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    Accepted Manuscript

    Research report

    The Dutch Eating Behaviour Questionnaire (DEBQ): Assessment of eating be

    haviour in an aging French population

    Nathalie Bailly, Isabelle Maitre, Marion Amand, Catherine Herv, Daniel

    Alaphilippe

    PII: S0195-6663(12)00371-6

    DOI: http://dx.doi.org/10.1016/j.appet.2012.08.029

    Reference: APPET 1627

    To appear in: Appetite

    Received Date: 29 August 2012

    Accepted Date: 31 August 2012

    Please cite this article as: Bailly, N., Maitre, I., Amand, M., Herv, C., Alaphilippe, D., The Dutch Eating Behaviour

    Questionnaire (DEBQ): Assessment of eating behaviour in an aging French population, Appetite(2012), doi: http://

    dx.doi.org/10.1016/j.appet.2012.08.029

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    The Dutch Eating Behaviour Questionnaire (DEBQ):

    Assessment of eating behaviour in an aging French population

    Authors:

    Nathalie Bailly*

    Isabelle Maitre

    Marion Amand

    Catherine Herv

    Daniel Alaphilippe

    Correspondence to: Nathalie Bailly, University Franois Rabelais, E.A. 2114. Psychologie des Ages de la Vie , Department of Psychology, 3 rue des Tanneurs, 37041Tours Cedex, France. [email protected]

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    Abstract:

    The aim of the study was to develop a French version of the Dutch EatingBehaviour Questionnaire (DEBQ) in order to provide a self-report measure for French

    people in the field of gerontology. A short version of the DEBQ was administered to

    262 participants aged 65 years and older. Single and multigroup confirmatory analyses

    were carried out. The fit measures for the three-factor model and the factorial invariance

    models with respect to age, sex and BMI status were satisfactory. Three subscales of

    DEBQ had satisfactory internal consistency. Regarding age, the results showed

    significant differences in emotional eating and restrained eating. Concerning sex,

    women had higher mean scores for emotional eating and restrained eating than men.

    Finally, the overweight older people had higher scores for emotional eating than the

    normal-weight participants. The short version of DEBQ should provide a useful

    measure for researchers and clinicians who are interested in exploring eating behaviours

    among the elderly.

    Keywords:

    Dutch Eating Behaviour Questionnaire

    Eating behaviour

    Elderly

    Older people

    Validation

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    Introduction

    Population aging is now a worldwide phenomenon. In the more developed

    regions, the proportion of the population 60 years and older is estimated to increase

    from 19 percent to 32 percent between 2000 and 2050, with those 80 years and older

    constituting more than one out of four of the elderly in 2050 (United Nations, 2003).

    This aging of the population has raised important questions concerning the specific

    nutrition of aging systems, changes in food preferences and overall quality of life

    (Elsner, 2002). Decreased physical activity and decreased energy expenditure with

    ageing predispose to fat accumulation and redistribution. According to several studies in

    developed countries, the early phase of aging (55 to 65 years) is often associated with a

    positive energy balance and an increase in body fat which is linked to excess morbidity,

    mortality, and health care costs (Andreyeva, Sturn & Ringel, 2004; Calle, Teras &

    Thun, 2005; Cornoni-Huntley, Harris, Everett, Albanes, Micozzi, Miles, & Feldman,

    1991). In the subsequent phase of aging (after 65 to 75 years), body fat and lean body

    mass decrease and continue to decline with a negative energy balance (Wilson &

    Morley, 2003). Age-related physiological changes contribute to the development of

    malnutrition in older adults (Chapman, 2007; Chen, Schilling, & Lyder, 2001).

    Eating is not an automatic process but is influenced to a large extent by cultural,

    social, and psychological pressures felt by each of us. Over the last 30 years, theories

    have been developed to assess various aspects of the motivation to eat which could

    impair adequate food intake and body weight control. Based on psychological theories,

    Van Strien et al. (Van Strien, Frijters, Bergers & Defares, 1986) defined three different

    eating behaviours. The psychosomatic theory (Bruch, 1973; Kaplan & Kaplan, 1957)

    emphasizes the role of emotional eating. It refers to eating in response to negative

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    emotions in order to relieve stress while disregarding internal physiological signals of

    hunger. The externality theory (Schachter, Goldman & Gordon, 1968; Rodin, 1981)

    refers to eating in response to food-related stimuli (sight or smell of food) regardless of

    the internal state of hunger and satiety. The theory of restrained eating (Herman &

    Polivy, 1980) reflects the degree of conscious food restriction (attempts to refrain from

    eating in order to lose or maintain a particular weight).

