Skip to main content
Top
Published in: Obesity Surgery 8/2021

01-08-2021 | Bariatric Surgery | Original Contributions

Development and Validation of New BODY-Q Scales Measuring Expectations, Eating Behavior, Distress, Symptoms, and Work Life in 4004 Adults From 4 Countries

Authors: Claire E. E. de Vries, Danny Mou, Lotte Poulsen, Trisia Breitkopf, Dennis J. S. Makarawung, Marinus J. Wiezer, Ruben N. van Veen, Maarten M. Hoogbergen, Jens A. Sorensen, Ronald S. L. Liem, Simon W. Nienhuijs, Ali Tavakkoli, Andrea L. Pusic, Anne F. Klassen

Published in: Obesity Surgery | Issue 8/2021

Login to get access

Abstract

Purpose

The BODY-Q is a rigorously developed patient-reported outcome measure (PROM) for patients seeking treatment for obesity and body contouring surgery. A limitation of the uptake of the BODY-Q in weight management treatments is the absence of scales designed to measure eating-specific concerns. We aimed to develop and validate 5 new BODY-Q scales measuring weight loss expectations, eating behaviors, distress, symptoms, and work life.

Material and Methods

In phase 1 (qualitative), patient and expert input was used to develop and refine the new BODY-Q scales. In phase 2 (quantitative), the scales were field-tested in bariatric and weight management clinics in the United States (US), The Netherlands, and Denmark between June 2019 and January 2020. Data were also collected in the US and Canada in September 2019 through a crowdworking platform. Rasch measurement theory (RMT) analysis was used for item reduction and to examine reliability and validity.

Results

The new BODY-Q scales were refined through qualitative input from 17 patients and 20 experts (phase 1) and field-tested in 4004 participants (phase 2). All items showed ordered thresholds and good fit to the Rasch model. The RMT analysis provided evidence of reliability, with PSI values ≥0.72, Cronbach alpha values ≥0.83, and test-retest values ≥0.79. Better scores on 4 scales (exception expectations scale) correlated with lower BMI, with the strongest correlation between the eating-related distress scale scores and BMI (r= −0.249, P < 0.001).

Conclusion

The new BODY-Q scales can be used in research and clinical practice to assess weight loss treatments from the patient perspective.

