The Modified Weight Bias Internalization Scale: measurement invariance by weight status and race among undergraduate women.

BACKGROUND: Internalized weight bias is the belief in negative, weight-based stereotypes and the application of these stereotypes to oneself. These negative stereotypes have harmful impacts on people with overweight/obesity, and weight-based discrimination is well-documented across a variety of settings. Given poor outcomes associated with internalized weight bias, particularly among individuals with obesity, it is necessary to validate measures assessing internalized weight bias among diverse samples. The present study sets out to investigate measurement invariance properties across weight status (women with vs. without overweight/obesity) and race (White vs. Asian; White vs. bi- or multi-racial) of the Modified Weight Bias Internalization Scale (WBIS-M), an 11 item self-report measure. METHODS: Participants were 746 racially/ethnically diverse women across the weight spectrum (24.9% with overweight/obesity). Confirmatory factor analyses of the WBIS-M were initially performed among the full sample, and all sub-samples. Each model showed good to excellent descriptive model fit. Subsequent analyses examined factor loadings and item thresholds of the WBIS-M to assess metric, threshold, and scalar invariance. Invariance was determined by assessing changes in Comparative Fit Index (ΔCFI ≤ -0.010), Root Mean Square Error of Approximation (ΔRMSEA ≤ 0.015), and Standardized Root Mean Square Residuals (ΔSRMR ≤ 0.030). RESULTS: Based on these previously established statistical cutoffs, the WBIS-M showed invariance across weight status and racial groups in the present sample. The current results lend support for use of the WBIS-M to measure internalized weight bias in women who do and do not have overweight/obesity, and among White, Asian, and bi- or multi-racial women. CONCLUSION: This may inform future studies that wish to utilize the WBIS-M, such as investigations of mean level differences in internalized weight bias. These findings may have clinical applications in the treatment and prevention of obesity, given the heightened levels of internalized weight bias and weight-based discrimination faced by individuals with higher body weights.

Evaluation of two weight stigma scales in Malaysian university students: weight self-stigma questionnaire and perceived weight stigma scale.

BACKGROUND: This study aimed to examine the psychometric properties of the Weight Self-Stigma Questionnaire (WSSQ) and Perceived Weight Stigma Scale (PWS) among Malaysian university students. METHODS: University students who were studying in a Malaysia university with a mean age of 24.0 years (n = 380; females 71.6%) were recruited through convenience sampling between 19 August and 30 September 2021. They completed a Google Form consisting of information on sociodemographic background, weight stigma, psychological distress and self-reported body weight and height. Psychometric testing was conducted using the classical test theory (including confirmatory factor analysis) and Rasch models to confirm the two-factor structure of WSSQ and the unidimensional structure of the PWS using the various fit indices. Concurrent validity of the total scores of WSSQ and PWS with psychological distress and body mass index (BMI) was also investigated. Internal consistency using Cronbach's alpha was conducted. RESULTS: The confirmatory factor analyses and Rasch analyses verified the two-factor structure for the WSSQ and the single-factor structure for the PWS. Both the WSSQ and PWS showed good internal consistency and good concurrent validity as demonstrated by their significant correlations with psychological distress and BMI. CONCLUSION: The WSSQ and PWS have strong validity and reliability, and they can both be used to assess weight stigma among Malaysian university students. LEVEL OF EVIDENCE: V: Descriptive study.

Psychological distress and internet-related behaviors between schoolchildren with and without overweight during the COVID-19 outbreak.

OBJECTIVE: The novel coronavirus disease 2019 (COVID-19) pandemic, and its resulting social policy changes may result in psychological distress among schoolchildren with overweight. This study thus aimed to (1) compare psychological distress (including fear of COVID-19 infection, stress, anxiety, and depression), perceived weight stigma, and problematic internet-related behaviors between schoolchildren with and without overweight; (2) assess whether perceived weight stigma and problematic internet-related behaviors explained psychological distress. METHODS: Schoolchildren (n = 1357; mean age = 10.7 years) with overweight (n = 236) and without overweight (n = 1121) completed an online survey assessing their fear of COVID-19 infection, stress, anxiety, depression, perceived weight stigma, problematic smartphone application use, problematic social media use, and problematic gaming. RESULTS: Schoolchildren with overweight had significantly higher levels of COVID-19 infection fear, stress, depression, perceived weight stigma, and problematic social media use than those without overweight. Regression models showed that perceived weight stigma and problematic internet-related behaviors were significant predictors of psychological distress among schoolchildren with overweight. CONCLUSION: Strategies to manage perceived weight stigma and problematic internet-related behaviors may have a positive influence on mental health among schoolchildren with overweight under health-threatening circumstances, such as the current COVID-19 pandemic.