    Most studies have indicated that these three eating behaviours are linked to the

    body mass index (BMI) (Baos, Cebolla, Etchemendy, Felipe, Rasal & Botella 2011;

    Bozan, Bas & Asci, 2011; Porter & Johnson, 2011; Ricca, Castellini, Lo Sauro Ravaldi,

    Lapi, Mannucci, Rotella & Faravelli, 2009; Van strien, Herman & Verheijden, 2009 ),

    nature of food consumption (Baos et al., 2011; Burton, Smit & Lightowler, 2007;

    Ouwens, Van Strien, & Van Der Staak, 2003; Porter & Johnson, 2011; Snoek, Van

    Strien, Janssens & Engels, 2007) and psychological outcomes such as depression,

    anxiety or body-esteem (Flament, Hill, Buchholz, Henderson, Tasca & Goldfield, 2012;

    Goossens, Braet, Van Vlierberghe & Mels, 2009; Porter & Johnson, 2011). The three

    types of eating behaviour can be reliably and validly measured using the Dutch eating

    Behaviour Questionnaire (DEBQ: Van Strien et al., 1986). The DEBQ consists of 33

    items with answers on a 5-point Likert scale (ranging from never to very often).

    The English version of the original DEBQ (Wardle, 1987) has been translated into

    many languages: Portuguese (Viana & Sinde, 2003), Turkish (Bozan et al. 2011),

    Spanish (Baos et al., 2011), French (Llutch,

    Kahn, Stricker-Krongrad, Ziegler, Drouin& Mjan, 1996) and Swedish (Halvarsson & Sjoden (1998).All these versions show

    good factorial validity (reporting a stable factor solution for the total DEBQ and for the

    three subscales) and reliability, and also satisfactory internal consistency. The DEBQ

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    has a stable factor structure across genders, weight categories, and random samples

    (Allison, Kalinsky & Gorman, 1992; Van Strien & Oosterveld, 2008). Different

    versions have been adapted for adults and adolescents (LLutch et al., 1996; Van Strien

    et al., 1986; Wardle, 1987) for children (Halvarsson & Sjoden, 1998: 9-10 years old;

    Van Strien & Oosterveld, 2008: 7- 12 years old) and for clinical populations (Baos et

    al., 2011; LLutch et al., 1996). A version of the questionnaire for parents (DEBQ-P) has

    been validated in the Italian population (Caccialanza, Nicholls, Cena, Maccarini,

    Rezzani, Anatonioli et al., 2004). However to date, no version adapted for an older and

    oldest-old population has been developed. Given the specific nutritional problems

    linked to an aging population, it seems important to have a reliable and valid tool to

    provide a better understanding of eating behaviours in aging, which can be used by

    public health nutrition practitioners and researchers.

    The aims of the present study were to test the factorial validity and internal

    consistency of a short version of the DEBQ in an older people population. Further aims

    were to test the factorial validity and the similarity of the factorial structure for men and

    women, older and the oldest-old, and for those who were or were not overweight (BMI-

    status). The final purpose was to obtain basic data concerning the DEBQ in an older

    population.

    Methods

    Participants

    Data presented in this study were obtained from the Aupalesens project:Improving

    pleasure of elderly people for better aging and for fighting against malnutrition

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    (http://www2.dijon.inra.fr/aupalesens/)1.A sample of 559 older French adults aged 65 years

    and older replied to a multidisciplinary questionnaire on food preferences, social factors and

    food context, sensory abilities, medical status and nutritional status of individuals aged

    65 years and older (the survey contained a total of more than 400 items). French older adults

    were recruited and stratified by age, gender and marital status in four towns in France.

    Volunteers were screened for cognitive impairment using the French adaptation of

    Folsteins Mini Mental Status Examination (MMSE; Desrosiers & Hbert, 1997) and

    were excluded if they scored less than 25. The Aupalesens project was funded by the

    French National Research Agency (ANR); the experimental protocols were approved by

    the local research ethics committee (CPP).

