Three-Factor Eating Questionnaire Disinhibition Research Articles

Predictors of successful weight loss with relative maintenance of fat-free mass in individuals with overweight and obesity on an 8-week low-energy diet.

A low-energy diet (LED) is an effective approach to induce a rapid weight loss in individuals with overweight. However, reported disproportionally large losses of fat-free mass (FFM) after an LED trigger the question of adequate protein content. Additionally, not all individuals have the same degree of weight loss success. After an 8-week LED providing 5020 kJ/d for men and 4184 kJ/d for women (84/70 g protein/d) among overweight and obese adults, we aimed to investigate the relationship between protein intake relative to initial FFM and proportion of weight lost as FFM as well as the individual characteristics associated with weight loss success. We assessed all outcomes baseline and after the LED. A total of 286 participants (sixty-four men and 222 women) initiated the LED of which 82 % completed and 70 % achieved a substantial weight loss (defined as ≥8 %). Protein intake in the range 1·0-1·6 g protein/d per kg FFM at baseline for men and 1·1-2·2 g protein/d per kg FFM at baseline for women was not associated with loss of FFM (P = 0·632). Higher Three-Factor Eating Questionnaire (TFEQ) hunger at baseline and reductions in TFEQ disinhibition and hunger during the LED were associated with larger weight loss (all P ≤ 0·020); whereas lower sleep quality at baseline predicted less successful weight loss using intention to treat analysis (P = 0·021), possibly driven by those dropping out (n 81, P = 0·067 v. completers: n 198, P = 0·659). Thus, the protein intakes relative to initial FFM were sufficient for maintenance of FFM and specific eating behaviour characteristics were associated with weight loss success.

Responses on the Three Factor Eating Questionnaire Restraint and Disinhibition Scales Change After a Controlled Energy-Restricted Diet (P21-002-19)

ObjectivesThe Three Factor Eating Questionnaire (TFEQ) is a validated psychometric tool widely used in nutrition research. The TFEQ measures three constructs related to human eating behavior (cognitive restraint of eating, disinhibition, and perceived hunger) and is typically used to identify “fixed” traits associated with obesity. Although inconsistent, evidence suggests that these constructs may be modifiable with diet and weight loss. We sought to determine the mutability of each TFEQ construct in response to a controlled energy-restricted diet in overweight and obese women. MethodsHealthy overweight and obese women aged 20–44 (N = 19) were provided with all foods for daily consumption at a level of 20% reduction of usual energy intake for a period of 8 weeks. Study food was packaged as separate meals representing breakfast, lunch, and dinner. Participants were instructed to consume all foods together as separate meals and between-meal snacking was prohibited. Body weight was measured at baseline and then weekly during the intervention. The TFEQ was administered at baseline and at the end of the 8-week controlled feeding. Differences in scores for each factor of the TFEQ were analyzed using paired t-tests. Results are presented as means ± SD. ResultsOn average, participants lost 3.8 ± 1.7 kg. TFEQ restraint scores were greater at the end of week 8 (12.3 ± 4.5) compared to baseline (8.2 ± 4.4), t(18) = 4.00, P < 0.001. Conversely, TFEQ disinhibition scores were lower at week 8 (6.9 ± 3.4) compared to baseline (9.5 ± 2.6), t(18) = 3.42, P = 0.003. Though not significantly different, TFEQ hunger scores were greater at baseline (6.7 ± 3.3) compared to week 8 (5.2 ± 3.4) despite 8 weeks of weight loss. Changes in TFEQ scores did not correlate with change in body weight. ConclusionsThese results suggest that dietary restriction aimed at eliminating between-meal snacking increases cognitive restraint of eating and decreases disinhibition, independent of weight loss. Additionally, the conscious intention of adhering to eating only 3 meals a day may have improved the perception of hunger cues while reducing susceptibility to external food cues. These attitudinal and behavioral changes are important for adherence to a healthy eating pattern. Funding SourcesUnited States Department of Agriculture, Agricultural Research Service #3062-51000-051-00D and the North Dakota Beef Commission.

