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The Dutch Eating Behaviour Questionnaire DEBQ


Most obese persons will not stay in treatment for obesity. ... states and hunger, probably because of early learning experiences (Hilde Bruch) ... – PowerPoint PPT presentation

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Title: The Dutch Eating Behaviour Questionnaire DEBQ

The Dutch Eating Behaviour Questionnaire (DEBQ)
  • Tatjana van Strien

Stunkards pessimistic verdict
  • Most obese persons will not stay in treatment for
  • Of those who stay in treatment most will not lose
  • Of those who do lose weight most will regain it
  • (Stunkard, 1958)

  • Also new methods show no satisfactory maintenance
    of treatment effects(Wilson, 1994).
  • Reason absence of fit between treatments and
  • Goal improve maintenance of treatment effects by
    fitting treatment and individuals

How to fit treatments and individuals?
  • There are different types of overeating
    emotional, external and restraint eating.
  • Each type has its own aetiology (derived from
    psychosomatic theory, externality theory and
    restraint theory)
  • Each type also has its own treatment
  • Thus fitting treatments and individuals by
    assessment of eating behaviour

The three types of overeating
  • Emotional eating eating in response to emotional
    arousal states such as fear anger or anxiety.
  • External eating eating in response to external
    food cues such as sight and smell of food
  • Restraint eating overeating after a period of
    slimming when the cognitive resolve to diet is

Three theories of overeating
  • Psychosomatic and externality theory attribute
    weight gain and obesity to overeating (emotional
    and external eating)
  • Restraint theory (paradoxically) attributes
    overeating and weight gain to dieting

Psychosomatic and externality theory
  • In both theories Mispercepetion of internal
    state prior to eating is causal factor in
    development of obesity
  • Psychosomatic theory emphasis on internal
    emotional factors
  • Externality theory focus on external food

Psychosomatic theory
  • Confusion of internal arousal states and hunger,
    probably because of early learning experiences
    (Hilde Bruch)
  • Low interoceptive awareness (alexithimia)

Psychosomatic theory Stress and satiety
Externality theory
  • External eating, that is, eating in response to
    food-related stimuli regardless of the internal
    state of hunger or satiety.
  • This is the result of externality as personality
    trait ( over-responsiveness to external stimuli
    in general (not only food, but also a movie, a
    sad story etc).

Restraint theory
  • Dieting as a cause rather than a consequence of
    over eating (Peter Herman and Janet Polivy,
    Toronto, Canada)
  • Natural weight homeostatically preserved

Restraint theorymilkshake-ice-cream experiment
Restraint theory
  • Restraint eatingfysiological defence mechanisms
    such as hunger and preference for sweets
    overeating, weight gain and obesity
  • Restraint eating loss of contact with hunger and
    satiety overeating weight gain and obesity

The three theories and therapy
  • Psychosomatic theory focus on evoking awareness
    of own impulses, feelings and needs
  • Externality theory behavior therapy stimulus
    control or cue exposure
  • Restraint theory accept ones natural weight

  • Assessment of an individuals structure of eating
    behaviour may enable a better fit between
    treatments and the individuals type of eating
    behaviour. So, with this goal in mind the DEBQ
    was developed.
  • DEBQ has separate scales for emotional, external
    and restrained eating the scale on emotional
    eating has two subscales 1) eating in response
    to diffuse emotions and 2) eating in response to
    clearly labelled emotions.

  • Excellent factorial validity
  • Satisfacory to good reliability
  • Satisfactory concurrent and discriminative
  • Officially available in Dutch and English.

  • In individual and group settings
  • For adults and children as young as nine years
  • Takes 10 minutes to complete
  • Norm groups are available

Administration and Scoring
  • Administration requires item-form and scoring
  • Item-form p1 demographic questions and
    questions on body weight and weight history p2
    and 3the 33 DEBQ-items with 5 point Likert
    scale. p4 Table of raw scores and norm scores.
  • Can be easily scored with scoring template.

  • Raw scores are obtained by adding the scores of
    the items of the scales. These raw scores can be
    noted on the back page.
  • A score on the scale for emotional eating can be
    obtained by adding the raw scores of the two
    subscales for emotional eating.
  • To compare raw scores with norm scores, raw
    scores should be divided by the total number of
    endorsed items on the scale
  • The appropriate normgroup can be chosen on the
    basis of the questions on p1 age, sex, weight
    category etc.

