Assessment of Eating Behavior E-Book

• Herausgeber: Hogrefe Publishing
• Kategorie: Geisteswissenschaft
• Serie: Psychological Assessment – Science and Practice
• Sprache: Englisch
• Veröffentlichungsjahr: 2023

Seitenzahl: 781

Beschreibung

Eating behavior encompasses a broad range of aspects: from under- to overeating and from normal to pathological eating. The expert contributors to this volume provide a comprehensive overview of assessment methods for eating behavior research and clinical practice, which include both self-report questionnaires and structured interviews as well as assessment of food intake in the laboratory, ecological momentary assessment, cognitive-behavioral tasks, and psychophysiological measures. They explore the assessment of eating disorders such as anorexia nervosa, bulimia nervosa, binge-eating disorder, and others. They also address topics that may be associated with disordered eating and obesity but are also relevant in persons without these conditions, such as restrained eating and dieting, emotional eating, food craving and food "addiction," orthorexia nervosa, intuitive and mindful eating, and grazing. Further topics that are strongly connected to eating behavior such as body image, physical activity, body composition and expenditure, food neophobia and disgust sensitivity, and weight-related stigmatization are also examined. This book is essential reading for researchers working in clinical and health psychology, consumer psychology, psychiatry, and nutrition science as well as practitioners, including psychotherapists, physicians, nutrition counsellors, who assess eating behavior and related aspects in their daily work.

Leseprobe

Psychological Assessment – Science and Practice, Vol. 6

Assessment of Eating Behavior

Edited by

Adrian Meule

Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany; Schoen Clinic Roseneck, Prien am Chiemsee, Germany

About the Editor

Adrian Meule, PhD, is a researcher at the University Hospital of the LMU Munich and the Schoen Clinic Roseneck (Prien am Chiemsee, Germany). His major research interests include eating behavior, eating disorders, obesity, and other topics in health and clinical psychology, about which he has published more than 150 scientific articles and book chapters as well as one book. He served as editor for several scientific journals and is currently on the editorial boards of Mental Health Science and Obesity Science and Practice.

Psychological Assessment – Science and Practice

Each volume in the series Psychological Assessment – Science and Practice presents the state-of-the-art of assessment in a particular domain of psychology, with regard to theory, research, and practical applications. Editors and contributors are leading authorities in their respective fields. Each volume discusses, in a reader-friendly manner, critical issues and developments in assessment, as well as well-known and novel assessment tools. The series is an ideal educational resource for researchers, teachers, and students of assessment, as well as practitioners.

Psychological Assessment – Science and Practice is edited with the support of the European Association of Psychological Assessment (EAPA).

Editor-in-Chief: Tuulia M. Ortner, Austria

Editorial Board: Itziar Alonso-Arbiol, Spain; Samuel Greiff, Luxembourg; Willibald Ruch, Switzerland; Karl Schweizer, Germany

Library of Congress Cataloging in Publication information for the print version of this book is available via the Library of Congress Marc Database under the LC Control Number 2023935606

Library and Archives Canada Cataloguing in Publication

Title: Assessment of eating behavior / edited by Adrian Meule (Department of Psychiatry and

Psychotherapy, University Hospital, LMU Munich, Munich, Germany; Schoen Clinic Roseneck, Prien am Chiemsee, Germany).

Names: Meule, Adrian, editor.

Series: Psychological assessment--science and practice ; v. 6.

Description: Series statement: Psychological assessment--science and practice ; vol. 6 | Includes

bibliographical references.

Identifiers: Canadiana (print) 20230178960 | Canadiana (ebook) 20230178987 | ISBN 9780889376168

(softcover) | ISBN 9781616766160 (PDF) | ISBN 9781613346167 (EPUB)

Subjects: LCSH: Eating disorders—Diagnosis. | LCSH: Eating disorders—Patients—Psychological testing.

Classification: LCC RC552.E18 A87 2023 | DDC 616.85/26075—dc23

© 2023 by Hogrefe Publishing

http://www.hogrefe.com

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Format: EPUB

ISBN 978-0-88937-616-8 (print) • ISBN 978-1-61676-616-0 (PDF) • ISBN 978-1-61334-616-7 (EPUB)

https://doi.org/10.1027/00616-000

Citability: This EPUB includes page numbering between two vertical lines (Example: |1|) that corresponds to the page numbering of the print and PDF ebook versions of the title.

Contents

Part I  Introduction

Chapter 1  Introduction: Assessment of Eating Behavior

Part II  Eating Behavior Domains

Chapter 2  Assessment of Restrained Eating and Dieting

Chapter 3  Assessment of Emotional Eating

Chapter 4  Assessment of Food Craving and Food “Addiction”

Chapter 5  Assessment of Orthorexia Nervosa

Chapter 6  Assessment of Intuitive Eating and Mindful Eating

Chapter 7  Assessment of Grazing

Chapter 8  Assessment of Anorexia Nervosa

Chapter 9  Assessment of Bulimia Nervosa

Chapter 10  Assessment of Binge Eating Disorder

Chapter 11  Assessment of Other Eating Disorders

Part III  Adjacent Domains

Chapter 12  Assessment of Body Image

Chapter 13  Assessment of Physical Activity

Chapter 14  Assessment of Body Composition and Energy Expenditure

Chapter 15  Assessment of Food Neophobia and Disgust Sensitivity

Chapter 16  Assessment of Weight-Related Stigmatization

Part IV  Assessment Methods and Issues

Chapter 17  Measuring Food Intake in the Laboratory

Chapter 18  Ecological Momentary Assessment of Eating Behavior

Chapter 19  Behavioral Tasks for Measuring and Changing Reactions to Food

Chapter 20  Psychophysiological Measures in Eating Behavior Research

Contributors

|1|Part IIntroduction

|3|Chapter 1Introduction

Assessment of Eating Behavior

Adrian Meule1,2

1 Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Germany

2 Schoen Clinic Roseneck, Prien am Chiemsee, Germany

Introduction

If not prevented by food shortage, humans typically eat every day. At first glance, eating seems like a very simple behavior: if you feel hungry, you eat something until you are satiated. Yet, it is in fact a very complex behavior. Humans have to make numerous decisions each day, for example, when to eat, what to eat, and how long or how much to eat. According to a study by Wansink and Sobal (2007), people make more than 200 of such food decisions every day – most of them unconsciously. Despite this complexity, it appears that eating works quite well for most people without having to think about it much. Yet, given its complexity, eating can also go awry, potentially resulting in eating and weight disorders.