The Weight-Related Eating Questionnaire offers a concise alternative to the Three-Factor Eating Questionnaire for measuring eating behaviors related to weight loss

ObjectiveDuring a one-year weight loss trial, we compared the Three-Factor Eating Questionnaire (TFEQ), a valid 51-item measure of restraint, disinhibition, and hunger subscales, with the newer 16-item Weight-Related Eating Questionnaire (WREQ) measuring routine and compensatory restraint and external and emotional eating. MethodsBoth questionnaires were administered to women with overweight or obesity (n = 186, mean ± SD, age 50 ± 10.6 y, BMI 34 ± 4.2 kg/m2) at five time points. Completion rates were 100% at baseline and Month 1, 94% at Month 3, 83% at Month 6, and 76% at Month 12. Confirmatory factor analysis was conducted on baseline WREQ data and correlations were calculated between TFEQ and WREQ subscales. Multilevel models evaluated the relationship between each subscale and weight change over time. ResultsFactor analysis revealed a WREQ structure consistent with previous research, and corresponding subscales on the TFEQ and WREQ were correlated. Lower baseline TFEQ restraint predicted greater weight loss. Across five administrations, TFEQ and WREQ restraint scores were positively related to weight loss (p < 0.01) and TFEQ disinhibition and WREQ external and emotional eating scores were negatively related (p < 0.001). Thus, with one baseline administration, only TFEQ restraint was significantly related to weight change, but multiple administrations showed relationships between all TFEQ and WREQ subscales and weight change. ConclusionsThe WREQ offers a shorter alternative to the TFEQ when repeatedly assessing eating behaviors related to weight change.

Functional brain networks associated with eating behaviors in obesity.

Obesity causes critical health problems including diabetes and hypertension that affect billions of people worldwide. Obesity and eating behaviors are believed to be closely linked but their relationship through brain networks has not been fully explored. We identified functional brain networks associated with obesity and examined how the networks were related to eating behaviors. Resting state functional magnetic resonance imaging (MRI) scans were obtained for 82 participants. Data were from an equal number of people of healthy weight (HW) and non-healthy weight (non-HW). Connectivity matrices were computed with spatial maps derived using a group independent component analysis approach. Brain networks and associated connectivity parameters with significant group-wise differences were identified and correlated with scores on a three-factor eating questionnaire (TFEQ) describing restraint, disinhibition, and hunger eating behaviors. Frontoparietal and cerebellum networks showed group-wise differences between HW and non-HW groups. Frontoparietal network showed a high correlation with TFEQ disinhibition scores. Both frontoparietal and cerebellum networks showed a high correlation with body mass index (BMI) scores. Brain networks with significant group-wise differences between HW and non-HW groups were identified. Parts of the identified networks showed a high correlation with eating behavior scores.

Transcranial direct current stimulation reduces food‐craving and measures of hyperphagia behavior in participants with Prader‐Willi syndrome

Prader-Willi syndrome (PWS) is a neurodevelopmental genetic disorder characterized by intellectual disabilities and insatiable appetite with compulsive eating leading to severe obesity with detrimental health consequences. Transcranial direct current stimulation (tDCS) has been shown to modulate decision-making and cue-induced food craving in healthy adults. We conducted a pilot double blind, sham-controlled, multicenter study of tDCS modulation of food drive and craving in 10 adult PWS participants, 11 adult obese (OB) and 11 adult healthy-weight control (HWC) subjects. PWS and OB subjects received five consecutive daily sessions of active or sham tDCS over the right dorsolateral prefrontal cortex (DLPFC), while HWC received a single sham and active tDCS in a crossover design. Standardized psychometric instruments assessed food craving, drive and hyperphagia by self-report and caregiver assessment over 30 days. Robust baseline differences were observed in severity scores for the Three-Factor Eating Questionnaire (TFEQ) and Dykens Hyperphagia Questionnaire (DHQ) for PWS compared to HWC while obese participants were more similar to HWC. Active tDCS stimulation in PWS was associated with a significant change from baseline in TFEQ Disinhibition (Factor II) (Ƶ = 1.9, P < 0.05, 30 days) and Total Scores (Ƶ = 2.3, P < 0.02, 30 days), and participant ratings of the DHQ Severity (Ƶ = 1.8, P < 0.06, 5 days) and Total Scores (Ƶ = 1.9, P < 0.05, 15 days). These findings support sustained neuromodulatory effects and efficacy of tDCS to reduce food drive and behaviors impacting hyperphagia in PWS. Transcranial direct current stimulation may represent a straight-forward, low risk and low cost method to improve care, management and quality of life in PWS.