Graphical abstract

Appendix
Available only for authorised users
Literature
1.
go back to reference Afshin A, Forouzanfar MH, Reitsma MB, et al. Health effects of overweight and obesity in 195 countries over 25 years. N Engl J Med. Massachussetts Medical Society. 2017;377:13–27. Afshin A, Forouzanfar MH, Reitsma MB, et al. Health effects of overweight and obesity in 195 countries over 25 years. N Engl J Med. Massachussetts Medical Society. 2017;377:13–27.
2.
go back to reference Must A, McKeown NM. The disease burden associated with overweight and obesity. Endotext. 2000 Must A, McKeown NM. The disease burden associated with overweight and obesity. Endotext. 2000
3.
go back to reference Wang YC, McPherson K, Marsh T, et al. Health and economic burden of the projected obesity trends in the USA and the UK. Lancet. Lancet Publishing Group; 2011. p. 815–25. Wang YC, McPherson K, Marsh T, et al. Health and economic burden of the projected obesity trends in the USA and the UK. Lancet. Lancet Publishing Group; 2011. p. 815–25.
4.
go back to reference World Health Organization Obesity and overweight, 2018. World Health Organization Obesity and overweight, 2018.
5.
go back to reference Dietz WH, Baur LA, Hall K, et al. Management of obesity: improvement of health-care training and systems for prevention and care. Lancet. Lancet Publishing Group; 2015. p. 2521–33. Dietz WH, Baur LA, Hall K, et al. Management of obesity: improvement of health-care training and systems for prevention and care. Lancet. Lancet Publishing Group; 2015. p. 2521–33.
6.
go back to reference Heymsfield SB, Wadden TA. Mechanisms, pathophysiology, and management of obesity. N. Engl. J. Med. Massachussetts Medical Society; 2017. p. 254–66. Heymsfield SB, Wadden TA. Mechanisms, pathophysiology, and management of obesity. N. Engl. J. Med. Massachussetts Medical Society; 2017. p. 254–66.
7.
go back to reference Colquitt JL, Pickett K, Loveman E, et al. Surgery for weight loss in adults (Cochrane Review). Cochrane Collab. 2014;244 Colquitt JL, Pickett K, Loveman E, et al. Surgery for weight loss in adults (Cochrane Review). Cochrane Collab. 2014;244
8.
go back to reference Schauer PR, Bhatt DL, Kirwan JP, et al. Bariatric surgery versus intensive medical therapy for diabetes - 5-year outcomes. N Engl J Med. 2017;376:641–51.CrossRef Schauer PR, Bhatt DL, Kirwan JP, et al. Bariatric surgery versus intensive medical therapy for diabetes - 5-year outcomes. N Engl J Med. 2017;376:641–51.CrossRef
9.
go back to reference Yanovski SZ, Yanovski JA. Long-term drug treatment for obesity: a systematic and clinical review. JAMA. 2014. p. 74–86. Yanovski SZ, Yanovski JA. Long-term drug treatment for obesity: a systematic and clinical review. JAMA. 2014. p. 74–86.
10.
go back to reference Wadden TA, Volger S, Sarwer DB, et al. A two-year randomized trial of obesity treatment in primary care practice. N Engl J Med. Massachusetts Medical Society. 2011;365:1969–79.CrossRef Wadden TA, Volger S, Sarwer DB, et al. A two-year randomized trial of obesity treatment in primary care practice. N Engl J Med. Massachusetts Medical Society. 2011;365:1969–79.CrossRef
11.
go back to reference Wadden TA, Berkowitz RI, Womble LG, et al. Randomized trial of lifestyle modification and pharmacotherapy for obesity. N Engl J Med. 2005;353:2111–20.CrossRef Wadden TA, Berkowitz RI, Womble LG, et al. Randomized trial of lifestyle modification and pharmacotherapy for obesity. N Engl J Med. 2005;353:2111–20.CrossRef
12.
go back to reference Appel LJ, Clark JM, Yeh HC, et al. Comparative effectiveness of weight-loss interventions in clinical practice. N Engl J Med. Massachussetts Medical Society. 2011;365:1959–68.CrossRef Appel LJ, Clark JM, Yeh HC, et al. Comparative effectiveness of weight-loss interventions in clinical practice. N Engl J Med. Massachussetts Medical Society. 2011;365:1959–68.CrossRef
13.
go back to reference Khera R, Murad MH, Chandar AK, et al. Association of pharmacological treatments for obesity with weight loss and adverse events a systematic review and meta-analysis. JAMA. 2016;315:2424–34.CrossRef Khera R, Murad MH, Chandar AK, et al. Association of pharmacological treatments for obesity with weight loss and adverse events a systematic review and meta-analysis. JAMA. 2016;315:2424–34.CrossRef