Some people do not consume enough calories or certain nutrients, leading to underweight or nutritional deficiencies. Such restrictive eating may be intentional (e.g., in persons with anorexia nervosa) but can also be unintentional (e.g., resulting from a physical illness). A much larger group of people, however, consume more energy than their body needs, resulting in them becoming overweight or obese (i.e., an excessive accumulation of body fat). As with restrictive eating, overeating can have different causes and patterns. For example, certain forms of overeating are characterized by a disinhibited eating style (e.g., binge eating episodes that are marked by a loss of control over eating). The majority of persons whose weight increases slowly over time, however, are largely unaware of living in a chronic state of positive energy balance (“passive overeating”; Davis, 2013). Figure 1.1 provides an overview of the different eating styles and eating disorders presented in Chapters 2 to 10 by arranging them according to body weight and on a continuum ranging from restrictive to disinhibited eating.

Following this introductory chapter, this book is organized in three parts. In Part II: Eating Behavior Domains, Chapters 2 to 11 describe the assessment of different eating styles and eating disorders. In Part III: Adjacent Domains, Chapters 12 to 16 describe the assessment of aspects that may determine or follow from the eating behaviors described in |4|Part II. In Part IV: Assessment Methods and Issues, Chapters 17 to 20 examine methodological issues in the assessment of eating behavior and its related aspects.

Figure 1.1.  Schematic depiction of eating styles and eating disorders arranged according to eating behavior and body weight.

Eating Behavior Domains

In Chapter 2, Polivy, Herman, and Mills describe the assessment of restrained eating and dieting. Research on restrained eating was heavily influenced – in fact, was started off – by a now classic experiment by Herman and Mack (1975). When participants had to consume a so-called preload (one or two milkshakes), unrestrained (i.e., “normal”) eaters adjusted their subsequent food intake (here, ice cream) while restrained eaters (who were trying to limit their food intake) actually increased their food intake (Figure 1.2). As later research confirmed that such and other experimental manipulations can lead to a “disinhibited” food intake in restrained eaters and as restrained eating measures are usually positively correlated with body mass index (BMI), restrained eating is located somewhat in the upper right corner in Figure 1.1. However, as will be demonstrated in Chapter 2, the assessment of restrained eating and dieting is much more complex as these terms are not synonymous and it appears that there is also a subgroup of successful restrained eaters who do not show disinhibited eating or an elevated body weight (Figure 1.3).

|5|

Figure 1.2.  Mean consumed ice cream in grams as a function of dietary restraint and experimental condition in the classic study by Herman and Mack (1975). Note that there were actually two preload conditions (consumption of one or two milkshakes), the numbers of which are collapsed in this depiction.

Figure 1.3.  Mean body mass index in kg/m² as a function of dietary restraint. The data are based on a study reported in Meule et al. (2012), in which 499 participants were not only classified as unrestrained and restrained eaters but restrained eaters were additionally categorized as successful and unsuccessful based on their perceived self-regulatory success in weight regulation.

|6|In Chapter 3, Evers, Michels, Verbeken, and Braet describe the assessment of emotional eating. Research on this eating style has largely focused on negative emotional states that trigger food intake and – similar to measures of restrained eating – measures of emotional eating are usually weakly, positively correlated with BMI (Frayn & Knäuper, 2018). This is why emotional eating is also located somewhat in the upper right corner in Figure 1.1, close to restrained eating. Yet again, as will be demonstrated in Chapter 3, the concept and assessment of emotional eating is much more complex than this, as it appears that certain affective states can also lead to a decrease in food intake and that self-report measures of emotional eating are not always congruent with other assessment methods.

In Chapter 4, Hoover and Gearhardt describe the assessment of food craving and food “addiction.” Both concepts are strongly related, with the latter term being controversially discussed among scientists and practitioners. Food craving can refer to a transient state of a current, strong desire to consume a specific food but also to a more trait-like eating style (i.e., individuals who often experience and give into such cravings). As such, the experience of food craving is an essential component of conceptualizing certain forms of overeating as an addiction. It appears that current assessment approaches of addiction-like eating strongly overlap with established eating disorders such as bulimia nervosa and binge eating disorder (Meule & Gearhardt, 2019), which is why food addiction is located between the two in the upper right corner in Figure 1.1.

In Chapter 5, Oberle and Noebel describe the assessment of so-called orthorexia nervosa – another concept that has been controversially discussed in the literature. It was proposed by Bratman (1997) who argued that some people are so obsessed with eating healthily that this can even be considered as a new type of disordered eating. While persons who show orthorexic eating tendencies are not trying to limit the quantity of food intake (i.e., the amount of food or calories consumed), they are more concerned about the quality of foods. As such, however, they do exhibit a form of restriction and it appears that there is a large overlap with anorexic eating behavior (at least with currently used measures of orthorexia nervosa; Meule & Voderholzer, 2021). Because of this, orthorexia nervosa is located somewhat in the lower left corner in Figure 1.1.

