Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Article
  • Published:

Pediatrics

Validity of the Adult Eating Behavior Questionnaire for adolescents treated in a weight management clinic

Abstract

Background

The Child and Adult Eating Behavior Questionnaires (CEBQ, AEBQ) are established measures of eating behaviors. However, no similar measure is available for adolescents. Prior research has validated the AEBQ in adult samples, and one study has explored using the measure with adolescents. However, no studies to date have examined the validity of the AEBQ in adolescent clinical populations. Furthermore, no studies have examined associations between the AEBQ and indicators of health status in adolescents.

Methods

A total of 280 adolescents (12–17 years old, 60% female) seen in a pediatric weight management clinic completed the AEBQ at intake. Confirmatory factor analysis (CFA) was conducted with AEBQ items to evaluate the model fit of one-, two-, seven-, and eight-factor structures. Intercorrelations between scale scores from AEBQ Food Approach and Food Avoidance domains were calculated. Associations of AEBQ scales with body mass index (BMI) and binge-eating behaviors were examined using Spearman Rho correlations and independent t-tests.

Results

CFAs revealed that the best fitting model was a seven-factor structure excluding the Hunger scale, although overall model fit was only marginally acceptable (X2 = 980.94, CFI = 0.925, TLI = 0.915, RMSEA = 0.074). Intercorrelation analyses indicated that all Food Approach scales were significantly associated with one another (r = 0.243–0.654); Food Avoidance scales were inconsistently correlated (r = 0.034–0.439). No AEBQ scales were correlated with BMI (r = −0.101–0.082). Stronger links were found with binge eating; higher frequency binge-related behaviors were associated with higher Food Approach scores.

Conclusions

The seven-factor structure of AEBQ demonstrates a marginally acceptable fit for treatment-seeking adolescents with obesity. The Food Approach scales demonstrated more convergent validity than the Food Avoidance scales. The Food Approach scales also exhibited some clinical utility for identifying patients with increased risk for binge eating, which is a common target for behavioral intervention. Implications for maximizing the AEBQ’s potential for assessing eating behaviors in adolescents with obesity are discussed.

This is a preview of subscription content, access via your institution

Access options

Buy this article

Prices may be subject to local taxes which are calculated during checkout

Similar content being viewed by others

References

  1. Hales CM, Fryer CD, Carroll MD, Freedman DS, Ogden CL. Trends in obesity and severe obesity prevalence in US youth and adults by sex and age, 2007–2008 to 2015–2016. JAMA. 2018;319:1723–5.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Carnell S, Wardle J. Appetite and adiposity in children: evidence for a behavioral susceptibility theory of obesity. Am J Clin Nutr. 2008;88:22–9.

    Article  CAS  PubMed  Google Scholar 

  3. Llewellyn C, Wardle J. Behavioral susceptibility to obesity: gene–environment interplay in the development of weight. Physiol Behav. 2015;152:494–501.

    Article  CAS  PubMed  Google Scholar 

  4. Gross AC, Kaizer AM, Vock DM, Siddiqui S, Fox CK. Cognitive, emotional, and behavioral contributors to early childhood weight status. J Child Health Care. 2019;23:382–91.

    Article  PubMed  Google Scholar 

  5. Jansen PW, Roza SJ, Jaddoe VW, Mackenbach JD, Raat H, Hofman A, et al. Children’s eating behavior, feeding practices of parents and weight problems in early childhood: results from the population-based Generation R Study. Int J Behav Nutr Phys Act. 2012;9:130.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Webber L, Hill C, Saxton J, Van Jaarsveld CH, Wardle J. Eating behaviour and weight in children. Int J Obes. 2009;33:21–8.

    Article  CAS  Google Scholar 

  7. Cooke LJ, Wardle J, Gibson EL, Sapochnik M, Sheiham A, Lawson M. Demographic, familial and trait predictors of fruit and vegetable consumption by pre-school children. Public Health Nutr. 2004;7:295–302.

    Article  CAS  PubMed  Google Scholar 

  8. Russell CG, Worsley T. Associations between appetitive traits and food preferences in preschool children. Food Qual Prefer. 2016;52:172–8.

    Article  Google Scholar 

  9. Syrad H, Johnson L, Wardle J, Llewellyn CH. Appetitive traits and food intake patterns in early life. Am J Clin Nutr. 2016;103:231–5.

