Relation between cognitive restraint and weight: Does a content validity problem lead to a wrong axis of care?

The aim of this research is to examine the relation between weight and cognitive restraint (CR), which is the intention to control food intake in order to maintain or lose weight, in a general French population sample. Is CR more prevalent in individuals with obesity than overweight, underweight or normal-weight subjects in this cross-sectional study? Are people affected by obesity non-restrained eaters? A total of 507 French people (80.2% women and 19.8% men), aged 18-78 years, responded to an online questionnaire. It appears that the most used questionnaire measuring CR has content validity problems as it seems to measure effective control and not the intention. Therefore, a numeric scale was used to answer the questions. Even if it is not possible in this study to test a causal link with latent variable modelling, our results seem to show that people with obesity more frequently intend to eat less or to eat healthier and/or to eat less sugar and fat than other people in order to control their weight. However, people affected by obesity do not succeed in so doing. These results raise the question of treatments advocating the increase of self-control. Finally, it would be necessary to obtain a real, scientific consensus on what CR is and on how to measure it in order to study the most effective treatments for people with overweight or obesity.

The Dutch Eating Behavior Questionnaire: Further psychometric validation and clinical implications of the French version in normal weight and obese persons.

OBJECTIVES: 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).