  • DEBQ-scale scores are devided in the seven
    categories very high, high, above mean, mean,
    below the mean, low and very low.
  • The intervals of the DEBQ-scale scores associated
    with the seven categories are available for the
    following norm-groups

  • a)subsamples of 1170 inhabitants of Ede(men,
    women, obese men, obese women, non-obese men
    non-obese women)
  • A sample of 724 high school females
  • A sample of 492 female college students
  • A sample of 303 female eating disorder patients
  • For further smaller samples of subjects
    DEBQ-scale statistics are provided.

DEBQ and therapyhigh emotional eating
  • A high degree of emotional eating points toward a
    deficient inner cognitive and affective structure
    and lack of interoceptive awareness.
  • An individual with a high degree of emotional
    eating may benefit best from therapy focusing on
    interoceptive awareness, low self esteem,
    feelings of social inadequacy and other
    psychological problems accompanying emotional
    eating, rather than focussing upon weight as the
    sole or most important causal factor.

DEBQ and therapyhigh external eating
  • A high degree of external eating, unsupported by
    a high degree of emotional eating, points to a
    sensitivity to external cues such as sight and
    smell of food.
  • Is often found in men.
  • Therapy should focus on sensitivity to food cues
    by means of behavioural methods such as stimulus
    control or food exposure.

DEBQ and therapyhigh restrained eating
  • A score on restrained eating should never be
    considered in isolation from scores on the other
    scales, but always in conjunction with them.
  • Also the weight history and current weight
    status of the patient should be taken into
    account as the tendency towards restraint
    breaking or bingeing.

DEBQ and treatmenthigh degree of restrained
  • Underweight in combination with severe dieting
    may point towards anorexia nervosa.
  • High weight fluctuation in combination with
    severe dieting and tendencies toward restraint
    breaking may point at bulimia nervosa.

DEBQ and treatmenthigh degree of restrained
  • High degree of restrained eating, but low degree
    of emotional and external eating these
    individuals may require more accurate
    information concerning nutrition and caloric
  • A high degree of restrained eating and a high
    degree of emotional or external eating in this
    case strict restriction of food intake is not
    likely to result in lasting weight loss unless
    the underlying psychic problems are solved or the
    sensitivity to food stimuli is treated.

Final remark
  • If an individual has always been overweight, he
    or she may be better off accepting his or her
    heavy build, instead of continuously starving him
    or herself.
  • A more accepting social or medical attidude
    towards those who are overweight would alleviate
    many psychological problems faced by the
    overweight social anxiety, low self esteem.

The two most asked questions
  • Can I, for reason of saving time, not also simply
    interview patients on their eating behaviour,
    for example by asking them the three questions
    Do you diet, Do you eat when emotionally upset,
    or when seeing tempting food?
  • How can I administer the DEBQ to patients when I
    have only 10-minutes time for them?

Why not simply ask them?
  • High chance of social desirable response(all
    obese live on air and diet all the time).
  • Answer on a single question gives no indication
    on the relative frequency of the eating
    behaviour in question within a person. Only
  • The questions have not been tested for their
    reliability and validity.
  • Answer gives no indication on relative frequency
    with respect to reference group.

How can the DEBQ be administered?
  • Adminstration and scoring of the DEBQ can be done
    by a secretary or doctors assistent.
  • The DEBQ can be given to the patient to fill it
    out at home, but the patient can also complete it
    in the waiting room (10 minutes).

  • A secretary can then score the DEBQ by means of
    the scoring templates, fill out the table with
    raw scores and the norm scores at the back of the
    item-form, and also make a comparison of the
    scores and the appropriate norm-group (5
  • The appropriate normgroup can be chosen on the
    basis of answers to questions on page 1 of the

Interpretation of the DEBQ
  • Also the interpretation of the DEBQ-outcome can
    be done by a assistent or secretary, provided
    they have been skilled for this.
  • Preferably the interpretation should be done by
    the GP, family doctor or the like.

Interpretation high emotional eating
  • Always start with emotional eating. If this is
    high in a patient, restriction of food intake or
    behavioural methods focussing on sensitivity to
    food cues are not likely to result in permanent
    weight loss, unless the psychological probems
    accompanying the emotional eating, such as low
    interoceptive awareness and low self esteem are
    solved. So the therapy should focus on these
    problems and not upon weight.
  • So the therapy should focus on these problems
    and not upon weight.