In Chapter 6, Zimmer-Gembeck, Stansfield, Kerin, and Donovan describe the assessment of intuitive eating and mindful eating. Both concepts are strongly related and their definitions somewhat overlap: Intuitive eating can be defined as a tendency to follow physical hunger and satiety cues when determining when, what, and how much to eat (Tylka & Kroon Van Diest, 2013) and mindful eating can be defined as a nonjudgmental awareness of physical and emotional sensations associated with eating (Framson et al., 2009). As both intuitive and mindful eating represent functional, adaptive, and healthy eating styles that promote having a normal weight in the absence of intentional food restriction or loss-of-control eating, they are located in the center of Figure 1.1.

In Chapter 7, Conceição, de Lourdes, and Neufeld describe the assessment of grazing. Grazing is characterized by repetitive eating of small amounts of food in an unplanned manner. Although measures of grazing usually correlate only weakly with BMI, grazing appears to be a highly prevalent eating style in persons with obesity (Heriseanu et al., 2017), which is why it is located on the right-hand side in Figure 1.1. While it is a form of overeating, it is not necessarily characterized by a distinct loss of control over eating like during binge eating episodes, which is why it is located between normal and disinhibited eating in Figure 1.1.

|7|In Chapter 8, Davis, Kells, and Wildes describe the assessment of anorexia nervosa. Although one of the first descriptions in the psychiatric literature is often attributed to Gull in 1873 (reprinted in Gull, 1997), there are also earlier reports about its symptomatology (cf. Bemporad, 1996). Anorexia nervosa is an eating disorder that is characterized by restriction of energy intake relative to requirements, leading to a significantly low body weight. Therefore, it is located in the lower left corner in Figure 1.1. However, two subtypes are commonly differentiated. The restricting type describes presentations in which weight loss is accomplished primarily through dieting, fasting, and/or excessive exercise. The binge/purge type describes presentations in which individuals engage in recurrent episodes of binge eating and purging behavior (e.g., self-induced vomiting). Thus, a subgroup of persons with anorexia nervosa do indeed show recurring disinhibited eating. Yet, it appears that at the same time they have similar levels of dietary restraint to those with restricting type anorexia nervosa (Uniacke et al., 2020), which is why this subtype is not separately depicted in Figure 1.1.

In Chapter 9, Abber, Ali, and Keel describe the assessment of bulimia nervosa. The term bulimia nervosa was coined by Russell (1979) but there are also earlier reports about its symptomatology (cf. Vandereycken, 1994). Bulimia nervosa is an eating disorder that is characterized by recurrent episodes of binge eating and inappropriate compensatory behaviors in order to prevent weight gain (e.g., self-induced vomiting). In contrast to persons with binge/purge type anorexia nervosa, however, persons with bulimia nervosa typically have normal weight or are slightly overweight. Therefore, bulimia nervosa is located at the top in Figure 1.1 and somewhat at the border from normal weight to overweight.

In Chapter 10, Egbert and Goldschmidt describe the assessment of binge eating disorder. Binge eating was first described as an eating pattern among obese persons by Stunkard (1959) although it appears that earlier case reports even date back to the 1930s (Stunkard, 1990; Wulff, 1932). Binge eating disorder is an eating disorder that is characterized by recurrent episodes of binge eating. Unlike persons with bulimia nervosa, however, persons with binge eating disorder do not engage in inappropriate compensatory behaviors to prevent weight gain. Accordingly, the majority of persons with binge eating disorder are overweight or obese. Therefore, binge eating disorder is located in the upper right corner in Figure 1.1.

In Chapter 11, Allison describes the assessment of other eating disorders, namely night eating syndrome, avoidant/restrictive food intake disorder (ARFID), rumination disorder, and pica. Night eating syndrome is characterized by recurrent episodes of night eating, as manifested by eating after awakening from sleep or by excessive food consumption after the evening meal. Similar to binge eating disorder, night eating syndrome was first described by Stunkard as early as the 1950s (Stunkard et al., 1955) but has not been included in diagnostic classification systems until 2013 (American Psychiatric Association, 2013). ARFID can be defined as an eating or feeding disturbance that is manifested by persistent failure to meet appropriate nutritional or energy needs. Rumination disorder is marked by repeated regurgitation of food that may be rechewed, reswallowed, or spit out. Pica is characterized by persistent eating of nonnutritive, nonfood substances. Locating these eating disorders on a spectrum from underweight to overweight and from restrictive to disinhibited eating is not straightforward. For example, although night eating syndrome has originally been conceptualized as an eating behavior among persons with obesity, its relationship with body weight is ambiguous (Meule et al., 2014). While ARFID is often associated with a low body weight, this is not the result of an intentional |8|food restriction driven by weight and shape concerns (i.e., unlike in persons with anorexia nervosa). Similarly, regurgitation of food in rumination disorder is not driven by an intention to lose weight or prevent weight gain (i.e., unlike self-induced vomiting in persons with bulimia nervosa). Finally, the essential feature of pica refers to the nature of consumed substances. Therefore, these eating disorders are not represented in Figure 1.1.

Adjacent Domains

In Chapter 12, Arkenau -Kathmann, Quittkat, and Vocks describe the assessment of body image. Body image refers to a person’s perception of their body and shape as well as attitudes and feelings toward their body. There is also a behavioral component, that is, body-related behaviors (e.g., body checking) that result from – and in turn can influence (Shafran et al., 2007) – a person’s body image. Marked weight and shape concerns and a disturbed body image are key features of eating disorders such as anorexia nervosa and bulimia nervosa and drive intentions to restrict eating. However, the relationship between body image and eating behavior is bidirectional. For example, weight and shape concerns can also be the result of weight gain after a longer period of excess energy intake.