    The present study concerns only older people living independently (the first

    category of the Aupalesens Project). The total sample included 262 French adults aged

    65 and older living in their own homes. The mean age of the participants was 73.49

    years (SD = 5.46, 65-90) with 178 women (67.9%, M age = 73.75, SD = 5.4) and 84

    men (32.1%, M age = 72.95, SD = 5.4). Regarding marital situation, 51 % (n = 134)

    were married or had a partner and 49 % (n = 128) lived alone. Regarding previous

    occupational status, the main categories were office workers (42.74%, n = 112),

    executives (33.6%, n = 88) and middle managers (21%, n = 55).

    BMI was calculated from height and weight measurements. International cut-off

    scores were used to determine whether a participant was overweight or obese.

    Participants with scores above 25 were considered overweight or obese. There were noThe Aupalesens project aims to investigate food preferences and behaviour associated with the desire to

    eat and the pleasure of eating in older people during aging. Four categories were identified: 1) peopleliving at home without any assistance, 2) people living at home with assistance, except for mealpreparation, 3) people living at home with assistance for meal preparation or meal delivery and 4) peopleliving in a nursing home

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    underweight participants (BMI < 18.50) in our sample. A total of 34.44% (n=90) of the

    participants had a normal weight status and 65.56 % (n=172) were overweight or obese.

    The distribution of BMI obtained for our sample was close to the percentages for the

    French population. In 2009, in France, 1.9% of people over 65 years of age were

    underweight and 60.2% were overweight or obese (Obpi, 2009).

    Instrument: the DEBQ

    The DEBQwas assessed using the French version of Van Striens scale (LLutch

    et al., 1996). The DEBQ consists of 33 items answered on a 5-point Likert scale

    (ranging from never to very often). Considering the aims of the Aupalesens project,

    the DEBQ could be for used on less autonomous populations including those loosing

    physical autonomy living in nursing homes. However, due to the fatigue and annoyance

    effect specific to this older population (oldest-old) and further comparison with them,

    we decided to shorten the DEBQ scale.To this end, a group of experts in gerontology

    and eating behaviours met to identify strategies for selecting items. Attention was

    focused both on the results of the French validation study (Llutch et al, 1996) and on the

    validation of the questionnaire in an adult population.

    Firstly, we examined the factorial loadings of the 33 items from previous

    research. Items such as Eat less if you have put on weightorDesire to eat when

    bored or restless were removed because of their lower factorial loadings when

    validated in French adults (Llutch et al., 1996). Secondly, the pertinence of the items in

    relation to an aging population was examined. For example items such as Tempted

    when food is being prepared and Tempted by snack bar/fast food store were

    removed due to their lack of relevance for an aging population. Indeed, older adults may

    have difficulty performing basic activities of daily living, such as eating or preparing

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    meals. Some of them require personal assistance services, assistive technology, help

    from others or all three to perform activities of daily living, and receive home delivery

    of meal trays (Davin, Paraponaris & Verger, 2009). As a result of this review, 16 items

    (Table 1) were selected to represent the three eating behaviour patterns: restrained

    eating (5 items), external eating (5 items) and emotional eating (6 items). This adapted

    scale was then pilot-tested with ten older people. All the participants stated that they had

    no difficulty understanding the items and expressed their willingness to complete all the

    items.

    Data analysis

    First we carried out a factor and item analysis on the DEBQ. A Kaiser-Meyer-

    Olkin (KMO) value of .82 indicated a good sampling adequacy for the factor analysis.

    Bartletts test of sphericity yielded a chi-square value of 1752 (p = .000), indicating that

    the model is appropriate.

    The factor analysis was performed by means of a principal component factor

    analysis with varimax rotation. Criteria for item selection were 1) a factor loadings

    above .40 on the appropriate factors and 2) factor loadings not exceeding .20 on non-

    appropriate factors.

    To test whether the three-factor structure was an adequate representation of the

    older adult responses, a confirmatory factor analysis (CFA - Joreskog & Sorbom, 1998)

    was performed on the total sample of participants. CFA was chosen over exploratory

    factor analysis (EFA) because it can be used (1) to test first whether the hypothesized

    factor structure for the set of measures fits the data and, if this is the case, (2) to

    examine how similarly the model fits across the different sub-samples (Bryant &

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    Yarnold, 1995). Firstly, we investigated whether the three-factor model was an adequate

    representation of the relationship between the items. Secondly, we investigated whether

    this model was appropriate for several subsamples by fitting multigroup models. Hence,

    a number of models were fitted for which equality constraints on parameters over the

    groups were gradually imposed, i.e., first the three-factor model was fitted for each

    group (Model 0), then equality constraints were imposed on the factor correlations