A prospective study on the link between weight-related self-stigma and binge eating: Role of food addiction and psychological distress.

OBJECTIVES: This prospective study investigated the link between weight-related self-stigma and binge eating by (a) examining the temporal association between weight-related self-stigma and binge eating; (b) investigating the mediating role of food addiction in the association between weight-related self-stigma and binge eating; and (c) examining the mediating role of psychological distress in the association between weight-related self-stigma and binge eating. METHOD: Participants comprised 1,497 adolescents (mean = 15.1 years; SD = 6.0). Body mass index and weight bias were assessed at baseline; psychological distress (i.e., depression, anxiety, and stress) assessed and food addiction at 3 months; and binge eating at 6 months. The mediation model was analyzed using Model 4 in the PROCESS macro for SPSS with 10,000 bootstrapping resamples. RESULTS: There was no significant direct association between weight-related self-stigma and binge eating. However, food addiction and psychological distress significantly mediated the association between weight-related self-stigma and binge eating. DISCUSSION: These findings highlight the indirect association between weight-related self-stigma and binge eating via food addiction and psychological distress. Consequently, intervention programs targeting food addiction and psychological distress among adolescents may have significant positive effects on outcomes for weight-related self-stigma and binge eating. The findings will be beneficial to researchers and healthcare professionals working with adolescents during this critical developmental period.

Brief non-dieting intervention increases intuitive eating and reduces dieting intention, body image dissatisfaction, and anti-fat attitudes: A randomized controlled trial.

This study developed and examined a brief dissonance-based non-dieting intervention designed to help college women reject unhealthy dieting behaviors, accept their bodies, and increase healthy eating. Participants included 94 female university students (mean age = 20.6 years; mean BMI = 23.8 kg/m2), randomly assigned either to the non-dieting intervention condition or a brochure control condition. The intervention consisted of two 90-120 min interactive group sessions designed to engender the rejection of dieting, increase body acceptance, and develop healthy eating skills. Assessment measures were collected at baseline, post-treatment, and one-month follow-up. The group sessions produced significant improvements in the intervention group compared to the control group on measures of dieting intention, intuitive eating, body image dissatisfaction, eating concerns, and anti-fat attitudes. These effects were sustained at one-month follow-up. There were also overall improvements over time in dietary intake and mental health-related quality of life across conditions. This study extends the research on non-dieting approaches by using a brief, dissonance-based structure and by applying the intervention to a young adult sample that included participants of normal weight. The findings here indicate that a non-dieting approach is acceptable and feasible, and can result in improvements in eating and weight-related behaviors, in young adult women.

Enhancing employee wellness: Translating an effective community behavioral weight-loss treatment to the worksite.

BACKGROUND: As rates of obesity continue to rise in the USA, there is a need for effective treatments for excess adiposity. Behavioral weight-loss interventions can produce clinically meaningful weight reduction through life-style modifications. However, few studies have evaluated the effectiveness of high-intensity behavioral weight-loss interventions at worksites. AIM: The present research investigated the effectiveness of a previously validated behavioral weight-loss intervention in a Hawai'i worksite. METHODS: Thirty-six participants were recruited from the employee population of a local employer. Participants received six months of group behavioral weight-loss treatment from trained providers. Anthropomorphic, physiological, psychological, and behavioral assessments were collected pre and post treatment. Select physiological and behavioral assessments were collected every four sessions. RESULTS: Sixty-one percent of participants adhered to treatment, and 78% of participants completed treatment. From pre to post treatment, results found that participants achieved clinically significant improvements in weight, body mass index (BMI), and waist circumference, with accompanying physiological, psychological, and behavioral improvements (F(12, 2)=101.379, p=0.010, partial η2=0.998). Analyses revealed that participants also achieved significant changes in weight, BMI, and waist circumference across time points, as well as improvements in specific eating habits. CONCLUSIONS: The present study demonstrated the efficacy of a worksite behavioral weight-loss program. The present intervention produced clinically significant weight losses for a large proportion of participants, accompanied by significant improvements in physiological, behavioral, and psychological outcomes. This research is promising for the ongoing implementation of behavioral weight-loss approaches.

Appearance-focused media use as a moderator of the relationship between fear of fat and weight bias: an exploratory study.