14.
go back to reference Coulman KD, Abdelrahman T, Owen-Smith A, et al. Patient-reported outcomes in bariatric surgery: a systematic review of standards of reporting. Obes Rev. 2013;14:707–20.CrossRef Coulman KD, Abdelrahman T, Owen-Smith A, et al. Patient-reported outcomes in bariatric surgery: a systematic review of standards of reporting. Obes Rev. 2013;14:707–20.CrossRef
15.
go back to reference Lindekilde N, Gladstone BP, Lübeck M, et al. The impact of bariatric surgery on quality of life: a systematic review and meta-analysis. Obes Rev. 2015;16:639–51.CrossRef Lindekilde N, Gladstone BP, Lübeck M, et al. The impact of bariatric surgery on quality of life: a systematic review and meta-analysis. Obes Rev. 2015;16:639–51.CrossRef
16.
go back to reference Patrick DL, Burke LB, Powers JH, et al. Patient-reported outcomes to support medical product labeling claims: FDA perspective. Value Heal. Blackwell Publishing Inc. 2007. p. S125-37. Patrick DL, Burke LB, Powers JH, et al. Patient-reported outcomes to support medical product labeling claims: FDA perspective. Value Heal. Blackwell Publishing Inc. 2007. p. S125-37.
17.
go back to reference de Vries CEE, Kalff MC, Prinsen CAC, et al. Recommendations on the most suitable quality-of-life measurement instruments for bariatric and body contouring surgery: a systematic review. Obes Rev. 2018;1395–411. de Vries CEE, Kalff MC, Prinsen CAC, et al. Recommendations on the most suitable quality-of-life measurement instruments for bariatric and body contouring surgery: a systematic review. Obes Rev. 2018;1395–411.
18.
go back to reference Klassen AF, Cano SJ, Alderman A, et al. The BODY-Q: a patient-reported outcome instrument for weight loss and body contouring treatments. Plast Reconstr Surg - Glob Open. 2016;4:e679.CrossRef Klassen AF, Cano SJ, Alderman A, et al. The BODY-Q: a patient-reported outcome instrument for weight loss and body contouring treatments. Plast Reconstr Surg - Glob Open. 2016;4:e679.CrossRef
19.
go back to reference Klassen AF, Cano SJ, Scott A, et al. Assessing outcomes in body contouring. Clin Plast Surg. 2014;645–54. Klassen AF, Cano SJ, Scott A, et al. Assessing outcomes in body contouring. Clin Plast Surg. 2014;645–54.
20.
go back to reference Poulsen L, Pusic A, Robson S, et al. The BODY-Q Stretch Marks Scale: a development and validation study. Aesthetic Surg J. Oxford Academic. 2018;38:990–7.CrossRef Poulsen L, Pusic A, Robson S, et al. The BODY-Q Stretch Marks Scale: a development and validation study. Aesthetic Surg J. Oxford Academic. 2018;38:990–7.CrossRef
21.
go back to reference Klassen AF, Kaur M, Poulsen L, et al. Development of the BODY-Q chest module evaluating outcomes following chest contouring surgery. Plast Reconstr Surg. 2018;142:1600–8.CrossRef Klassen AF, Kaur M, Poulsen L, et al. Development of the BODY-Q chest module evaluating outcomes following chest contouring surgery. Plast Reconstr Surg. 2018;142:1600–8.CrossRef
22.
go back to reference Riff KWYW, Tsangaris E, Goodacre T, et al. International multiphase mixed methods study protocol to develop a cross-cultural patient-reported outcome instrument for children and young adults with cleft lip and/or palate (CLEFT-Q). BMJ Open. 2017;7:1–9. Riff KWYW, Tsangaris E, Goodacre T, et al. International multiphase mixed methods study protocol to develop a cross-cultural patient-reported outcome instrument for children and young adults with cleft lip and/or palate (CLEFT-Q). BMJ Open. 2017;7:1–9.
23.
go back to reference Klassen AF, Cano SJ, Scott A, et al. Satisfaction and quality-of-life issues in body contouring surgery patients: a qualitative study. Obes Surg. 2012;22:1527–34.CrossRef Klassen AF, Cano SJ, Scott A, et al. Satisfaction and quality-of-life issues in body contouring surgery patients: a qualitative study. Obes Surg. 2012;22:1527–34.CrossRef
24.
go back to reference Wild D, Grove A, Martin M, et al. Principles of good practice for the translation and cultural adaptation process for patient-reported outcomes (PRO) measures: report of the ISPOR Task Force for Translation and Cultural Adaptation. Value Heal. Blackwell Publishing Inc. 2005;8:94–104.CrossRef Wild D, Grove A, Martin M, et al. Principles of good practice for the translation and cultural adaptation process for patient-reported outcomes (PRO) measures: report of the ISPOR Task Force for Translation and Cultural Adaptation. Value Heal. Blackwell Publishing Inc. 2005;8:94–104.CrossRef