    Article  CAS  PubMed  Google Scholar 

  10. Croker H, Cooke L, Wardle J. Appetitive behaviours of children attending obesity treatment. Appetite. 2011;57:525–9.

    Article  CAS  PubMed  Google Scholar 

  11. Gross AC, Fox CK, Rudser KD, Foy AM, Kelly AS. Eating behaviours are different in youth with obesity and severe obesity. Clin Obes. 2016;6:68–72.

    Article  CAS  PubMed  Google Scholar 

  12. Derks IP, Sijbrands EJ, Wake M, Qureshi F, van der Ende J, Hillegers MH, et al. Eating behavior and body composition across childhood: a prospective cohort study. Int J Behav Nutr Phys Act. 2018;15:96.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Steinsbekk S, Wichstrøm L. Predictors of change in BMI from the age of 4 to 8. J Pediatr Psychol. 2015;40:1056–64.

    Article  PubMed  Google Scholar 

  14. Hayes JF, Altman M, Kolko RP, Balantekin KN, Holland JC, Stein RI, et al. Decreasing food fussiness in children with obesity leads to greater weight loss in family‐based treatment. Obesity. 2016;24:2158–63.

    Article  PubMed  Google Scholar 

  15. Van Strien T. Causes of emotional eating and matched treatment of obesity. Curr Diab Rep. 2018;18:35.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Nathan BM, Rudser KD, Abuzzahab MJ, Fox CK, Coombes BJ, Bomberg EM, et al. Predictors of weight-loss response with glucagon-like peptide-1 receptor agonist treatment among adolescents with severe obesity. Clin Obes. 2016;6:73–8.

    Article  CAS  PubMed  Google Scholar 

  17. Miller WC, Hering M, Cothran C, Croteau K, Dunlap R. After-school physical activity and eating behaviors of middle school students in relation to adult supervision. J Nutr Educ Behav. 2012;44:326–34.

    Article  PubMed  Google Scholar 

  18. Reicks M, Banna J, Cluskey M, Gunther C, Hongu N, et al. Influence of parenting practices on eating behaviors of early adolescents during independent eating occasions: implications for obesity prevention. Nutrients. 2015;7:8783–801.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Wray‐Lake L, Crouter AC, McHale SM. Developmental patterns in decision‐making autonomy across middle childhood and adolescence: European American parents’ perspectives. Child Dev. 2010;81:636–51.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Ashcroft J, Semmler C, Carnell S, Van Jaarsveld CH, Wardle J. Continuity and stability of eating behaviour traits in children. Eur J Clin Nutr. 2008;62:985–90.

    Article  CAS  PubMed  Google Scholar 

  21. Derks IP, Bolhuis K, Sijbrands EJ, Gaillard R, Hillegers MH, Jansen PW. Predictors and patterns of eating behaviors across childhood: results from The Generation R study. Appetite. 2019;141:104295.

    Article  PubMed  Google Scholar 

  22. Decaluwé V, Braet C, Fairburn CG. Binge eating in obese children and adolescents. Int J Eat Disord. 2003;33:78–84.

    Article  PubMed  Google Scholar 

  23. Johnson WG, Rohan KJ, Kirk AA. Prevalence and correlates of binge eating in white and African American adolescents. Eat Behav. 2002;3:179–89.

    Article  PubMed  Google Scholar 

  24. Morgan CM, Yanovski SZ, Nguyen TT, McDuffie J, Sebring NG, Jorge MR, et al. Loss of control over eating, adiposity, and psychopathology in overweight children. Int J Eat Disord. 2002;31:430–41.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Wardle J, Guthrie CA, Sanderson S, Rapoport L. Development of the children’s eating behaviour questionnaire. J Child Psychol Psychiatry. 2001;42:963–70.

    Article  CAS  PubMed  Google Scholar 

  26. Boswell N, Byrne R, Davies PS. Eating behavior traits associated with demographic variables and implications for obesity outcomes in early childhood. Appetite. 2018;120:482–90.