Cued to Act on Impulse: More Impulsive Choice and Risky Decision Making by Women Susceptible to Overeating after Exposure to Food Stimuli.

There is increasing evidence that individual differences in tendency to overeat relate to impulsivity, possibly by increasing reactivity to food-related cues in the environment. This study tested whether acute exposure to food cues enhanced impulsive and risky responses in women classified on tendency to overeat, indexed by scores on the three factor eating questionnaire disinhibition (TFEQ-D), restraint (TFEQ-R) and hunger scales. Ninety six healthy women completed two measures of impulsive responding (delayed discounting, DDT and a Go No-Go, GNG, task) and a measure of risky decision making (the balloon analogue risk task, BART) as well as questionnaire measures of impulsive behaviour either after looking at a series of pictures of food or visually matched controls. Impulsivity (DDT) and risk-taking (BART) were both positively associated with TFEQ-D scores, but in both cases this effect was exacerbated by prior exposure to food cues. No effects of restraint were found. TFEQ-D scores were also related to more commission errors on the GNG, while restrained women were slower on the GNG, but neither effect was modified by cue exposure. Overall these data suggest that exposure to food cues act to enhance general impulsive responding in women at risk of overeating and tentatively suggest an important interaction between tendency for impulsive decision making and food cues that may help explain a key underlying risk factor for overeating.

Validation of the Leeds Food Preference Questionnaire in Arabs.

The Leeds Food Preference Questionnaire (LFPQ) is a computerised procedure that assesses liking, wanting and relative preferences for shared characteristics of food. This study adapted the LFPQ (LFPQ-A) to assess its cross-cultural validity in an Arab sample by examining its performance for food characteristics of fat (high or low) and taste (sweet or nonsweet), under fasted and fed states. Individual differences in eating behaviour were examined by testing for associations between the LFPQ-A outcomes and subscales of the Three Factor Eating Questionnaire (TFEQ). Thirty healthy males (age: 36.3±10.0 years; body mass index: 29.7±5.3 kg/m2) participated in the study. All participants attended the laboratory in the morning following an overnight fast, and performed the LFPQ-A under fasted and fed conditions (after a standardised test meal). Results showed that implicit wanting and relative preference for non-sweet foods decreased in the fed compared to the fasted state, whereas scores for sweet foods increased. Explicit liking and explicit wanting were also higher for non-sweet foods in the fasted condition, and decreased to a greater extent in the fed condition compared to a lesser decrease for sweet foods. Scores on all LFPQ-A outcomes for high-fat non-sweet foods were positively associated with TFEQ Disinhibition. Outcome scores for low-fat non-sweet foods were positively associated with TFEQ Restraint. The LFPQ-A showed outcomes that were consistent with studies performed in Western samples, therefore the current study helps to confirm the validity of the LFPQ-A as a measurement of liking and wanting and preference for food among Arabs.

Similarities and differences between excessive exercising anorexia nervosa patients compared with DSM-IV defined anorexia nervosa subtypes