In Chapter 13, Lampe and Gorrell describe the assessment of physical activity. Although not included as a diagnostic criterion, excessive or compulsive exercise can often be observed in persons with eating disorders such as anorexia nervosa and bulimia nervosa. The relationship between physical activity and eating behavior, however, is not restricted to persons with eating disorders and, similar to body image, is bidirectional. For example, eating behavior (e.g., carbohydrate intake) influences exercise performance. Vice versa, physical activity also influences eating behavior as it seems that acute exercise is associated with a short-term suppression of hunger and energy intake and exercising regularly appears to be associated with better appetite control (Drenowatz et al., 2019).

In Chapter 14, Casanova, O’Driscoll, Finlayson, Stubbs, and Hopkins describe the assessment of body composition and energy expenditure. By taking a person’s height into account, BMI is a fairly good estimator of a person’s percent body fat, at least in certain groups of individuals (e.g., young adult women; Meule & Platte, 2018). However, it is less precise in others, particularly athletes with a large amount of muscle mass, children and adolescents, pregnant or breastfeeding women, and elderly persons. As will be described in this chapter, there are several methods to measure body composition more precisely, for example, by differentiating fat and fat-free mass. Besides physical activity, body composition (particularly fat-free mass) is a major determinant of energy expenditure, yet it also relates to appetite and energy intake. Thus, similar to the previous chapters on adjacent domains, there is a bidirectional relationship: eating behavior influences body composition and energy expenditure and vice versa.

In Chapter 15, Hartmann and van der Horst describe the assessment of food neophobia and disgust sensitivity. Food neophobia refers to the fear or reluctance to eat unfamiliar or novel foods. In children, it has been suggested that food neophobia can be considered as lying on the continuum ranging from food neophobia to picky/fussy eating to ARFID (Dovey, 2018). Disgust sensitivity refers to the predisposition for experiencing disgust. At first glance, both concepts seem quite similar: In relation to food, both neophobia and the experience of disgust result in the avoidance of consuming a particular food. How|9|ever, it seems that they can indeed influence food selection and consumption independently. In one study, for example, food neophobia and disgust sensitivity were uncorrelated with each other and both concepts independently predicted lower intentions to eat insect-based foods (La Barbera et al., 2018).

In Chapter 16, Lindloff and Meadows describe the assessment of weight-related stigmatization. Weight stigmatization refers to negative attitudes, beliefs, and behaviors towards persons who are overweight because of their weight or size. Similar terms include weight discrimination, weight bias, antifat bias, or antifat attitudes. Besides the assessment of stigmatizing attitudes in nonoverweight persons towards persons who are overweight, an important line of research in this field is the self-stigmatization or internalization of weight bias in these persons with overweight. Experiences of weight stigma and higher levels of weight bias internalization have been linked to a range of adverse outcomes, including physical, psychological, and social detriments (Pearl, 2018).

Assessment Methods and Issues

In Chapter 17, Higgs describes how food intake can be measured in the laboratory. The majority of measures described in Parts II and III of this book are self-report questionnaires. While such measures are widely used, they are susceptible to be biased (e.g., due to social desirability or recall bias). Measuring food intake in the laboratory may, therefore, be a more “objective” approach in eating behavior research. For example, it allows for examining not only amount, calories, or macronutrients of consumed food but also food choice (if several foods are offered) and eating microstructure (e.g., eating rate, duration). Measuring food intake in the laboratory is often disguised as a taste test in an attempt to avoid that participants feel that their eating is being observed. While there is support that such bogus taste tests can validly be used as a measure of food intake, there are numerous aspects that need to be considered when planning and conducting such studies (Best et al., 2018; Buckland & Dalton, 2018; Hetherington & Rolls, 2018; Meule, 2018; Robinson et al., 2018; Stubbs & Finlayson, 2018).

In Chapter 18, Zhang, Mason, and Smith describe ecological momentary assessment of eating behavior. Similar to measuring food intake in the laboratory, ecological momentary assessment can avoid biases inherent in self-report questionnaires. Here, participants answer questions about their food intake and other information (e.g., hunger, mood) usually several times a day. Thus, ecological momentary assessment allows the capturing of this information almost in real time, thus avoiding recall biases. In contrast to measuring food intake in the laboratory, it also allows for capturing dynamic changes in eating and associated aspects and – as eating is assessed in daily life – avoids the artificial situation inherent in laboratory studies. Yet, although it solves many issues compared with other assessment methods, there are also caveats as ecological momentary assessment may itself change eating behavior. For example, it has been found that keeping a daily snack diary suffices to decrease unhealthy snacking (Verhoeven et al., 2014).

In Chapter 19, Masterton and Jones describe behavioral tasks for measuring and changing reactions to food. Reactions to food that are often automatic, implicit, and unconscious are a strong force that drives eating behavior. In this chapter, the authors focus on three main domains that have been of increased interest in recent years: inhibitory control, approach–avoidance tendencies, and attentional biases. Moreover, research indi|10|cates that these reactions to food (or other) stimuli cannot only be measured but can also be modified by adapting reaction time tasks as trainings, which is done by simply altering stimulus–response contingencies (Kemps & Tiggemann, 2021; Tiggemann & Kemps, 2020). As of yet, however, studies have produced inconsistent findings whether this cognitive bias modification also results in changes of real-world consumption behaviors.