    (Model 1), then additional equality restrictions were imposed on the factor loadings

    (Model 2) and, finally, equality restrictions were imposed on the unique variances

    (Model 3). Model fit was examined using the ratio of 2 and degree of freedom (2/df),

    and the root mean square error of approximation (RMSEA). The ratio should not exceed

    2; the RMSEA should not exceed the .05 level. The RMSEA is accompanied by the test

    of close fit, which should not reach significance. For multigroup models, a 2 difference

    test can be used to test whether imposing additional restrictions leads to a significant

    drop in fit. Multigroup tests were performed for age, sex and BMI-status. The test on

    factorial invariance for age was conducted on two age groups (based on the median):

    65- 73 years-old (n=141) and 73 years-old and older (n= 121).

    Finally, scores for each of the three scales were obtained by dividing the sum of

    the item-scores by the total number of items on that scale. For each scale, means and

    standard deviations (SD) were calculated and compared according to sex, BMI-status

    and age.

    All analyses were conducted with AMOS-SPSS.

    Results

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    The factorial structure of the shorter form was examined using exploratory factor

    analysis on the 262 older people of 65 years and older. The scree-test suggested that a

    three-factor solution was the best fit for the data (Table 1).

    The three factors explained 54% of the variance among the scale items (30.27%,

    13.39%, and 10.37%). Factor 1 included the six emotional eating items (eigenvalue =

    4.8). Factor 2 included the five restrained eating items (eigenvalue = 2.1). Factor 3

    included the five externality eating items (eigenvalue = 1.66). In line with the results of

    Van strien et al., our findings thus support a three-factor model in an older population.

    Cronbachs alpha value was .90 for emotional eating, .71 for restrained eating and .70

    for externality eating, indicating satisfactory internal consistencies in our study.

    Factor structure and factorial invariance

    Table 2 shows the fit measures of the three-factor model in the total sample and

    the multigroup models for the test of factorial invariance. First, a baseline model was

    examined involving three correlated latent factors (emotion, restriction and externality)

    with six items loading for emotion, five items each loading for restriction and

    externality. The 2/df was just above 2 and the RMSEA was higher than .05. The

    indices were acceptable but not good. If the initial model to be tested did not provide an

    adequate representation of the data, the modification indices (MIs) and standardized

    expected parameter changes (SEPCs) were used to modify the model, as recommended

    by Kaplan (1989). MIs and SEPCs suggested error covariances between 1) items 13

    and 15 (external dimension), 2) items 1 and 8 (emotion dimension) and 3) items 9 and

    16. The model was modified to incorporate these additional parameters; the fit indices

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    associated with this model are presented in Table 2 as Model (a). Analysis revealed that

    the model now provided a better fit to the data as evidenced by the low RMSEA and

    higher 2/df.

    The second section of Table 2 contains the fit measures of the multigroup

    models for testing factorial invariance for age. Model 0 - the model specifying that the

    three-factor model is adequate for both groups with varying parameter values for the

    groups - had adequate fit measures. Thus, the three-factor model was applicable for

    older and the oldest-old participants. The results were basically the same for Model 1

    and the 2 difference test showed that the difference in fit for Model 0 and 1 is not

    significant. The results were the same for Model 1 and Model 2. This was not the case

    for Model 3: the 2 difference test showed that adding equality restrictions on the unique

    variance led to a significant difference in fit. The third section of Table 2 contains the fit

    measures of the multigroup model for testing factorial invariance for sex. All the

    models had acceptable fit measures and the differences between the models are not

    significant indicating that the three-factor model was applicable for the older men and

    women. However, in Model 3, the 2 difference test showed that adding equality

    restrictions on the unique variances led to a significant difference in fit. The fourth

    section of Table 2 contains the results for the factorial invariance test in relation to BMI

    status. The results indicate that the three-factor structure was applicable for normal

    weight status and overweight status, while Model 3, the most restricted model, led to

    a significant difference in fit.