This study describes anorexia nervosa (AN) patients who use excessive exercise for weight management and how this behaviour relates to the classical Diagnostic and Statistical Manual of Mental Disorders - Fourth Edition (DSM-IV) sub-grouping of AN. The study compared 428 clinical AN patients with 119 age and gender-matched controls. The AN cases were initially dichotomised according to DSM-IV subtype criteria into restricting (RAN; N=198) and binge-purge (BPAN; N=230) anorexia. The psychometric instruments were chosen to reflect key features concerning the diagnosis of eating disorders and characteristics of eating and food behaviour and included the 26-item Eating Attitude Test (EAT-26), Three Factor Eating Questionnaire (TFEQ), Dutch Eating Behaviour Questionnaire (DEBQ), Eysenck Personality Inventory (EPI) and Rosenberg Self-Esteem scale (RSE). Structured clinical interviews (1) were carried out in order to identify the subgroup of patients who use excessive exercise in order to facilitate weight control (EAN). The three groups (RAN, BPAN, EAN) did not differ in measures of current age, current body mass index, age of onset of AN and measures of restrained eating. However, significant differences were observed on EAT-26, DEBQ emotional and external factors, TFEQ disinhibition and hunger factors, EPI extraversion and neuroticism, and self-esteem. The EAN were similar to the RAN on the majority of variables but showed significant differences on extraversion, neuroticism, self-esteem and disease pathology (EAT-26). Compared with BPAN, EAN had lower disease pathology (EAT-26 scores), scored higher on the EPI extraversion scale, lower on the neuroticism scale and had greater self-esteem. The EAN also displayed significantly lower emotional and external eating (DEBQ) than BPAN and significantly lower disinhibition and hunger scores (TFEQ). These data suggest that EAN group display a mixed profile of characteristics resembling both BPAN and RAN. When EAN are defined as a separate group they appear to be phenotypically more similar to RAN than BPAN on this particular profile of variables. However when DSM-IV criteria are applied they are almost exclusively classified as BPAN. This outcome suggests that EAN do constitute an identifiable group that can be distinguished from RAN and BPAN. Consequently it is likely that the behaviour of excessive exercising should be considered as clinically relevant on the outcome of treatment.

Self-efficacy and restrained eating in relation to weight loss among overweight men and women in Turkey

The purpose of this study was to examine the potential improvements in eating self-efficacy, eating behavior and other psychological factors in obese subjects participating in a weight management program. The participants in this study consisted of 96 persons (76 women and 20 men) who were attending the first session of a commercially run 20-week treatment program for weight reduction. Self-efficacy in relation to eating was assessed by the Weight Efficacy Lifestyle Questionnaire. The participants also completed the Three Factor Eating Questionnaire (TFEQ), Rosenberg Self-esteem Scale, Social Physique Anxiety Scale, State Trait Anxiety Inventory and Body Parts Satisfaction Scale prior to weight management program and again 20 weeks after the program. High self-efficacy score was significantly associated with high weight loss among all participants. Also, high negative emotions and physical discomfort scores were significantly associated with high weight loss among all participants. Results indicated that there was a significant decrease in the TFEQ hunger and disinhibition scores during the study. As a conclusion, our findings suggest that the role of self-efficacy has an important role in obesity treatment regarding to weight control behavior.

Heightened responses to the hedonic qualities of sucrose in olfactory conditioning for women scoring high on the three-factor eating questionnaire disinhibition scale

In flavour?flavour learning (FFL), repeated co-experience of a novel flavour and a hedonically valanced flavour can lead to changes in liking for the novel flavour. Some studies suggest that restrained eaters are insensitive to FFL, while disinhibited eaters may over respond to hedonic stimuli. Here we assessed FFL through associations between food-related odours and sweet and bitter tastes to explore further how eating attitudes influence FFL. 52 women, pre-selected to be high or low on the restraint and disinhibition factors from the Three-Factor Eating Questionnaire (TFEQ), evaluated two novel odours orthonasally before experiencing retronasal pairings of one odour with sucrose and the second with quinine before orthonasal re-evaluation of the odours. At post-training, overall liking increased for the sucrose-paired odour but this effect was greater in women with high scores on the TFEQ disinhibition factor. Liking for the quinine-paired odour decreased equally in all groups. The sucrose-paired odour was rated as sweeter, and quinine-paired odour more bitter at post-training and these acquired sensory qualities were unaffected by restraint or disinhibition factors from the TFEQ. Overall, these data found no evidence of impaired FFL in restrained women, but instead found greater responsiveness to hedonic qualities of sucrose in women scoring high on the disinhibition factor, consistent with suggestions that this factor identifies individuals with heightened hedonic sensitivity to food.