In Chapter 20, Lutz, van Dyck, and Vögele describe psychophysiological measures in eating behavior research. Physiology is, obviously, highly relevant to eating behavior. The digestion of food represents an interplay of complex physiological processes. Yet, physiological reactions occur even before food has been ingested. For example, salivary flow increases merely in response to seeing or smelling food, with more salivation being related to a stronger craving for the food (Meule & Hormes, 2015). In addition, there are numerous psychophysiological methods that have been used in eating behavior research that measure physiological responses that are not part of the digestive system. Among others, these include measuring brain activity, facial muscular activity, eye movements, or cardiovascular activity.

Conclusions

This volume treats the assessment of many different eating styles and eating disorders, describes the assessment of domains that are adjacent to eating behavior, and discusses methodological topics. As eating behavior is so multifaceted, however, it cannot fully cover all aspects that might be relevant to eating behavior research. For example, as the focus of this book is more on psychological aspects of eating behavior, it does not include a detailed description of dietary intake assessment – that is, how to assess consumed macro- and micronutrients in daily life – as would be required during nutrition counseling. Other omissions include the assessment of certain forms of nutrition (e.g., vegetarianism, pescetarianism, veganism) and their motivational and attitudinal aspects (e.g., attitudes towards meat consumption and animal welfare). These are just a few examples but there are probably many more aspects that could be mentioned here. Yet, with the topics covered in this book, readers – both researchers and practitioners – will be well-equipped for the assessment of eating behavior and its related aspects.

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|13|Part IIEating Behavior Domains

|15|Chapter 2Assessment of Restrained Eating and Dieting

Janet Polivy,1 C. Peter Herman,1 and Jennifer S. Mills2

1 Department of Psychology, University of Toronto, Canada

2 Department of Psychology, York University, Canada

Introduction

The purpose of this chapter is to describe and discuss the various measures used in the assessment of restrained eating and dieting. We separate these two constructs, despite the fact that restrained eating has often been seen as virtually synonymous with dieting. Indeed, it was originally proposed as a way of capturing chronic dieting attempts. As will become evident, the characteristics associated with long-term, on-again/off-again dieting are not always the same as those associated with single-episode, current dieting. Thus, we will treat restrained eating and dieting as separate constructs requiring different assessment and measurement approaches. Moreover, we will focus the present discussion only on “normal dieting” and normal restrained eating, not on eating disorders and their measurement, which will be addressed in later chapters.

Defining Restrained Eating and Dieting

One cannot assess an attribute without defining it, and with dieting and restrained eating, definitions can be somewhat complex. People have different reasons for dieting and/or restricting their eating. Many people eat or avoid particular foods for ethical, moral, or religious reasons, such as eating only religiously defined halal or kosher foods, or being vegetarian or vegan because of a moral opposition to killing animals for food. Some people follow a healthful food regimen which they regard as a diet. Others eat or avoid particular foods because of allergies, digestive issues, or other health concerns. The goal in these instances is unrelated to weight or appearance, and may not involve any restriction on the number of calories consumed. Many individuals who “diet” do so in order to be healthier by losing weight, and thus they restrict their food intake but are not particularly concerned with their body shape or appearance. Nevertheless, most of the psychological literature on eating behavior, and more specifically restrained eating and dieting, focuses on a different group, namely the large number of people who go on weight-loss |16|diets specifically in order to try to improve their appearance and/or body image. These are the individuals whom researchers consider to be restrained eaters or dieters.

But even defining weight-loss dieters is not a simple matter. Should people who try to restrict their eating in order to lose weight or to look more attractive be considered dieters if they do not succeed in restricting their intake with any consistency? Or should only those who actually succeed at cutting back on their intake be considered dieters? Are people who say that they are dieters actually dieters regardless of whether they are really restricting their food intake? Is being a dieter based on intent, self-identification, or action?

Identifying restrained eaters or weight-loss dieters also leads to some interesting distinctions. Restrained eaters were originally defined by Herman and Polivy (1980) as chronic dieters who make repeated attempts to lose weight by dieting, but who are also inclined to bouts of overeating interspersed among periods of restricting intake. Moreover, these chronic on-again, off-again dieters displayed a set of behaviors (restraining one’s eating but then eating excessive amounts), emotional reactions (such as greater responses to emotional provocation), and attentional or cognitive patterns (such as a focus on food cues). Thus, restrained eating is more than simply being on a diet to lose weight at any given moment, and is therefore not the same as being a dieter per se. As Martz, Sturgis, and Gustafson (1996, p. 298) pointed out, “recent literature defined dieting as a set of current behaviors, whereas dietary restraint is defined as a more enduring style of eating behavior including excessive food restriction, dieting, and sometimes binge eating and weight-cycling.”

Dieting tends to be defined much more simply in the research literature as simply whether one is attempting to restrict one’s intake in order to control one’s weight (either losing weight or maintaining an already reduced weight; e.g., Lowe, 1993), but dieting can also be based on restriction of amounts or certain types of food (e.g., following a particular weight-loss diet that eliminates sugar or carbohydrates). Like dieting, restrained eating has been defined and assessed in different ways (e.g., Polivy et al., 2020). In this chapter, we will try to distinguish among different measures of restrained eating and dieting based on the definitions used by those who constructed the assessment devices.

Defining Dieting

Researchers studying dieting (not restrained eating) are usually looking specifically at current dieters, individuals who claim to be on a diet at present. Lowe (1993, p. 100) defines “current dieting” as “a current effort to reduce caloric intake to lose weight” and “a commitment to lose weight by dieting.” However, French and Jeffrey (1994, p. 195) reviewed the literature (at that time) on dieting and noted that “current dieting, chronic dieting, desire to lose weight, specific weight control behaviors, and weight changes may have different effects on health and need to be distinguished.” When Martz and colleagues (1996) attempted to construct a scale to measure “dieting to lose weight,” they suggested operationalizing dieting on the basis of not only specific behaviors, but also on the basis of cognitions and intentions, specifying that actual weight loss may not occur despite the appropriate dieting behaviors and intentions and thus should not be part of the operationalization of the concept. Moreover, simply asking people whether or not they are dieting at that moment forces a dichotomy of dieting versus not dieting to which Martz et al. object. Accordingly, they developed a set of current dieting behaviors rather |17|than a single question to measure dieting. They concluded that dieting should refer only to various current behaviors in a specific episode, whereas the more chronic condition should be seen as restrained eating. Importantly, trends in weight control behaviors change over time, which adds complexity to defining dieting. Any definition of dieting needs to be flexible and may vary according to social trends. Intermittent fasting, as an example, has multiple eating patterns associated with it, depending on how much time elapses between meals and the time of day during which people eat.