PURPOSE: Previous research has found that fear of fat, or the fear of gaining weight, is fairly common within both normative and clinical populations. Similarly, weight bias, or biased attitudes directed at obese individuals, has been found across multiple segments of society. A common link shared between fear of fat and weight bias is the inherent emphasis on anti-fat feelings. Previous research has demonstrated an anti-fat bias within media content. Therefore, the purpose of the current research is to examine exposure to appearance-focused media as a moderator of the relationship between fear of fat and weight bias. METHODS: One hundred and eighty-seven female participants (Mage = 21.05, MBMI = 22.60) were administered a battery of assessments, including the Goldfarb Fear of Fat Scale and the Universal Measure of Bias of Fat Scale. Participants were also asked to report their frequency of exposure to appearance-focused media (TV and magazines). RESULTS: Results of this study suggest that appearance-focused media partially moderated the relationship between fear of fat and weight bias. CONCLUSIONS: This suggests the messages portrayed by the media may be strengthening the relationship between fear of gaining weight and discrimination directed at obese individuals. Understanding this relationship has important implications for reducing weight stigma. LEVEL OF EVIDENCE: Level V, cross-sectional descriptive study.

Mediated effects of eating disturbances in the association of perceived weight stigma and emotional distress.

PURPOSE: This study aimed to examine the relationships between perceived weight stigma, eating disturbances, and emotional distress across individuals with different self-perceived weight status. METHODS: University students from Hong Kong (n = 400) and Taiwan (n = 307) participated in this study and completed several questionnaires: Perceived Weight Stigma questionnaire; Three-factor Eating Questionnaire; Hospital Anxiety and Depression Scale. Each participant self-reported their height, weight, and self-perceived weight status. RESULTS: After controlling for demographics, perceived weight stigma was associated with eating disturbances (ß = 0.223, p < 0.001), depression (ß = 0.143, p < 0.001), and anxiety (ß = 0.193, p < 0.001); and eating disturbances was associated with depression (ß = 0.147, p < 0.001) and anxiety (ß = 0.300, p < 0.001) in the whole sample. Additionally, eating disturbances mediated the association between perceived weight stigma and emotional distress. Similar findings were shown in the subsamples who perceived themselves as higher weight or normal weight and in the male and female subsamples. However, in the subsamples who perceived themselves as lower weight, only the links between eating disturbances and emotional distress were significant. CONCLUSION: Perceived weight stigma was associated with eating disturbances and emotional distress in young adults with both higher and normal weight. Eating disturbances were associated with emotional distress regardless of participants' weight status. LEVEL OF EVIDENCE: Level V, cross-sectional descriptive study.

Attitudes toward and beliefs about obese persons across Hong Kong and Taiwan: wording effects and measurement invariance.

BACKGROUND: The psychosocial consequences of obesity are important but often underrated. The Attitudes Toward Obese Persons (ATOP) and Beliefs About Obese Persons (BAOP) scales used to measure weight-related bias have little psychometric information, especially in East Asian contexts. The objective of this study was to use rigorous statistical methods to demonstrate the psychometric properties of these two instruments in Hong Kong and Taiwanese college students. METHODS: A convenience sample of 707 students was recruited from the universities in Hong Kong and Taiwan. Several competing confirmatory factor analyses (CFAs) were conducted to confirm the factorial structure of the ATOP and BAOP. The best fit models for the ATOP and BAOP were chosen for the examination of the measurement invariance across subcultures. We then compared configurable models with or without loading and/or intercept constrained before correlating the latent constructs between the best models for the ATOP and BAOP. RESULTS: The comparison in multiple CFAs found that the model with one factor and two correlated-wording-method factors outperformed the other models for both the ATOP and BOAP. However, the internal consistency was suboptimal (ATOP: α = .56 to .80; BTOP: α = .57 to .65) and the measurement invariance was somewhat unsupported among the Hong Kong and Taiwan samples. Moreover, after controlling wording effects, the latent construct of the ATOP was moderately associated with that of BAOP (r = .356; p < .001). CONCLUSION: Chinese versions of the ATOP and BAOP can be treated as a unidimensional factor for use in Hong Kong and Taiwan university students. However, further refinements of both instruments may be needed before using them to capture the social attitudes and beliefs toward obesity individuals, which is expected to advance our understanding of weight-related bias in East Asian contexts.

Elucidating knowledge and beliefs about obesity and eating disorders among key stakeholders: paving the way for an integrated approach to health promotion.

