Title: The Dutch Eating Behaviour Questionnaire (DEBQ)
1The Dutch Eating Behaviour Questionnaire (DEBQ)
2Stunkards pessimistic verdict
- Most obese persons will not stay in treatment for
obesity. - Of those who stay in treatment most will not lose
weight. - Of those who do lose weight most will regain it
- (Stunkard, 1958)
3Goal
- Also new methods show no satisfactory maintenance
of treatment effects(Wilson, 1994). - Reason absence of fit between treatments and
individuals - Goal improve maintenance of treatment effects by
fitting treatment and individuals
4How to fit treatments and individuals?
- There are different types of overeating
emotional, external and restraint eating. - Each type has its own aetiology (derived from
psychosomatic theory, externality theory and
restraint theory) - Each type also has its own treatment
- Thus fitting treatments and individuals by
assessment of eating behaviour
5The three types of overeating
- Emotional eating eating in response to emotional
arousal states such as fear anger or anxiety. - External eating eating in response to external
food cues such as sight and smell of food - Restraint eating overeating after a period of
slimming when the cognitive resolve to diet is
abandoned
6Three theories of overeating
- Psychosomatic and externality theory attribute
weight gain and obesity to overeating (emotional
and external eating) - Restraint theory (paradoxically) attributes
overeating and weight gain to dieting
7Psychosomatic and externality theory
- In both theories Mispercepetion of internal
state prior to eating is causal factor in
development of obesity - Psychosomatic theory emphasis on internal
emotional factors - Externality theory focus on external food
environment
8Psychosomatic theory
- Confusion of internal arousal states and hunger,
probably because of early learning experiences
(Hilde Bruch) - Low interoceptive awareness (alexithimia)
9Psychosomatic theory Stress and satiety
10Externality theory
- External eating, that is, eating in response to
food-related stimuli regardless of the internal
state of hunger or satiety. - This is the result of externality as personality
trait ( over-responsiveness to external stimuli
in general (not only food, but also a movie, a
sad story etc).
11Restraint theory
- Dieting as a cause rather than a consequence of
over eating (Peter Herman and Janet Polivy,
Toronto, Canada) - Natural weight homeostatically preserved
12Restraint theorymilkshake-ice-cream experiment
13Restraint theory
- Restraint eatingfysiological defence mechanisms
such as hunger and preference for sweets
overeating, weight gain and obesity - Restraint eating loss of contact with hunger and
satiety overeating weight gain and obesity
14The three theories and therapy
- Psychosomatic theory focus on evoking awareness
of own impulses, feelings and needs - Externality theory behavior therapy stimulus
control or cue exposure - Restraint theory accept ones natural weight
undieting
15 DEBQ
- Assessment of an individuals structure of eating
behaviour may enable a better fit between
treatments and the individuals type of eating
behaviour. So, with this goal in mind the DEBQ
was developed. - DEBQ has separate scales for emotional, external
and restrained eating the scale on emotional
eating has two subscales 1) eating in response
to diffuse emotions and 2) eating in response to
clearly labelled emotions.
16Psychometrics
- Excellent factorial validity
- Satisfacory to good reliability
- Satisfactory concurrent and discriminative
validity - Officially available in Dutch and English.
17DEBQ
- In individual and group settings
- For adults and children as young as nine years
old - Takes 10 minutes to complete
- Norm groups are available
18Administration and Scoring
- Administration requires item-form and scoring
template - Item-form p1 demographic questions and
questions on body weight and weight history p2
and 3the 33 DEBQ-items with 5 point Likert
scale. p4 Table of raw scores and norm scores. - Can be easily scored with scoring template.
19Scoring
- Raw scores are obtained by adding the scores of
the items of the scales. These raw scores can be
noted on the back page. - A score on the scale for emotional eating can be
obtained by adding the raw scores of the two
subscales for emotional eating. - To compare raw scores with norm scores, raw
scores should be divided by the total number of
endorsed items on the scale - The appropriate normgroup can be chosen on the
basis of the questions on p1 age, sex, weight
category etc.