Defining Restrained Eating

The original definition of restrained eating was proposed by Herman and Polivy (1975), and reflected not only the attempt to restrict food intake by dieters, but also other attributes seen as part of the construct. Restrained eating was seen as a complex set of behaviors (both food restriction, and a breakdown of that restriction resulting in episodes of excessive consumption), weight fluctuations presumably resulting from these behaviors, plus attitudes about one’s weight and eating, cognitions about food and eating, emotional responses to eating, and the motivation to be thinner. In addition, the Restraint Scale (RS) asked about frequency of “dieting” (Herman & Polivy, 1980). The definition of restrained eating as originally presented by Herman and Polivy (1975, 1980) was that it is a complex individual-difference trait consisting of dieting behaviors, episodes of diet abandonment and overeating, and a set of cognitions, attitudes, and a motivation to be thinner or more physically attractive. Finally, self-identification as a dieter was assessed by asking how often one dieted, with possible responses from “never” to “always.” Thus, Herman and Polivy saw restrained eating as composed of: individual differences in motivation to be thinner, by means of cognitive efforts to “restrain” one’s food intake; behavioral restriction and also overeating in the face of overwhelming temptations; emotional reactions to such eating (e.g., feeling guilty after overeating); and a self-identification as someone who diets to control one’s weight. Both restriction and succumbing to temptation were seen as critical to the definition of restrained eating (Herman & Polivy, 1980; Polivy & Herman, 1985, 1987; Williamson et al., 2007).

In 1985, a new measure, the Three Factor Eating Questionnaire (TFEQ), was developed by Stunkard and Messick to capture multiple aspects of eating behavior. The TFEQ had a subscale that the authors named “cognitive restraint” as well as subscales assessing “disinhibition” and “hunger.” These authors were primarily interested in identifying successful dieters who managed to restrict their intake consistently enough to lose weight. Unfortunately, using the same term (“restraint”) as Herman and Polivy’s earlier conceptualization has led to decades of confusion in the literature, if only because Stunkard deliberately separated the disinhibition component from the restriction component in his questionnaire. Thus, “cognitive restraint” (which, naturally, became shortened by those using the questionnaire to “restraint” or “restrained eating”) differs from the earlier notion of restraint: The Stunkard and Messick version is meant to describe only successful control over food intake, not caloric restriction combined with episodes of overeating or disinhibition (see Heatherton et al., 1988; or Polivy et al., 2020 for more complete discussions of this issue).

A year later, van Strien and her colleagues presented their eating assessment device, the Dutch Eating Behavior Questionnaire (DEBQ; Strien, Frijters, Berger, & Defares, 1986; |18|Strien, Frijters, Staveran et al., 1986). This measure also contains a subscale labeled “restrained eating” along with scales assessing “emotional eating” and “external eating.” Similar to the TFEQ, van Strien viewed restrained eating as successful restriction of intake without a disinhibitory component (see Heatherton et al., 1988 or Polivy et al., 2020).

The restrained eating described by both the Stunkard group and the van Strien group appears to be successful dietary restriction over a long term (Laessle et al., 1989; Tuschl et al., 1990), and is independent of the other dimensions (e.g., periodic episodes of disinhibited eating and emotional and cognitive responses to food and eating) that were seen as critical components of restrained eating by Herman and Polivy (Heatherton et al., 1988; Polivy et al., 2020). These later conceptions of restrained eating may be seen as purer views of dietary restriction.

Questionnaire Measures of Dieting and Restrained Eating

In order to predict and understand how people behave around foods of various types, we need to identify dieters and restrained eaters. We will examine the main measures that have been developed and used for this purpose.

Dieting Scales

Single Questions: For the most part, researchers have been content to simply ask participants if they are currently on a diet as a yes/no question (e.g., Lowe et al., 1991; Neumark-Sztainer et al., 1997; Rideout & Barr, 2009). Despite the finding that clear, single-item questions asking about whether or not one is currently dieting to lose weight do correlate well with energy intake, several researchers have tried to develop multi-item measures of current dieting.

Cognitive Behavioral Dieting Scale:Martz and colleagues (1996) developed the Cognitive Behavioral Dieting Scale (CBDS), a 14-item scale designed to measure current dieting behaviors and related thoughts during the preceding two weeks. Internal and test–retest reliability were both high (α = .95; r = .95) and the scale predicted caloric intake. While related to restrained eating, the behaviors measured by the CBDS were deemed to be different from dietary restraint, and to reflect simple dieting. Martz and colleagues concluded that this measure operationalizes dieting and measures it on a continuum. Unfortunately, this measure does not seem to have attracted much research attention.

