Content validation of the Eating Behavior and Appetite Questionnaire (EBAQ) in adolescents with obesity or overweight

Obesity in children and adolescents is a growing global concern. Changes in appetite and eating behaviors are clinically relevant outcomes for long-term management of obesity. The Eating Behavior and Appetite Questionnaire (EBAQ) was developed as existing patient-reported outcome measures do not comprehensively capture concepts important to individuals with obesity. Its content and psychometric validity have been demonstrated in adults; this study evaluated the content validity of the 17-item EBAQ in adolescents with obesity or overweight.

This cross-sectional qualitative study included US-based adolescents (12-17 years) with obesity or with overweight and ≥1 obesity-related complication. Cognitive interviews were conducted via telephone/teleconference using a semi-structured interview guide. Participants completed the EBAQ and provided feedback on its relevance, clarity, and comprehensiveness. Transcripts were coded using a coding framework.

Fifteen adolescents (mean age, 14.7 years; mean body-mass index, 33.6 kg/m²) participated. Most (12/15, 80%) had not received obesity management medications (OMMs). All (15/15, 100%) understood the instructions and recall period, and 14/15 (93%) understood the response options. Each item was understood by ≥ 80% of the participants (≥12/15), except for Item 5 ('Appetite was controlled'). Item 5 was understood by all participants who had received OMMs (n = 3) but only a few of the treatment-naïve participants (n = 4), suggesting more relevance for those on treatment. Each item was deemed relevant by ≥ 54% of the participants (≥7/15), except Item 17 ('Eating because stressed') which was considered relevant by 46% (6/13) of the participants. Overall, most participants (11/15, 73%) found the EBAQ well-structured, easy to understand and complete, and relevant.

Findings support the conceptual relevance, clarity, and appropriateness of the 17-item EBAQ for adolescents with obesity or overweight. The EBAQ may be used to assess appetite and eating behavior outcomes in adolescents with obesity or overweight in clinical trials and observational studies.