20Norms
- DEBQ-scale scores are devided in the seven
categories very high, high, above mean, mean,
below the mean, low and very low. - The intervals of the DEBQ-scale scores associated
with the seven categories are available for the
following norm-groups
21Norms
- a)subsamples of 1170 inhabitants of Ede(men,
women, obese men, obese women, non-obese men
non-obese women) - A sample of 724 high school females
- A sample of 492 female college students
- A sample of 303 female eating disorder patients
- For further smaller samples of subjects
DEBQ-scale statistics are provided.
22DEBQ and therapyhigh emotional eating
- A high degree of emotional eating points toward a
deficient inner cognitive and affective structure
and lack of interoceptive awareness. - An individual with a high degree of emotional
eating may benefit best from therapy focusing on
interoceptive awareness, low self esteem,
feelings of social inadequacy and other
psychological problems accompanying emotional
eating, rather than focussing upon weight as the
sole or most important causal factor.
23DEBQ and therapyhigh external eating
- A high degree of external eating, unsupported by
a high degree of emotional eating, points to a
sensitivity to external cues such as sight and
smell of food. - Is often found in men.
- Therapy should focus on sensitivity to food cues
by means of behavioural methods such as stimulus
control or food exposure.
24DEBQ and therapyhigh restrained eating
- A score on restrained eating should never be
considered in isolation from scores on the other
scales, but always in conjunction with them. - Also the weight history and current weight
status of the patient should be taken into
account as the tendency towards restraint
breaking or bingeing.
25DEBQ and treatmenthigh degree of restrained
eating
- Underweight in combination with severe dieting
may point towards anorexia nervosa. - High weight fluctuation in combination with
severe dieting and tendencies toward restraint
breaking may point at bulimia nervosa.
26DEBQ and treatmenthigh degree of restrained
eating
- High degree of restrained eating, but low degree
of emotional and external eating these
individuals may require more accurate
information concerning nutrition and caloric
balance. - A high degree of restrained eating and a high
degree of emotional or external eating in this
case strict restriction of food intake is not
likely to result in lasting weight loss unless
the underlying psychic problems are solved or the
sensitivity to food stimuli is treated.
27Final remark
- If an individual has always been overweight, he
or she may be better off accepting his or her
heavy build, instead of continuously starving him
or herself. - A more accepting social or medical attidude
towards those who are overweight would alleviate
many psychological problems faced by the
overweight social anxiety, low self esteem.
28The two most asked questions
- Can I, for reason of saving time, not also simply
interview patients on their eating behaviour,
for example by asking them the three questions
Do you diet, Do you eat when emotionally upset,
or when seeing tempting food? - How can I administer the DEBQ to patients when I
have only 10-minutes time for them?
29Why not simply ask them?
- High chance of social desirable response(all
obese live on air and diet all the time). - Answer on a single question gives no indication
on the relative frequency of the eating
behaviour in question within a person. Only
yes/no - The questions have not been tested for their
reliability and validity. - Answer gives no indication on relative frequency
with respect to reference group.
30How can the DEBQ be administered?
- Adminstration and scoring of the DEBQ can be done
by a secretary or doctors assistent. - The DEBQ can be given to the patient to fill it
out at home, but the patient can also complete it
in the waiting room (10 minutes).
31Administration
- A secretary can then score the DEBQ by means of
the scoring templates, fill out the table with
raw scores and the norm scores at the back of the
item-form, and also make a comparison of the
scores and the appropriate norm-group (5
minutes). - The appropriate normgroup can be chosen on the
basis of answers to questions on page 1 of the
item-form.
32Interpretation of the DEBQ
- Also the interpretation of the DEBQ-outcome can
be done by a assistent or secretary, provided
they have been skilled for this. - Preferably the interpretation should be done by
the GP, family doctor or the like.
33Interpretation high emotional eating
- Always start with emotional eating. If this is
high in a patient, restriction of food intake or
behavioural methods focussing on sensitivity to
food cues are not likely to result in permanent
weight loss, unless the psychological probems
accompanying the emotional eating, such as low
interoceptive awareness and low self esteem are
solved. So the therapy should focus on these
problems and not upon weight. - So the therapy should focus on these problems
and not upon weight.