Dietary Intent Scale: The Dietary Intent Scale (DIS; Stice, 1998a) has been described by its author as “a 9-item measure of dietary behaviors with three sub-scales assessing reduced intake of food, abstaining from eating, and consumption of low-calorie foods” (p. 282). The original paper presenting this scale described it somewhat differently as

a nine-item measure of restraint … that was created for the present study because of the questionable validity of the RS. A pilot study (N = 117) indicated that the DIS is internally (α = .94) and temporally reliable (1-month test–retest r = .92). (Stice, 1998b, p. 247)

|19|Because later work by Stice continues to describe the DIS as a measure of dieting rather than restraint (e.g., Stice et al., 2004, 2010), we will include it here. As Stice (1998b) indicated, the scale appears to have good internal and test–retest reliability. The full nine-item questionnaire is available in Stice (1998b).

Perceived Self-Regulatory Success in Dieting Scale:Fishbach and colleagues (2003) developed a measure of self-perceived success at dieting. The Perceived Self-Regulatory Success in Dieting Scale (PSRS) consists of three questions designed to distinguish between successful and unsuccessful dieters. The scale has been found to have reasonable internal reliability (α = .72–.79), and validity was determined by its consistent negative correlations with body mass index (BMI) and various measures of dietary concern (Meule et al., 2012).

Current Dieting Questionnaire: A more recent and more streamlined dieting scale was presented by Williamson and his colleagues (2007). The Current Dieting Questionnaire (CDQ) consists of three dichotomous (true/false; yes/no) self-report items with reasonably good internal reliability (α = .85). The three items are available in the paper discussing the scale (Williamson et al., 2007).

Restrained Eating Scales

As we mentioned earlier, the various measures of restrained eating were constructed with different goals in mind. The RS (Herman & Polivy, 1980) was intended to measure chronic dieting that consists of cycles of restriction, or at least attempted restriction, and periods of disinhibition or overeating, whereas the TFEQ and DEBQ both have subscales for purely restricted eating and other subscales to measure such constructs as disinhibition (TFEQ) or emotional eating (DEBQ). The Eating Disorder Examination (EDE; Fairburn & Beglin, 1994) was, like the RS, designed to identify more disordered dieting and overeating behaviors. As we will see, these different goals led to somewhat different, although related, measures, with the RS and EDE restrained eating measures combining dietary restriction with episodes of disinhibited overeating, while the TFEQ and DEBQ restraint scales explicitly remove disinhibitory lapses of control, assessing actual restriction of food intake.

Restraint Scale: The construct of restrained eating was originally proposed to account for the self-reported behavior of chronic weight-concerned dieters, who described dieting for long periods (all-day or all-week long) only to eat excessively at night or on the weekend. The RS (Herman & Polivy, 1975, 1980) was thus designed to measure restrictive dieting behaviors and cognitions, bouts of overeating and their consequences, and also attitudes about oneself or one’s body, all of which were believed to be part of the broad construct of restrained eating. Weight fluctuations, for example, could result from alternations between restricting one’s intake and overeating or splurging when the diet was abandoned. Measurement of such fluctuations was included to assess the extent to which individuals both reduced and increased their food intake. The RS is a 10-item self-report questionnaire that asks about dieting, weight fluctuations, and attitudes toward one’s body and eating (e.g., “Do you have feelings of guilt after overeating?” and “Do you eat sensibly in front of others and splurge alone?”). The internal reliability (α = .79–.86) and test–retest reliability of the scale have been found over several studies to be good (e.g., Stice et al., 2004), and early concerns about the possibility of the scale being bifactorial have proven not to be an issue (Heatherton et al., 1988; Stice et al., 2004).

|20|Three Factor Eating Questionnaire: The TFEQ (Stunkard & Messick, 1985) was designed (as its name suggests) to measure three aspects of eating behavior, which were derived iteratively from a large number of initial items into cognitive restraint (20 items), disinhibition (20 items), and hunger (15 items). The coefficient alpha internal reliabilities were above .92 for the first two factors and .85 for hunger. The cognitive restraint factor has been shortened to simply being called a measure of restraint (the TFEQ-R). It is described as assessing behaviors designed to reduce or maintain weight, as well as concerns with thinness and physique (e.g., Stice et al., 2004) or “the extent to which one engages in cognitive and behavioral efforts to limit food intake” (French & Jeffrey, 1997, p. 34). Thus, like the RS, the full TFEQ measures both cognitions and behaviors related to weight-loss dieting.

Later work on the TFEQ identified two dimensions of TFEQ-R, flexible and rigid control of eating (Westenhoefer et al., 1999), later called flexible and rigid restraint (e.g., Masheb & Grilo, 2002; Westenhoefer et al., 2013). Flexible restraint appears to be associated with more positive eating behaviors and lower weight, less overeating, and more successful weight loss, whereas rigid restraint is opposite on all these dimensions (Westenhoefer et al., 1999).

Dutch Eating Behavior Questionnaire: The DEBQ measures restrained, emotional, and external eating. The restrained eating subscale contains 10 items, with excellent internal reliability (α = .95; Strien et al., 1986). The intent of the DEBQ-R was to assess “the degree to which an individual eats less than he or she actually would like to eat” (Strien, Frijters, Staveran et al., 1986, p. 747). The focus is thus specifically on actual behavioral reductions in intake rather than the combination of restriction and overconsumption captured by the RS or restriction and body concern captured by the TFEQ-R. The external eating and emotional eating scales look at other influences on eating behavior separately from restrained eating.

Eating Disorder Examination: The EDE began as a structured interview assessing four factors: restraint and food avoidance, eating concern, shape concern, and weight concern (Fairburn & Cooper, 1993). Later, a self-report questionnaire version was developed (EDE-Q; Fairburn & Beglin, 1994). Both versions of the EDE are widely used, mainly in the eating disorder area, as the purpose of the interview and questionnaire versions is to identify people suffering from an anorexia or bulimia nervosa. The agreement between the two versions of the EDE is acceptable for all four subscales, although greater pathology seems to be reported on the EDE-Q than in the interviews (Wilfley et al., 1997).