    Article  PubMed  Google Scholar 

  27. Koch A, Pollatos O. Interoceptive sensitivity, body weight and eating behavior in children: a prospective study. Front Psychol. 2014;5:1003.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Sleddens EF, Kremers SP, Thijs C. The Children’s Eating Behaviour Questionnaire: factorial validity and association with body mass index in Dutch children aged 6–7. Int J Behav Nutr Phys Act. 2008;5:49.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Hunot C, Fildes A, Croker H, Llewellyn CH, Wardle J, Beeken RJ. Appetitive traits and relationships with BMI in adults: development of the Adult Eating Behaviour Questionnaire. Appetite. 2016;105:356–63.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Mallan KM, Fildes A, de la Piedad Garcia X, Drzezdzon J, Sampson M, et al. Appetitive traits associated with higher and lower body mass index: evaluating the validity of the adult eating behaviour questionnaire in an Australian sample. Int J Behav Nutr Phys Act. 2017;14:130.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Zickgraf HF, Rigby A. The Adult Eating Behaviour Questionnaire in a bariatric surgery‐seeking sample: Factor structure, convergent validity, and associations with BMI. Eur Eat Disord Rev. 2019;27:97–104.

    Article  PubMed  Google Scholar 

  32. Van Strien T, Frijters JE, Bergers GP, Defares PB. The Dutch Eating Behavior Questionnaire (DEBQ) for assessment of restrained, emotional, and external eating behavior. Int J Eat Disord. 1986;5:295–315.

    Article  Google Scholar 

  33. Mitchell TB, Cushing CC, Amaro CM. Psychometric properties of the Power of Food Scale in a community sample of preadolescents and adolescents. J Child Fam Stud. 2016;25:2733–9.

    Article  Google Scholar 

  34. Johnson F, Wardle J, Griffith J. The adolescent food habits checklist: reliability and validity of a measure of healthy eating behaviour in adolescents. Eur J Clin Nutr. 2002;56:644–9.

    Article  CAS  PubMed  Google Scholar 

  35. Hunot-Alexander CM, Beeken RJ, Fildes A, Croker H, Llewellyn CH, Steinsbekk S. Confirmation of the factor structure and reliability of the Adult Eating Behavior Questionnaire in an adolescent sample. Front Psychol. 2019;10:1991.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Elkins A, Zickgraf HF. Picky eating and food neophobia: Resemblance and agreement in parent/young adult dyads. Appetite. 2018;126:36–42.

    Article  PubMed  Google Scholar 

  37. Gulati AK, Kaplan DW, Daniels SR. Clinical tracking of severely obese children: a new growth chart. Pediatrics. 2012;130:1136–40.

    Article  PubMed  PubMed Central  Google Scholar 

  38. American Psychiatric Association. Diagnostic and statistical manual of mental disorders (DSM-5®). American Psychiatric Pub; 2013.

  39. Mundfrom DJ, Shaw DG, Ke TL. Minimum sample size recommendations for conducting factor analyses. Int J Test. 2005;5:159–68.

    Article  Google Scholar 

  40. Muthén LK, Muthén BO. Mplus User’s Guide, 8th ed. Los Angeles, CA: Muthén & Muthén; 1998;2017.

  41. Hu LT, Bentler PM. Cutoff criteria for fit indexes in covariance structure analysis: conventional criteria versus new alternatives. Struct Equ Modeling. 1999;6:1–55.

    Article  Google Scholar 

  42. Matsunaga M. How to factor-analyze your data right: do’s, don’ts, and how-to’s. Int J Psychol Res. 2010;3:97–110.

    Article  Google Scholar 

  43. Nunnally JC. Assessment of reliability. In: Psychometric theory. 2nd ed. New York: McGraw-Hill; 1979. p 245–6.

  44. Sonneville KR, Horton NJ, Micali N, Crosby RD, Swanson SA, Solmi F, et al. Longitudinal associations between binge eating and overeating and adverse outcomes among adolescents and young adults: does loss of control matter? JAMA Pediatr. 2013;167:149–55.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Toussi R, Fujioka K, Coleman KJ. Pre-and postsurgery behavioral compliance, patient health, and postbariatric surgical weight loss. Obes. 2009;17:996–1002.

    Article  Google Scholar 

  46. Kirk S, Armstrong S, King E, Trapp C, Grow M, Tucker J, et al. Establishment of the Pediatric Obesity Weight Evaluation Registry: a national research collaborative for identifying the optimal assessment and treatment of pediatric obesity. Child Obes. 2017;13:9–7.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Amy C. Gross.

Ethics declarations

Conflict of interest

CKF and ACG receive research support from Rhythm Pharmaceuticals. There are no other competing financial interests related to this manuscript.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Molitor, S.J., Fox, C.K., Bensignor, M.O. et al. Validity of the Adult Eating Behavior Questionnaire for adolescents treated in a weight management clinic. Int J Obes 45, 1086–1094 (2021). https://doi.org/10.1038/s41366-021-00778-6

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41366-021-00778-6

This article is cited by

Search

Quick links