Psychological correlates of eating behavior in overweight/obese adolescents in Taiwan: Psychometric and correlation analysis of the Three-Factor Eating Questionnaire (TFEQ)-R21

Background: The Three-Factor Eating Questionnaire (TFEQ) is a self-assessment scale used widely in the studies of eating behavior, but its short form TFEQ-R21 has not been validated in the Taiwanese population. This study aimed to assess the factor structure and reliability of TFEQ-R21 and to identify the correlates of eating behavior in obese and non-obese Taiwanese adolescents. Methods: A total of 445 individuals aged 13-15 years were analyzed. They self-reported their eating disorder behavior, body shape preoccupation, weight-related self-stigma, anxiety, and depression. We applied a confirmatory factor analysis to test the model fit of TFEQ-R21 for the three pre-conceptualized domains in the data. Further univariate and multivariate linear regression analyses were applied to identify the correlates of different TFEQ-R21 subdomains. Results: The Comparative Fit Index for the TFEQ-R21 was 0.908, which confirmed the three-factor structure (i.e., cognitive restraint [CR], uncontrolled eating [UE], and emotional eating [EE]) in the Taiwan version of TFEQ-R21. Only CR correlated with disordered eating (r = 0.351, p < 0.001). Body shape discrepancy, rather than weight status, was associated with CR in both males (beta = 0.15, 95% odds ratio [CI] 0.05-0.25) and females (beta = 0.21, 95% CI 0.10-0.32). Gender differences were noted in the correlates of UE and EE, where ideal body shape in males and self-perceived stigma in females were the main associative factors. Conclusion: The Taiwan version of the TFEQ-R21 is a robust, reliable tool by which to measure adolescent eating behavior. Gender differences in the eating behavior correlates require clinical and public health attention when implementing weight management programs. Copyright (C) 2020, Taiwan Pediatric Association. Published by Elsevier Taiwan LLC.