BACKGROUND: Understanding the knowledge and beliefs of key stakeholders is crucial in developing effective public health interventions. Knowledge and beliefs about obesity and eating disorders (EDs) have rarely been considered, despite increasing awareness of the need for integrated health promotion programs. We investigated key aspects of knowledge and beliefs about obesity and EDs among key stakeholders in Australia. METHODS: Using a semi-structured question guide, eight focus groups and seven individual interviews were conducted with 62 participants including health professionals, personal trainers, teachers and consumer group representatives. An inductive thematic approach was used for data analysis. RESULTS: The findings suggest that, relative to obesity, EDs are poorly understood among teachers, personal trainers, and certain health professionals. Areas of commonality and distinction between the two conditions were identified. Integrated health promotion efforts that focus on shared risk (e.g., low self-esteem, body dissatisfaction) and protective (e.g., healthy eating, regular exercise) factors were supported. Suggested target groups for such efforts included young children, adolescents and parents. CONCLUSIONS: The findings indicate areas where the EDs and obesity fields have common ground and can work together in developing integrated health promotion programs.

Internal health locus of control predicts willingness to track health behaviors online and with smartphone applications.

Given rising technology use across all demographic groups, digital interventions offer a potential strategy for increasing access to health information and care. Research is lacking on identifying individual differences that impact willingness to use digital interventions, which may affect patient engagement. Health locus of control, the amount of control an individual believes they have over their own health, may predict willingness to use mobile health (mHealth) applications ('apps') and online trackers. A cross-sectional study (n = 276) was conducted to assess college students' health locus of control beliefs and willingness to use health apps and online trackers. Internal and powerful other health locus of control beliefs predicted willingness to use health apps and online trackers while chance health locus of control beliefs did not. Individuals with internal and powerful other health locus of control beliefs are more willing than those with chance health locus of control beliefs to utilize a form of technology to monitor or change health behaviors. Health locus of control is an easy-to-assess patient characteristic providers can measure to identify which patients are more likely to utilize mHealth apps and online trackers.

Eating disorder features and quality of life: Does gender matter?

PURPOSE: This study examined whether gender moderates the associations between eating disorder features and quality-of-life impairment and whether eating disorder features can explain gender differences in quality of life in a sample of undergraduate students. METHODS: The SF-12 Physical and Mental Component Summary Scales were used to measure health-related quality of life (HRQoL), and the Eating Disorders Examination Questionnaire (EDE-Q) was used to quantify eating disorder behaviors and cognitions. These self-report forms were completed by undergraduate men and women (n = 709). RESULTS: Gender was a significant predictor of mental HRQoL, such that women in this sample reported poorer mental HRQoL than men. Eating disorder cognitions were the strongest predictor of undergraduate students' mental and physical HRQoL, while binge eating negatively predicted their physical HRQoL only. Gender was not found to moderate the associations between eating disorder features and HRQoL, and eating disorder cognitions were found to mediate the association between gender and mental HRQoL such that a proportion of the difference between undergraduate men and women's mental HRQoL was attributable to eating disorder cognitions. CONCLUSION: This study provided further evidence of the significant impact of eating disorder features, particularly eating disorder cognitions, on HRQoL. The finding that gender did not moderate the relationships between eating disorder features and HRQoL indicates the importance of investigating these features in both men and women in future research.

Toddlers' bias to look at average versus obese figures relates to maternal anti-fat prejudice.

Anti-fat prejudice (weight bias, obesity stigma) is strong, prevalent, and increasing in adults and is associated with negative outcomes for those with obesity. However, it is unknown how early in life this prejudice forms and the reasons for its development. We examined whether infants and toddlers might display an anti-fat bias and, if so, whether it was influenced by maternal anti-fat attitudes through a process of social learning. Mother-child dyads (N=70) split into four age groups participated in a preferential looking paradigm whereby children were presented with 10 pairs of average and obese human figures in random order, and their viewing times (preferential looking) for the figures were measured. Mothers' anti-fat prejudice and education were measured along with mothers' and fathers' body mass index (BMI) and children's television viewing time. We found that older infants (M=11months) had a bias for looking at the obese figures, whereas older toddlers (M=32months) instead preferred looking at the average-sized figures. Furthermore, older toddlers' preferential looking was correlated significantly with maternal anti-fat attitudes. Parental BMI, education, and children's television viewing time were unrelated to preferential looking. Looking times might signal a precursor to explicit fat prejudice socialized via maternal anti-fat attitudes.

