionnelle, équipe de liaison et de soins en addictologie et psychiatrie de liaison, 92104 Boulogne-Billancourt, France.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Rabemampianina
authors.affiliation: Groupe de réflexion sur l'obésité et le surpoids, 28, rue Ponthieu, 75008 Paris, France.
authors.forename: Gérard
authors.initials: G
authors.lastname: Apfeldorfer
authors.affiliation: CHRU de Tours, équipe de liaison et de soins en addictologie, 37044 Tours cedex 9, France; CHRU de Tours, clinique psychiatrique universitaire, 37044 Tours cedex 9, France; CHRU de Tours, centre spécialisé pour la prise en charge de l'obésité sévère, 37044 Tours, France; UMR Inserm U930 ERL, 37200 Tours, France; Université François-Rabelais de Tours, 37000 Tours, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Ballon
authors.affiliation: CHRU de Tours, centre spécialisé pour la prise en charge de l'obésité sévère, 37044 Tours, France; Université François-Rabelais de Tours, 37000 Tours, France; CHRU de Tours, service de médecine interne-nutrition, 37000 Tours, France; Université François-Rabelais de Tours, Inserm UMR 1069, 37032 Tours cedex 1, France.
authors.forename: Charles
authors.initials: C
authors.lastname: Couet
authors.affiliation: Université François-Rabelais de Tours, département de psychologie, EA 2114 « psychologie des âges de la vie », 37041 Tours, France.
authors.forename: Christian
authors.initials: C
authors.lastname: Réveillère
authors.affiliation: CHRU de Tours, clinique psychiatrique universitaire, 37044 Tours cedex 9, France; UMR Inserm U930 ERL, 37200 Tours, France; Université François-Rabelais de Tours, 37000 Tours, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Gaillard
authors.affiliation: CHRU de Tours, clinique psychiatrique universitaire, 37044 Tours cedex 9, France; UMR Inserm U930 ERL, 37200 Tours, France; Université François-Rabelais de Tours, 37000 Tours, France.
authors.forename: Wissam
authors.initials: W
authors.lastname: El-Hage
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D050110:Bariatric Surgery / Q000523:psychology; D015992:Body Mass Index; D001835:Body Weight; D003431:Cross-Cultural Comparison; D004644:Emotions; D001068:Feeding and Eating Disorders / Q000175:diagnosis* / Q000523:psychology*; D005260:Female; D005602:France; D006801:Humans; D007389:Internal-External Control; D008297:Male; D009426:Netherlands; D009765:Obesity / Q000175:diagnosis* / Q000523:psychology*; D011594:Psychometrics / Q000706:statistics & numerical data; D012016:Reference Values; D015203:Reproducibility of Results; D011795:Surveys and Questionnaires; D014175:Translating; D016896:Treatment Outcome