    Eating behaviours in relation to age, sex and BMI-status

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    Table 3 shows the means and standard deviations of the scales obtained in the

    total sample and sub-sample (younger-old/older-old, men/women, and normal weight/

    overweight). In all the samples, restrained eating was the most prevalent type of eating

    behaviour, followed by external eating and emotional eating. Regarding age, results

    show significant differences in emotional eating (t(260) = 2.14 , p =.033) and restrained

    eating (t(260) = 2.12 , p =.035). The younger-old had higher mean scores for restriction

    and emotion than the older-old. Similarly, regarding sex, women had higher mean

    scores for emotional eating (t(260) = 5.31 , p =.000) and restrained eating (t(260) =

    2.80 , p =.006) than men. The DEBQ responses showed no significant age and gender

    interactions (restrained eating: F(1,257) = 0.04; NS emotional eating: F(1,257)=0.19;

    NS and external eating: F(1.257) = 0.23; NS). Finally, regarding BMI status,

    overweight older people had higher scores for emotional eating than normal-weight

    participants (t(260) =2.24 , p =.026). No differences for external eating were observed

    between groups in the subsamples.

    Discussion

    The aim of this study was to validate a short version of the DEBQ to measure

    restrained, emotional and external eating in an older adult population. A confirmatory

    factor analysis was performed to assess 1) the construct validity for the measure of

    eating behaviour dimensions, and 2) whether the factorial structure is invariant for age,

    sex and BMI-status. An additional objective was to provide some basic data for this firstvalidation study among people aged 65 years and older.

    A tool of 16 items (6 for emotional eating, 5 for external eating and 5 for

    restrained eating) was drawn up which selected items according to their appropriateness

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    for older people and their previous factor loadings in adults. A three-factor model

    showed acceptable fit indicating that this short version represents three dimensional

    factors. These three factors correspond to those of the original work of Van Strein et al.

    (1986) and the different language adult versions (LLutch et al., 1996; Wardle, 1987). To

    our knowledge, the CFA method has been used in only two previous studies (Baos et

    al., 2011; Van Strien & Oosterveld, 2007). The CFA was chosen in preference to

    exploratory factor analysis (EFA) because it can be used on models which have a well-

    developed underlying theory and to examine how similarly a model fits across diverse

    sub samples. In this study, the tests for factorial invariance showed that the three-factor

    model was applicable for the younger-old and oldest-old, men and women and the two

    groups of BMI status. Adding equality constraints on the factor correlations (Model 1)

    and on the factor loadings (Model 2) did not lead to a significant increase in 2 values.

    Nonetheless, the more restrictive model (Model 3), where equality restrictions were

    imposed on the unique variances, led to a significant difference in fit.

    Although the internal consistency values of DEBQ are good, they are lower thanthose reported in the original version of DEBQ (Van Strien et al., 1986 - alpha between

    .80 an.95) and those reported in an adult French population (Llutch et al., 1996 alpha

    between .82 and .91). The absence of previous data on an older population makes

    comparison difficult (the maximum age was 41 years in Llutchs French validation). For

    a better understanding of these first results a larger sample of older people needs to be

    investigated. Nonetheless, regarding the structure and the psychometric properties of the

    DEBQ, this shorten scale appears to be a good self-report screening instrument that

    measures eating behaviours and attitudes to eating in an older adult population.

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    Examination of the subsample scores on restrained, emotional and external

    eating reveals that restrained eating was the most prevalent type of reported eating

    behaviour, followed by emotional and external eating. The importance of restrained

    eating behaviour in the older people suggests that this population is particularly aware

    of food intake. In response to the prevalence of malnutrition in the older people, France

    has developed health awareness campaigns directed towards seniors and set up specific

    controlling bodies (PNNS: National Nutritional Health Programme; HAS: French

    National Authority for Health). These health recommendations can discourage older

    people from eating food considered unhealthy by social medical science. In addition,

    diabetes, cholesterol and other common diseases in older people can also lead to

    restrained food intake, for example reducing the consumption of cured meats and high-

    sugar content foods. This observed restrained eating behaviour would therefore be

    linked to a desire to remain healthy. Concerning age, our results indicate that restrained

    eating is higher in the younger-old group (65-73 years old) than in the oldest-old (over

    73 years old). According to the restrained theory, restrained eaters attempt to control

    their eating but with age, uncontrollable and irreversible events occur (bereavement,

    death of close friends, role loss, etc.) which put considerable strain on one's perceived

    control (Infurna, Gerstorf & Zarit, 2011; Skaff, 2007). This perceived loss of control

    can explain the difference on restrained eating between younger-old and the oldest-old.