The relative stigmatization of eating disorders and obesity in males and females.

OBJECTIVE: Anorexia nervosa (AN), bulimia nervosa (BN), binge-eating disorder (BED), and obesity are stigmatized conditions known to affect both men and women. However, little research has examined differences in stigmatization of individuals with these diagnoses or the impact of gender on stigmatization. Such perceptions may play an important role in understanding and reducing the stigma associated with weight and dysfunctional eating behaviors. This study investigated stigmatizing attitudes toward eating disorders and obesity in men and women. METHOD: Participants were university undergraduates (N = 318; 73.6% female; mean age = 21.58 years, SD=3.97) who were randomly assigned to read one vignette describing a male or female target diagnosed with AN, BN, BED, or obesity. Participants then completed measures of stigma and perceived psychopathology. Measures were analyzed using a 4 (target diagnosis) x 2 (target gender) MANOVA and subsequent ANOVAs. RESULTS: Measures of stigma and perceived psychopathology revealed significant main effects for diagnosis (p < .001), but not for target gender. There were no interactions between target diagnosis and gender. Although all diagnostic conditions were stigmatized, more biased attitudes and perceptions of impairment were associated with targets with AN and BN compared to targets with BED and obesity. Additionally, individuals with AN, BN, and BED were perceived as having significantly more psychological problems and impairment than individuals with obesity. CONCLUSION: Although individuals with eating disorders and obesity both face stigmatizing attitudes, bias against individuals with AN, BN, and BED may exceed stigma toward obesity in the absence of binge eating. Future research is necessary to address stigmatizing beliefs to reduce and prevent discrimination against both men and women with eating disorders and obesity.

The relationship between weight stigma and eating behavior is explained by weight bias internalization and psychological distress.

Weight stigma is associated with a range of negative outcomes, including disordered eating, but the psychological mechanisms underlying these associations are not well understood. The present study tested whether the association between weight stigma experiences and disordered eating behaviors (emotional eating, uncontrolled eating, and loss-of-control eating) are mediated by weight bias internalization and psychological distress. Six-hundred and thirty-four undergraduate university students completed an online survey assessing weight stigma, weight bias internalization, psychological distress, disordered eating, along with demographic characteristics (i.e., age, gender, weight status). Statistical analyses found that weight stigma was significantly associated with all measures of disordered eating, and with weight bias internalization and psychological distress. In regression and mediation analyses accounting for age, gender and weight status, weight bias internalization and psychological distress mediated the relationship between weight stigma and disordered eating behavior. Thus, weight bias internalization and psychological distress appear to be important factors underpinning the relationship between weight stigma and disordered eating behaviors, and could be targets for interventions, such as, psychological acceptance and mindfulness therapy, which have been shown to reduce the impact of weight stigma. The evidence for the health consequences resulting from weight stigma is becoming clear. It is important that health and social policy makers are informed of this literature and encouraged develop anti-weight stigma policies for school, work, and medical settings.

Potential Policies and Laws to Prohibit Weight Discrimination: Public Views from 4 Countries.

CONTEXT: People viewed as "overweight" or "obese" are vulnerable to weight-based discrimination, creating inequities and adverse health outcomes. Given the high rates of obesity recorded globally, studies documenting weight discrimination in multiple countries, and an absence of legislation to address this form of discrimination, research examining policy remedies across different countries is needed. Our study provides the first multinational examination of public support for policies and legislation to prohibit weight discrimination. METHODS: Identical online surveys were completed by 2,866 adults in the United States, Canada, Australia, and Iceland. We assessed public support for potential laws to prohibit weight-based discrimination, such as adding body weight to existing civil rights statutes, extending disability protections to persons with obesity, and instituting legal measures to prohibit employers from discriminating against employees because of body weight. We examined sociodemographic and weight-related characteristics predicting support for antidiscrimination policies, and the differences in these patterns across countries. FINDINGS: The majority of participants in the United States, Canada, and Australia agreed that their government should have specific laws in place to prohibit weight discrimination. At least two-thirds of the participants in all 4 countries expressed support for policies that would make it illegal for employers to refuse to hire, assign lower wages, deny promotions, or terminate qualified employees because of body weight. Women and participants with higher body weight expressed more support for antidiscrimination measures. Beliefs about the causes of obesity were also related to support for these laws. CONCLUSIONS: Public support for legal measures to prohibit weight discrimination can be found in the United States, Canada, Australia, and Iceland, especially for laws to remedy this discrimination in employment. Our findings provide important information for policymakers and interest groups both nationally and internationally and can help guide discussions about policy priorities to reduce inequities resulting from weight discrimination.

