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Psychometric analysis of the Three-Factor Eating Questionnaire-R21: results from a large diverse sample of obese and non-obese participants

Abstract

Background:

The 21-item Three-Factor Eating Questionnaire (TFEQ-R21) is a scale that measures three domains of eating behavior: cognitive restraint (CR), uncontrolled eating (UE) and emotional eating (EE).

Objectives:

To assess the factor structure and reliability of TFEQ-R21 (and if necessary, refine the structure) in diverse populations of obese and non-obese individuals.

Design:

Data were obtained from obese adults in a United States/Canadian clinical trial (n=1741), and overweight, obese and normal weight adults in a US web-based survey (n=1275). Confirmatory factor analyses were employed to investigate the structure of TFEQ-R21 using baseline data from the clinical trial. The model was refined to obtain adequate fit and internal consistency. The refined model was then tested using the web-based data. Relationships between TFEQ domains and body mass index (BMI) were examined in both populations.

Results:

Clinical data indicated that TFEQ-R21 needed refinement. Three items were removed from the CR domain, producing the revised version TFEQ-R18V2 (Comparative Fit Index (CFI)=0.91). Testing TFEQ-R18V2 in the web-based sample supported the revised structure (CFI=0.96; Cronbach's coefficient α of 0.78–0.94). Associations with BMI were small. In the clinical study, the CR domain showed a significant and negative association with BMI. On the basis of the web-based survey, it was shown that the relationship between BMI and CR is population-dependent (obese versus non-obese, healthy versus diabetics).

Conclusions:

In two independent datasets, the TFEQ-R18V2 showed robust factor structure and good reliability. It may provide a useful tool for characterizing UE, CR and EE.

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Acknowledgements

This study was sponsored by Pfizer Inc. Editorial Support was provided by Joyce A Healey at Pfizer Inc., New London, CT, USA; Zoë Thornton-Jones, PhD, at Envision Pharma; the study was funded by Pfizer Inc. Joseph C Cappelleri, Andrew G Bushmakin, Robert A Gerber, Chris Sexton and Nancy Kline Leidy participated in the conception and design of the study, and data interpretation and writing of the manuscript. Michael R Lowe and Jan Karlsson provided significant advice and consultation, and participated in the data interpretation and writing of the manuscript.

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Correspondence to J C Cappelleri.

Appendix

Appendix

The Three-Factor Eating Questionnaire—Revised 21-Item (TFEQ-R21)

1. I deliberately take small helpings to control my weight.

(1) Definitely true, (2) Mostly true, (3) Mostly false, (4) Definitely false

2. I start to eat when I feel anxious.

(1) Definitely true, (2) Mostly true, (3) Mostly false, (4) Definitely false

3. Sometimes when I start eating, I just can’t seem to stop.

(1) Definitely true, (2) Mostly true, (3) Mostly false, (4) Definitely false

4. When I feel sad, I often eat too much.

(1) Definitely true, (2) Mostly true, (3) Mostly false, (4) Definitely false

5. I don’t eat some foods because they make me fat.

(1) Definitely true, (2) Mostly true, (3) Mostly false, (4) Definitely false

6. Being with someone who is eating, often makes me want to also eat.

(1) Definitely true, (2) Mostly true, (3) Mostly false, (4) Definitely false

7. When I feel tense or “wound up”, I often feel I need to eat.

(1) Definitely true, (2) Mostly true, (3) Mostly false, (4) Definitely false

8. I often get so hungry that my stomach feels like a bottomless pit.

(1) Definitely true, (2) Mostly true, (3) Mostly false, (4) Definitely false

9. I’m always so hungry that it’s hard for me to stop eating before finishing all of the food on my plate.

(1) Definitely true, (2) Mostly true, (3) Mostly false, (4) Definitely false

10. When I feel lonely, I console myself by eating.

(1) Definitely true, (2) Mostly true, (3) Mostly false, (4) Definitely false

11. I consciously hold back on how much I eat at meals to keep from gaining weight.

(1) Definitely true, (2) Mostly true, (3) Mostly false, (4) Definitely false

12. When I smell a sizzling steak or see a juicy piece of meat, I find it very difficult to keep from eating—even if I’ve just finished a meal.

(1) Definitely true, (2) Mostly true, (3) Mostly false, (4) Definitely false

13. I’m always hungry enough to eat at any time.

(1) Definitely true, (2) Mostly true, (3) Mostly false, (4) Definitely false

14. If I feel nervous, I try to calm down by eating.

(1) Definitely true, (2) Mostly true, (3) Mostly false, (4) Definitely false

15. When I see something that looks very delicious, I often get so hungry that I have to eat right away.

(1) Definitely true, (2) Mostly true, (3) Mostly false, (4) Definitely false

16. When I feel depressed, I want to eat.

(1) Definitely true, (2) Mostly true, (3) Mostly false, (4) Definitely false

17. How often do you avoid “stocking up” on tempting foods?

(1) Almost never, (2) Seldom, (3) Usually, (4) Almost always

18. How likely are you to make an effort to eat less than you want?

(1) Unlikely, (2) A little likely, (3) Somewhat likely, (4) Very likely.

19. Do you go on eating binges even though you’re not hungry?

(1) Never, (2) Rarely, (3) Sometimes, (4) At least once a week

20. How often do you feel hungry?

(1) Only at mealtimes, (2) Sometimes between meals (3) Often between meals (4) Almost always

21. On a scale from 1 to 8, where 1 means no restraint in eating and 8 means total restraint, what number would you give yourself?

Mark the number that best applies to you: 1 2 3 4 5 6 7 8.

©2000. HRQL Group HB—Göteborg University on-Campus Company, Göteborg, Sweden.

The uncontrolled eating domain was composed of items 3, 6, 8, 9, 12, 13, 15, 19, 20. The cognitive restraint domain was composed of items 1, 5, 11, 17, 18, 21. The emotional eating domain was composed of items 2, 4, 7, 10, 14, 16.

Before calculating the domain scores, items 1–16 should be reverse coded and item 21 should be recoded as follows: 1–2 scores as 1; 3–4 as 2; 5–6 as 3; 7–8 as 4.

Note: Items 17, 18 and 21 are not part of the Three-Factor Eating Questionnaire revised 18-item, version 2 (TFEQ-R18V2).

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Cappelleri, J., Bushmakin, A., Gerber, R. et al. Psychometric analysis of the Three-Factor Eating Questionnaire-R21: results from a large diverse sample of obese and non-obese participants. Int J Obes 33, 611–620 (2009). https://doi.org/10.1038/ijo.2009.74

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