Impulsivity is associated with the disinhibition but not restraint factor from the Three Factor Eating Questionnaire

Recent data implicate impulsivity as a personality trait associated with obesity, binge eating and restrained eating. However, impulsivity is recognised as having multiple dimensions, and it remains unclear which aspects of impulsive behaviour best predict disordered eating. To try and elucidate further the relationship between impulsivity and eating behaviour, 147 women completed a behavioural measure and two self-report measures of impulsivity along with the Three Factor Eating Questionnaire (TFEQ). Overall scores on the Barratt Impulsiveness Scale (BIS-II), along with scores on the Non-planning and Motor Subscales of the BIS-II, were higher in women scoring high on the TFEQ disinhibition (TFEQ-D) scale. Likewise, women scoring high on the TFEQ-D showed more impulsive choice when discounting hypothetical monetary awards. However, responses to measures of functional relative to dysfunctional impulsivity did not differ depending on TFEQ-D score. No measure of impulsivity was related to scores on the TFEQ restraint scale. These data suggest that a tendency to act impulsively is associated with a tendency to overeat, and may be a factor which predicts the likelihood of the development of binge eating and the breakdown of dieting.

Characterization of obese individuals who claim to detect no relationship between their eating pattern and sensations of hunger or fullness

To study the phenomenon that obese subjects show considerable individual variability in their reported relationships between eating and sensations of hunger and fullness. A laboratory study of the relationship between eating behaviour traits and the episodic oscillations in sensations of hunger and fullness in response to obligatory, fixed energy breakfast (481 kcal) and lunch (675 kcal) meals. Obese subjects were divided into two groups based on their responses to four 'screening' questions associated with their habitual experience of hunger and fullness sensations before and after eating: those who experienced sensations of hunger and fullness related to eating (Related-R; n=20, body mass index (BMI)=42.4 kg/m(2)) and those for whom eating was not related to hunger or fullness sensations (Unrelated - UR; n=19, BMI=41.3 kg/m(2)). In addition, a control, lean group (Control - C; n=14, BMI=22.6 kg/m(2)) who experienced sensations of hunger and fullness related to eating was studied. The Three-Factor Eating Questionnaire (TFEQ) was used to measure the eating behaviour traits, disinhibition, restraint and hunger. Profiles of subjective appetite sensations were continuously monitored across the day using visual analogue scales. All groups displayed clear meal-related oscillations in subjective sensations of hunger, fullness, desire to eat and prospective consumption. In contrast, the TFEQ disinhibition and hunger scores (but not restraint scores) were significantly different (P<0.05) between the groups ((UR; D=13.5+/-0.5, H=10.0+/-0.5), R (D 7.5+/-0.6, H 6.1+/-0.4), C(D 3.7+/-0.5, H 3.7+/-0.5)). In addition, analysis of the intra-meal changes in subjective appetite sensations revealed that the UR group displayed a smaller meal-induced suppression of hunger and elevation of fullness. These data indicate that the reported relationship between eating and hunger/fullness was associated with obese individuals showing high or low disinhibition scores. In addition, the data suggest that the processes underlying disinhibition may be associated with a modulation of the recognition of meal-related satiety sensations.

Binge eating and other psychopathology in patients with type II diabetes mellitus.

Type II diabetes mellitus (DM), a common disease with many potential complications, is strongly associated with obesity. Alterations in food consumption can dramatically alter glucose control in individuals with Type II DM. Binge eating disorder (BED) is also closely associated with obesity. The nature of the relationship, if any, between Type II DM and BED is unclear. Forty-three individuals (23 females, 20 males) with Type II DM were assessed using the Structured Clinical Interview for DSM-IV (SCID-I), the Three-Factor Eating Questionnaire (TFEQ), and the Impact of Weight Scale. The most recent hemoglobin A1c level was recorded. Height and weight were also measured. Eleven subjects (25.6%) were diagnosed with BED. Individuals with BED had higher body mass index (BMI) scores, higher TFEQ Disinhibition and Hunger scores, and higher scores on all Impact of Weight subscales (except eating) compared with those without BED. Glycosylated hemoglobin levels did not differ between the two groups (8.1% vs. 8.4%; p = 0.553). Rates of BED in subjects with Type II DM were substantial. Other types of psychopathology were also common. Although glycosylated hemoglobin levels were similar in patients with and without BED, the presence of BED was associated with greater obesity. Assessment for BED is an important aspect of the management of patients with Type II DM.