25.
go back to reference Organization WHO. Process of translation and adaptation of instruments. Organization WHO. Process of translation and adaptation of instruments.
26.
go back to reference Harris PA, Taylor R, Thielke R, et al. Research electronic data capture (REDCap)-a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. NIH Public Access. 2009;42:377–81.CrossRef Harris PA, Taylor R, Thielke R, et al. Research electronic data capture (REDCap)-a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. NIH Public Access. 2009;42:377–81.CrossRef
28.
go back to reference Rasch G. Studies in mathematical psychology: 1. Probabilistic models for some intelligence and attainment tests. Danmarks Pædagogiske Institut: Copenhagen; 1960. Rasch G. Studies in mathematical psychology: 1. Probabilistic models for some intelligence and attainment tests. Danmarks Pædagogiske Institut: Copenhagen; 1960.
29.
go back to reference Rabin R, De Charro F. EQ-5D: A measure of health status from the EuroQol group. Ann Med. Royal Society of Medicine Press Ltd; 2001. p. 337–43. Rabin R, De Charro F. EQ-5D: A measure of health status from the EuroQol group. Ann Med. Royal Society of Medicine Press Ltd; 2001. p. 337–43.
30.
go back to reference Bradley KD, Peabody MR, Akers KS, et al. Rating scales in survey research: using the Rasch model to illustrate the middle category measurement flaw. Surv Pract. 2015;8:1–12.CrossRef Bradley KD, Peabody MR, Akers KS, et al. Rating scales in survey research: using the Rasch model to illustrate the middle category measurement flaw. Surv Pract. 2015;8:1–12.CrossRef
31.
go back to reference Khadka J, Gothwal VK, McAlinden C, et al. The importance of rating scales in measuring patient-reported outcomes. Health Qual Life Outcomes. 2012;10:80.CrossRef Khadka J, Gothwal VK, McAlinden C, et al. The importance of rating scales in measuring patient-reported outcomes. Health Qual Life Outcomes. 2012;10:80.CrossRef
32.
go back to reference Cohn I, Raman J, Sui Z. Patient motivations and expectations prior to bariatric surgery: a qualitative systematic review. Obes Rev. 2019;1608–18. Cohn I, Raman J, Sui Z. Patient motivations and expectations prior to bariatric surgery: a qualitative systematic review. Obes Rev. 2019;1608–18.
33.
go back to reference Poulsen L, Klassen A, Jhanwar S, et al. Patient expectations of bariatric and body contouring surgery. Plast Reconstr Surg - Glob Open. 2016;4:e694.CrossRef Poulsen L, Klassen A, Jhanwar S, et al. Patient expectations of bariatric and body contouring surgery. Plast Reconstr Surg - Glob Open. 2016;4:e694.CrossRef
34.
go back to reference Parretti HM, Hughes CA, Jones LL. “The rollercoaster of follow-up care” after bariatric surgery: a rapid review and qualitative synthesis. Obes Rev. 2019;20:88–107.CrossRef Parretti HM, Hughes CA, Jones LL. “The rollercoaster of follow-up care” after bariatric surgery: a rapid review and qualitative synthesis. Obes Rev. 2019;20:88–107.CrossRef
35.
go back to reference Mou D, Sisodia RC, Castillo-Angeles M, et al. The surgeon’s perceived value of patient-reported outcome measures (PROMs). Ann Surg. 2020:1–6. Mou D, Sisodia RC, Castillo-Angeles M, et al. The surgeon’s perceived value of patient-reported outcome measures (PROMs). Ann Surg. 2020:1–6.
36.
go back to reference Coulman KD, MacKichan F, Blazeby JM, Owen-Smith A. Patient experiences of outcomes of bariatric surgery: a systematic review and qualitative synthesis. Obes Rev. 2017;547–59. Coulman KD, MacKichan F, Blazeby JM, Owen-Smith A. Patient experiences of outcomes of bariatric surgery: a systematic review and qualitative synthesis. Obes Rev. 2017;547–59.
37.
go back to reference Natvik E, Gjengedal E, Råheim M. Totally changed, yet still the same: patients’ lived experiences 5 years beyond bariatric surgery. Qual Health Res. 2013;23:1202–14.CrossRef Natvik E, Gjengedal E, Råheim M. Totally changed, yet still the same: patients’ lived experiences 5 years beyond bariatric surgery. Qual Health Res. 2013;23:1202–14.CrossRef
38.