Effectiveness of a peer-delivered dissonance-based program in reducing eating disorder risk factors in high school girls.

OBJECTIVE: This pilot study investigated the feasibility, acceptability, and effectiveness of a peer-led dissonance-based eating disorders (ED) prevention/risk factor reduction program with high school girls. METHOD: Ninth grade girls (n = 50) received the peer-led program within the school curriculum. A quasi-experimental design was used to assess changes in ED risk factors preintervention and postintervention compared with waitlist control. Participants were followed through 3-month follow-up. RESULTS: Peer-leader adherence to an intervention manual tailored for this age group was high. The intervention was rated as highly acceptable, with a large proportion of participants reporting that they enjoyed the program and learned and applied new information. Intervention participants exhibited significantly greater pre-post reductions in a majority of risk-factor outcomes compared to waitlist controls. When groups were combined to assess program effects over time there were significant pre-post reductions in a majority of outcomes that were sustained through 3-month follow-up. DISCUSSION: This pilot study provides tentative support for the effectiveness of using peer leaders to implement an empirically supported ED risk factor reduction program in a high school setting. Additional research is needed to replicate results in larger, better-controlled trials with longer follow-up.

Weight bias among professionals treating eating disorders: attitudes about treatment and perceived patient outcomes.

OBJECTIVE: This study aimed to assess weight bias among professionals who specialize in treating eating disorders and identify to what extent their weight biases are associated with attitudes about treating obese patients. METHOD: Participants were 329 professionals treating eating disorders, recruited through professional organizations that specialize in eating disorders. Participants completed anonymous, online self-report questionnaires, assessing their explicit weight bias, perceived causes of obesity, attitudes toward treating obese patients, perceptions of treatment compliance and success of obese patients, and perceptions of weight bias among other practitioners. RESULTS: Negative weight stereotypes were present among some professionals treating eating disorders. Although professionals felt confident (289; 88%) and prepared (276; 84%) to provide treatment to obese patients, the majority (184; 56%) had observed other professionals in their field making negative comments about obese patients, 42% (138) believed that practitioners who treat eating disorders often have negative stereotypes about obese patients, 35% (115) indicated that practitioners feel uncomfortable caring for obese patients, and 29% (95) reported that their colleagues have negative attitudes toward obese patients. Compared to professionals with less weight bias, professionals with stronger weight bias were more likely to attribute obesity to behavioral causes, expressed more negative attitudes and frustrations about treating obese patients, and perceived poorer treatment outcomes for these patients. DISCUSSION: Similar to other health disciplines, professionals treating eating disorders are not immune to weight bias. This has important implications for provision of clinical treatment with obese individuals and efforts to reduce weight bias in the eating disorders field.

The Loss of Control Over Eating Scale: development and psychometric evaluation.

OBJECTIVE: This study describes the development, content validity, and convergent validity of the Loss of Control over Eating Scale (LOCES). METHOD: An initial pool of 56 items covering 13 facets of loss-of-control eating was assembled by reviewing qualitative literature, clinical descriptions, and research on binge eating. Eating disorder experts (n = 34) and eating disorder clients (n = 22) rated each proposed item's clarity and relevance to the construct of loss-of-control eating, rated 13 facets for their relevance to the construct, and provided open-ended feedback about the items and facets. Based on the experts' and clients' quantitative and qualitative feedback, scale items were clarified, 28 items were added, and 10 were deleted. University students (n = 476; 70% female, mean age = 20.4 years) completed the resulting 74-item questionnaire, rating how often they had the experience identified in the item while eating in the last 4 weeks. They also completed the measures of eating disturbance, general distress, functional impairment, and general self-control. RESULTS: The resulting 24-item LOCES (Cronbach's α = .96) retained items with highest item-total correlations and coverage of the 12 construct facets that experts rated as important. The LOCES was significantly correlated with eating disturbances, general distress, functional impairment, and general self-control. Three subfactors were identified: behavioral, cognitive/dissociative, and positive/euphoric aspects of loss-of-control eating. A brief, seven-item version of the LOCES was developed and validated. DISCUSSION: A thorough process of development, content validation, and psychometric evaluation in multiple samples yielded the multifaceted LOCES and its brief form. These instruments may be useful in assessing loss-of-control eating in both clinical and nonclinical settings.