    It could also be postulated that the sensorial, physical and social losses among the

    oldest-old would lead individuals to put the pleasure of eating before healthrecommendations. This is clearly summarised by one of the interviewees in the

    Aupalesens project who said eating is the only pleasure left! (Sulmont-Ross, Matre

    & Issanchou, 2010). Thus, this loss of control on restrained eating may be a deliberate

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    choice. In addition, our results indicate higher scores for emotional eating in the

    younger-old than for the oldest-old. Younger-old are more prone to eat in response to

    negative emotions to relieve stress. Gerontological research suggests a decline in

    negative emotions with age (Carstensen, Fung & Charles, 2003). In particular, socio-

    emotional selectivity theory (Carstensen, et al., 2003) suggests that elders improve in

    affect optimization,i.e., the ability to maximize positive emotion and dampen negative

    emotion. The oldest-old would thus have less need for emotion eating. However, to

    investigate this further it would be interesting to introduce a positive emotion item (e.g.,

    Desire to eat when happy) in the DEBQ scale to understand better the role of both

    positive and negative emotions on eating behaviour.

    Our study indicates that women scored higher in restrained and emotion eating

    than men. Regarding restrained eating, our results are similar to those observed in

    previous studies in young adult and adult populations (Wardle, 1987). It has been

    suggested that higher scores for dietary restraint in women could be explained by the

    fact that women are more likely to diet than men. Therefore, women express restrained

    behaviours in response to greater awareness and concern about food and fear of gaining

    weight (de Castro, 1995). In addition, current societal standards for female beauty

    emphasize the desirability of thinness (Wiseman, Gray, Mosimann, Ahrens, 1992)

    leading women to be more concerned than men about the effects of aging on their

    appearance (Gupta & Schork, 1993). Several authors highlight a standard of aging

    whereby older women are judged much more harshly than older men (Tiggemann,

    2004; Wilcox, 1997). With regard to emotional eating, older women are more prone to

    this than older men. Gerontological literature indicates that older women experience

    depression and anxiety more often than older men (Schoevers, Beekman, Deeg, Janker

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    & van Tilburg, 2003). This suggests emotion-oriented coping among older women is

    used to alleviate negative emotional states (Konttinen, Mnnist, Sarlio-Lhteenkorva,

    Silventoinen, & Haukkala, 2010; Spoor, Bekker, Van Strien & van Heck, 2007).

    Finally, concerning the BMI status, our study indicates that emotional eating is

    more important for the overweight participants. Our results are in line with previous

    studies (Greeno & Wing, 1994; Van Strien, Frijters, Roosen, Knuiman-Hijl & Defares,

    1985) which support the idea that overweight individuals are more likely to use food as

    an emotional defence to cope with a negative event, which causes overconsumption

    which, in turn, leads to obesity (Kaplan & Kaplan, 1957). However, contrary to

    previous results (Baos et al., 2011; Snoek et al., 2007; Wardle, 1987), BMI status did

    not influence restrained eating in the older group. This could be related to the body

    mass index (BMI) used to measure body fat. Many authors consider BMI to be

    unsuitable and not to take into account the age-related changes in body fat distribution.

    Some claim that the BMI thresholds for overweight and obesity are overly restrictive

    for older people (Flicker, McCaul, Hankey, Jamrozik, Brown, Byles, & Almeida,

    2010). Recent evidence indicates that in older people, obesity is paradoxically

    associated with a lower rather than higher, mortality risk (Chapman, 2010). Evidence

    from practice, in addition to literature reviews, does not support the use of BMI when

    assessing nutritional issues in individual older subjects. Furthermore, this could also

    explain the high rate of overweight participants in our sample (65.56%).

    Our study has several limitations. Given the characteristics of our sample (younger-old,living independently with no cognitive impairment, previously have high-level

    professional occupations, etc.), we can assume that our participants have not yet had to

    deal with major health or social problems. The high functioning level of our sample

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    could have biased certain results. A study involving a more representative sample of the

    older French population would improve understanding of eating behaviour in old age.

    Further research should involve less autonomous and older people. These first results

    among younger-old should be compared with those for the oldest-old. Indeed, the loss

    of control in preparing meals and food choice for people with assistance for meal

    preparation or meal delivery will change eating behavior in terms of restrained,

    emotional and external eating. The DEBQ scale also needs to be tested for its

    concurrent, discriminant and predictive validity. To improve prevention and treatment

    strategies, factors that influence eating behaviours among older people need to be

    investigated. In particularly, social eating networks, body self-esteem, general eating

    habits, health status (misfitting or unclean dentures, lack of dentition) and mental health

    (anxiety, depression) undoubtedly impact on the motivation to eat among older people.

