From the Guidelines
To screen for obesity, healthcare providers should use Body Mass Index (BMI) as the primary tool, alongside waist circumference measurements, as recommended by the American Heart Association 1. When assessing for obesity, it is essential to consider both the simplicity and limitations of BMI as a measure. BMI, calculated as body weight in kilograms divided by height in meters squared (kg/m2), is a widely used anthropometric measure to assess for total body adiposity. However, it does not distinguish between lean and fat mass, which can lead to misclassification of individuals with high levels of lean body mass as overweight or obese. Despite these limitations, BMI has been shown to be a useful tool in epidemiological studies, with increased morbidity and mortality associated with higher BMI values 1. In addition to BMI, waist circumference measurements can provide valuable information on central adiposity, which is a significant risk factor for cardiovascular disease. Men with waist circumferences greater than 102 cm (> 40 inches) and women with waist circumferences greater than 88 cm (> 35 inches) are at increased risk for cardiovascular disease 1. While food questionnaires such as the Three-Factor Eating Questionnaire (TFEQ), the Dutch Eating Behavior Questionnaire (DEBQ), or the Food Frequency Questionnaire (FFQ) can provide insights into eating behaviors and patterns, they should be used in conjunction with objective measurements like BMI and waist circumference for accurate obesity screening. The effectiveness of these tools stems from their ability to identify problematic eating behaviors and patterns of adiposity that contribute to weight gain, allowing for targeted interventions that address specific behavioral patterns and risk factors. In clinical practice, the use of BMI and waist circumference measurements as primary tools for assessing adiposity is supported by guidelines from the National Committee for Quality Assurance and the American Heart Association 1.
From the Research
Eating Assessment Tools for Obesity Screening
The following eating assessment tools can be used to screen for obesity:
- Three-Factor Eating Questionnaire (TFEQ) 2, 3, 4, 5: This questionnaire evaluates three different factors in eating behavior: restraint, disinhibition, and hunger.
- TFEQ-R18 5: A reduced version of the TFEQ, which has been validated for use in overweight and obese females.
- Clinical screening questionnaire for eating behaviors associated with overweight and obesity 6: This questionnaire assesses eating behaviors such as consumption of sugary beverages, fruits and vegetables, and physical activity.
Key Factors in Eating Behavior
The key factors in eating behavior that are associated with obesity include:
- Disinhibition: positively associated with body mass index and body fat percentage 3
- Cognitive restraint: lower values are associated with obesity 2, 3
- Hunger: higher scores are associated with obesity 2, 4
- Emotional eating: positively correlated with body weight, fat percentage, and calorie intake 5
Validation and Reliability of Eating Assessment Tools
The validity and reliability of the eating assessment tools have been established through various studies:
- TFEQ: has been validated for use in various populations, including overweight and obese individuals 2, 3, 4
- TFEQ-R18: has been validated for use in overweight and obese females, with a Cronbach's alpha of 0.73 5
- Clinical screening questionnaire: has been associated with body mass index and being overweight and/or obese 6