go back to reference Engström M, Forsberg A. Wishing for deburdening through a sustainable control after bariatric surgery. Int J Qual Stud Health Well-being. 2011;6 Engström M, Forsberg A. Wishing for deburdening through a sustainable control after bariatric surgery. Int J Qual Stud Health Well-being. 2011;6
39.
go back to reference Coulman KD, MacKichan F, Blazeby JM, et al. Patients’ experiences of life after bariatric surgery and follow-up care: a qualitative study. BMJ Open. BMJ Publishing Group. 2020;10:e035013.CrossRef Coulman KD, MacKichan F, Blazeby JM, et al. Patients’ experiences of life after bariatric surgery and follow-up care: a qualitative study. BMJ Open. BMJ Publishing Group. 2020;10:e035013.CrossRef
40.
go back to reference Ogden J, Avenell S, Ellis G. Negotiating control: patients’ experiences of unsuccessful weight-loss surgery. Psychol Health. 2011;26:949–64.CrossRef Ogden J, Avenell S, Ellis G. Negotiating control: patients’ experiences of unsuccessful weight-loss surgery. Psychol Health. 2011;26:949–64.CrossRef
41.
go back to reference Warholm C, Øien AM, Raheim M. The ambivalence of losing weight after bariatric surgery. Int J Qual Stud Health Well-being. 2014;9:22876.CrossRef Warholm C, Øien AM, Raheim M. The ambivalence of losing weight after bariatric surgery. Int J Qual Stud Health Well-being. 2014;9:22876.CrossRef
42.
go back to reference Wee CC, Davis RB, Jones DB, et al. Sex, race, and the quality of life factors most important to patients’ well-being among those seeking bariatric surgery. Obes Surg. 2016;26:1308–16.CrossRef Wee CC, Davis RB, Jones DB, et al. Sex, race, and the quality of life factors most important to patients’ well-being among those seeking bariatric surgery. Obes Surg. 2016;26:1308–16.CrossRef
43.
go back to reference Mancini A, Borel AL, Coumes S, et al. Bariatric surgery improves the employment rate in people with obesity: 2-year analysis. Surg Obes Relat Dis. 2018;14:1700–4.CrossRef Mancini A, Borel AL, Coumes S, et al. Bariatric surgery improves the employment rate in people with obesity: 2-year analysis. Surg Obes Relat Dis. 2018;14:1700–4.CrossRef
44.
go back to reference Kantarovich K, Wnuk S, Cassin S, et al. Employment outcomes 2 years after bariatric surgery: relationship to quality of life and psychosocial predictors. Obes Surg. 2019;29:2854–61.CrossRef Kantarovich K, Wnuk S, Cassin S, et al. Employment outcomes 2 years after bariatric surgery: relationship to quality of life and psychosocial predictors. Obes Surg. 2019;29:2854–61.CrossRef
45.
go back to reference Sockalingam S, Wnuk S, Kantarovich K, et al. Employment outcomes one year after bariatric surgery: the role of patient and psychosocial factors. Obes Surg. Springer New York LLC2015;25:514–22. Sockalingam S, Wnuk S, Kantarovich K, et al. Employment outcomes one year after bariatric surgery: the role of patient and psychosocial factors. Obes Surg. Springer New York LLC2015;25:514–22.
46.
go back to reference Courtney MJ, Mahawar K, Burnell P, et al. Occupational outcomes of obesity surgery—do the employed return to work, and do the unemployed find work? Obes Surg. 2018;28:963–9.CrossRef Courtney MJ, Mahawar K, Burnell P, et al. Occupational outcomes of obesity surgery—do the employed return to work, and do the unemployed find work? Obes Surg. 2018;28:963–9.CrossRef
47.
go back to reference Sharples AJ, Cheruvu CVN. Systematic review and meta-analysis of occupational outcomes after bariatric surgery. Obes Surg. 2017;27:774–81.CrossRef Sharples AJ, Cheruvu CVN. Systematic review and meta-analysis of occupational outcomes after bariatric surgery. Obes Surg. 2017;27:774–81.CrossRef
Metadata
Title
Development and Validation of New BODY-Q Scales Measuring Expectations, Eating Behavior, Distress, Symptoms, and Work Life in 4004 Adults From 4 Countries
Authors
Claire E. E. de Vries
Danny Mou
Lotte Poulsen
Trisia Breitkopf
Dennis J. S. Makarawung
Marinus J. Wiezer
Ruben N. van Veen
Maarten M. Hoogbergen
Jens A. Sorensen
Ronald S. L. Liem
Simon W. Nienhuijs
Ali Tavakkoli
Andrea L. Pusic
Anne F. Klassen
Publication date
01-08-2021
Publisher
Springer US
Published in
Obesity Surgery / Issue 8/2021
Print ISSN: 0960-8923
Electronic ISSN: 1708-0428
DOI
https://doi.org/10.1007/s11695-021-05462-2

Other articles of this Issue 8/2021

Obesity Surgery 8/2021 Go to the issue