Personality and dimensions of dietary restraint.

Given that dietary restraint and associated dietary behavior may predispose individuals to frank eating disorders, and that differences in personality profiles have been observed across subtypes of eating disorders, we sought to address whether aspects of restrained eating (cognitive restraint, disinhibition, and susceptibility to hunger) could be distinguished using the Temperament and Character Inventory (TCI). One hundred and one women aged 18-45 selected at random from the community completed the Diagnostic Interview for Genetic Studies (DIGS), the TCI, and the Three Factor Eating Questionnaire (TFEQ). Novelty seeking (NS) was significantly positively correlated with disinhibition. Self-directedness (SD) was negatively correlated with the total TFEQ score, disinhibition, and susceptibility to hunger. Self-transcendence (ST) correlated positively with total TFEQ score and cognitive restraint. These findings suggest that individuals with character traits denoting low SD and high ST may be particularly reactive and susceptible to societal messages pertaining to the ideology of slenderness.

Binge eating in bariatric surgery patients.

Eating behavior, attitudes toward eating and body weight and shape, and depression were assessed in a sample of 64 morbidly obese gastric bypass surgery candidates. The Beck Depression Inventory (BDI), the Three-Factor Eating Questionnaire (TFEQ), and the Eating Disorder Examination (EDE) were administered at the first preoperative visit. Twenty-five subjects (39%) reported at least one binge episode per week on average over the 3 months prior to seeking treatment. Binge eaters had significantly higher TFEQ Disinhibition and Hunger scores than nonbinge eaters. Binge eaters also differed from nonbinge eaters in terms of attitudes toward eating, shape, and weight. A significant number of gastric bypass surgery candidates report binge eating. The findings are consistent with other studies showing binge eaters to be a distinctive subgroup of the obese.

Binge eating in bariatric surgery patients

Objective Eating behavior, attitudes toward eating and body weight and shape, and depression were assessed in a sample of 64 morbidly obese gastric bypass surgery candidates. Method: The Beck Depression Inventory (BDI), the Three-Factor Eating Questionnaire (TFEQ), and the Eating Disorder Examination (EDE) were administered at the first preoperative visit. Results: Twenty-five subjects (39%) reported at least one binge episode per week on average over the 3 months prior to seeking treatment. Binge eaters had significantly higher TFEQ Disinhibition and Hunger scores than nonbinge eaters. Binge eaters also differed from nonbinge eaters in terms of attitudes toward eating, shape, and weight. Discussion: A significant number of gastric bypass surgery candidates report binge eating. The findings are consistent with other studies showing binge eaters to be a distinctive subgroup of the obese. © 1998 by John Wiley & Sons, Inc. Int J Eat Disord 23: 89–92, 1998.

Preoperative Eating Behavior and Weight-loss Following Gastric Banding for Obesity.

BACKGROUND AND METHODS: The relationships between cognitive restraint and the tendency to disinhibition, as assessed by the Three Factor Eating Questionnaire (TFEQ), and the weight loss at 1 year following gastric banding are evaluated. RESULTS: A significant predictability of the TFEQ Disinhibition score on the postoperative weight reduction was observed, while the amount of weight lost was negatively related to the preoperative TFEQ Cognitive Restraint score. CONCLUSION: It must then be hypothesized that the operated subjects feel a strong aversive stimulus and then they are led to reduce their food consumption only when they lose control and tend to overeat. The discomfort due to proximal gastric pouch distention facilitates the development of food aversion and then both the decrease of food intake and a change in eating behavior. The subjects must therefore be encouraged to adopt an eating style that cannot allow them to avoid such a feeling.