Successful and Unsuccessful Restraint: It was pointed out decades ago that measures of restraint, particularly the RS, do not discriminate well between successful and unsuccessful restriction of intake (e.g., Laessle et al., 1989; Ogden, 1993). Ogden suggested two items to assess such success. One of the items simply asks about current weight-loss dieting status (answered on a 5-point scale from never to always), but the other asks how successful one views oneself in this enterprise (answered on the same 5-point scale). She used these questions as additions to the RS and DEBQ-R scales and found that for both questionnaires, the most successful dieters had the lowest scores on restraint, the least successful scored the highest, and moderately successful dieters scored between the other two groups. Those who tried the most to diet and failed most often thus had the highest restraint scores on two of the main measures of restrained eating. Ogden thus sees her measure as one of successful restraint, rather than simply of successful dieting. |21|Van Strien (1997) found different results using these questions with the DEBQ-R scale, finding higher scores on DEBQ-R for successful than for unsuccessful dieting, and no evidence that attempting to reduce intake was related to unsuccessful dieting nor that actually eating less was associated with successful dieting. Although one could question whether Ogden’s measure reflects dieting or restrained eating, it probably does not actually matter how these questions are classified: they help to raise the issue of self-rated success versus failure for both dieting and restrained eating.

Outcomes and Effectiveness of Measures of Dieting and Restrained Eating

In order to decide which assessment measure one should use, it is important to know how the various techniques perform. Obviously, we cannot review all of the evidence here, but we will try to present a general view of how well each measurement instrument achieves its intended goal of predicting how people will behave with respect to eating, and what each measure seems to assess.

Measures of Dieting

The simplest measure, simply asking people whether or not they are dieting to lose weight, has been found to have mixed results in terms of predicting either reduced caloric intake or weight loss. In one study the question predicted reported expenditure of energy through exercising, but not caloric intake (e.g., French et al., 1994), whereas in other studies by the same research team, it was associated not only with decreased energy intake (Neumark-Sztainer et al., 1997) but also with lower intakes of fat and sugar, increased intake of fruits and vegetables, and a greater frequency of weighing oneself (French & Jeffrey, 1997). However, individuals who self-identify as current dieters have also been found to underreport their energy intake when self-reports are compared to actual food diaries (e.g., Rennie et al., 2006) and to have higher BMIs than nondieters (e.g., Rideout & Barr, 2009).

Stice’s DIS was also not found to correlate with caloric intake in one study (Stice et al., 2010) but it did correlate negatively with both calories and grams of fat consumed in another (Stice et al., 2004). It did not predict weight loss over time (Stice, 1998a), however. More recently, DIS scores did not correlate with various measures indicating failure of self-regulation (as the RS did), nor did it predict eating behavior, leading the authors of the study to conclude that “it is still unclear what exactly the DIS measures” (Boyce et al., 2015, p. 6).

The PSRS is really an indirect measure of dieting, as it asks not about whether or how much one is dieting, but how successful one has been at it. This may be a problem for it, at least as a measure of dieting, because it is not clear that respondents can indicate if they are actually not dieters. In our own laboratory, we re-examined data from 17 studies wherein we measured both RS and PSRS and we found that individuals who scored as successful dieters did not eat less when tempting food was available, and were actually more likely to be unrestrained eaters and current nondieters (Nguyen & Polivy, 2014). On |22|the other hand, we did find that regardless of restraint level, high scorers on the PSRS did have lower BMIs, indicating that although most of them might not actually be dieting or concerned about their eating at all, the ones who were dieters might be more successful, as they do weigh less. Similarly, Alblas and colleagues (2021) found that regardless of restraint level, those lower on PSRS made more unhealthy food choices on a computerized food-choice measure than those scoring high. Thus, the PSRS may not be a measure of dieting per se, but it does seem to identify more successful dieters.

The CDQ was successful in predicting weight loss during a diet study. In addition, scores on the CDQ did increase during the dietary restriction phase of the study, indicating that the scale does measure current dieting (Williamson et al., 2007).

Measures of Restrained Eating

The RS has consistently been found to measure the combination of (a) dieting/restricting intake and (b) bouts of overeating and abandonment of restrictions or disinhibition (e.g., Boyce et al., 2015; Heatherton et al., 1988; Laessle et al., 1989; Ogden, 1993; Stice et al., 2004, 2010; Williamson et al., 2007). The RS does not predict consistent caloric restriction, or actual dieting behavior on any given occasion involving food, but it is associated with unsuccessful dieting attempts and disinhibited eating. For example, Ogden (1993, p. 75) concluded (looking only at the RS) that “restrained eating represents attempts at restriction followed by compensatory eating,” and Laessle et al. (1989) indicated that the RS is related to unsuccessful dieting, disinhibited eating, and weight fluctuations, but not to successful caloric restriction. The TFEQ-R and DEBQ-R scales, on the other hand, seem to be more consistently associated with caloric restriction, or more successful dieting (e.g., French et al., 1994; Laessle et al., 1989; Rideout & Barr, 2009; Rodgers et al., 2018; Strien, 1997; Westenhoefer et al., 2013; Williamson et al., 2007), although some studies do not find a (negative) correlation between these measures of restrained eating and actual caloric consumption over many days (Stice et al., 2004, 2007, 2010). A study comparing self-rated successful versus unsuccessful dieters found that the successful dieters scored lower and the unsuccessful dieters scored higher on both the RS (as would be expected) and the DEBQ-R (more surprisingly; Ogden, 1993). A more recent study concluded that the RS is a better measure than the DEBQ for identifying individuals who struggle the most to control their food intake (Adams et al., 2019).

Conclusions

Dieting Versus Restrained Eating: Are They the Same?