    Nonetheless, this first study shows that the French adaptation of the shorten

    scale has satisfactory psychometric properties and may therefore be a valuable

    instrument for researchers and clinicians who are interested in exploring the motivation

    to eat in older people.

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    Table 1: Varimax rotated 3-factor solution of the DEBQ (16 items) for older subjects.

    Emotional

    Eating

    30.27%

    Restrained Eating

    13.39%

    External Eating

    10.37%

    1 - Desire to eat when irritated .675 .100 .187

    2 Eat more when see others eat .131 .061 .499

    3 Desire to eat when watch others eat .345 .048 .684

    4 Eat less after eating too much -.133 .510 .077

    5 Eat less than you would like .118 .634 .152

    6 Desire to eat when walk past the baker .239 .047 .461

    7 Eat less to avoid weight gain become heavier .137 .793 .033

    8 Desire to eat when something unpleasant is about

    to happen

    .872 .011 .078

    9 Desire to eat when feeling lonely .707 .167 .199

    10 Watch what you eat .051 .646 -.103

    11 Desire to eat when depressed or discouraged .791 .101 .215

    12 Desire to eat when things go wrong .892 .037 .100

    13 Desire to eat when see or smell food .003 .049 .738

    14 Eat slimming foods .187 .724 -.048

    15 Eat more if food tastes good .021 -.096 .696

    16 Desire to eat when emotionally upset .881 .015 .085

    Cronbachs Alpha .90

    (6 items)

    .71

    (5 items)

    .70

    (5 items)

    As the DEBQ is protected by copyright (Berne convention), only abbreviated items are given.

    Table 2: Fit measures for the DEBQ three-factor models and the multigroup models forage, sex and BMI status.

    Fit Measures 2 difference test

    2df p

    2/dfRMSEA p

    2df p

    Three-factor Model 210 101 .000 2.07 .064 .031Three-factor Model(a) 157 98 .000 1.63 .049 .52

    Test for age (multigroup model)

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    Model 0 281 192 .000 1.47 .043 .89Model 1 291 205 .000 1.42 .040 .94 9.5 13 .73Model 2 297 211 .000 1.41 .04 .95 6.3 6 .39Model 3 332 232 .000 1.43 .04 .94 34.4 21 .03

    Test for sex (multigroup model)Model 0 266 192 .000 1.39 .039 .96Model 1 283 205 .000 1.38 .038 .96 17.6 13 .17Model 2 291 211 .000 1.38 .038 .97 7.6 6 .27Model 3 352 232 .000 1.51 .045 .82 60.7 21 .00

    Test for BMI (multigroup model)Model 0 282 192 .000 1,40 ,039 ,95Model 1 291 205 .000 1,41 ,040 ,95 19.6 13 ,11Model 2 298 211 .000 1,38 ,038 ,97 2,71 6 .84Model 3 332 232 .000 1,58 ,047 ,68 74,49 21 .00

    Table 3- Means, Standard deviations (SD) for restrained, emotional and external eatingin the total sample and the sub-sample of younger-old and older-older, women and men,normal weight and overweight participants.

    Restrained Eating Emotional eating External eating

    All sample (n=262) 2.87 (.92) 2.02 (.97) 2.48 (.73)

    Age

    Younger-old (141) 2.98 (.92) 2.14 (1.09) 2.54 (.73)Older-old (121) 2.74 (.90) 1.88 (.90) 2.42 (.74)

    Sex

    Women (178) 2.98 (.88) 2.23 (1.01) 2.50 (.74)Men (84) 2.64 (.96) 1.58 (.71) 2.44 (.73)

    BMI-status

    Normal weight (90) 2.82 (.97) 1.83 (.90) 2.49 (.64)Overweight (172) 2.90 (.90) 2.12 (1) 2.48 (.76)

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    The Dutch Eating Behaviour Questionnaire (DEBQ):

    Assessment of eating behaviour in an aging French population

    Research highlights

    We test a short version of the DEBQ in an aging population

    Single and multigroup confirmatory analyses were carried out

    Women scored higher in restrained and emotion eating

    Younger-old group scored higher in restrained and emotion eating

    French version of DEBQ may be a valuable instrument in exploring themotivation to eat in older people.