Yes / OBJECTIVE: Develop and validate a child and adolescent version of the Three Factor Eating Questionnaire (CTFEQr17), and to assess its psychometric properties and factor structure. We also examined associations between the CTFEQr17 and body mass index (BMI) and food preferences. DESIGN: A two-phase approach was utilised, employing both qualitative and quantitative methodologies. SETTING: Primary and secondary schools, UK. SUBJECTS: In phase 1, 76 children (39 boys; mean age: 12.3±1.4 years) were interviewed to ascertain their understanding of the original TFEQr21 and to develop accessible and understandable items to create the CTFEQr17. In phase 2, 433 children (230 boys; mean age: 12.0±1.7 years) completed the CTFEQr17 and a food preference questionnaire, a subsample (n = 253; 131 boys) had their height and weight measured and 45 children (23 boys) were interviewed to determine their understanding of the CTFEQr17. RESULTS: The CTFEQr17 showed good internal consistency (Cronbach’s α=0.85) and the three factor structure was retained: cognitive restraint (CR), uncontrolled eating (UE) and emotional eating (EE). Qualitative data demonstrated a high level of understanding of the questionnaire (95%). A high CR was found to be significantly associated with a higher body weight, BMI and BMI percentile. High UE and EE scores were related to a preference for high fat savoury and high fat sweet foods. The relationships between CTFEQr17, anthropometry and food preference were stronger in girls compared to boys. CONCLUSIONS: The CTFEQr17 is a psychometrically sound questionnaire for use in children and adolescents, and is associated with anthropometric and food preference measures.

Currently there is limited research addressing the eating behaviours of preadolescent children, despite evidence suggesting that friends and peers may contribute to the developing eating attitudes and behaviours of children of this age. Eating behaviours in terms of this thesis include both under- and over- eating behaviours, with a specific focus on the under-eating behaviour, dietary restraint, and the over-eating behaviours emotional eating and external eating. The fundamental aim of this thesis was to examine friend and peer influences on children s eating behaviours, with a specific focus on a community sample of preadolescent children. Based on links established in the literature between childhood eating behaviours (dietary restraint, emotional eating and external eating) and parental controlling feeding practices (pressure to eat and restriction) and childhood symptoms of anxiety and depression, these factors were also considered alongside the contribution of friends and peers, both cross-sectionally and longitudinally. The longitudinal stability and continuity of self-reported eating behaviours and perceived parental feeding practices in preadolescent children were also examined in this thesis. A pilot study and experimental study provided an objective measure of children s snack food intake following a school lunchtime, when offered a selection (healthy and unhealthy) of snack foods in the presence of friends and peers. Links between food intake in the presence of friends and peers, and self-reported eating behaviours, parental controlling feeding practices, child symptoms of anxiety and depression and BMI were further explored. The research in this thesis suggests that friends dieting behaviours predict individual children s dieting behaviours, and also highlights links between problematic eating and anxiety in preadolescent children. Parental controlling feeding practices were found to have a negative impact on preadolescents eating behaviours and were also found to be potentially linked to the development or maintenance of anxiety and depression symptoms in children of this age. Preadolescents reports of eating behaviours and perceptions of the controlling feeding practices their parents utilised with them were stable over time, but, with the exception of restriction, lacked continuity. Dietary restraint, emotional eating and external eating decreased over a 12 month period. While some of the research in this thesis requires replication, the results present many novel and interesting findings. Using longitudinal and experimental data, the research reported on in this thesis highlights the important contributions of friends, peers, parents and individual anxiety and low mood to the eating attitudes and behaviours of preadolescent aged children.

This thesis contributes to a growing body of research examining the relationship between sociocultural influences and disordered eating behaviour. The aim of the current research was to extend on previously developed theoretical models to more closely examine agerelated differences in an integrated sociocultural model of disordered eating behaviour. The proposed model was informed by components of the dual-pathway model and the tripartite influence model. Nine-hundred and ninety-five women, from four different age groups (i.e., preadolescent, early adolescent, late adolescent and young adult), completed self-report measures of perceived pressure to be thin, modelling of disordered eating behaviour, media exposure, internalisation of the thin-ideal, social comparison, body dissatisfaction, body mass index, and disordered eating behaviour. Using structural equation modelling (SEM) techniques, a sociocultural model of disordered eating was tested and found to have good fit to the data. A number of age-related differences in the strength of the relationship between variables were found. Interestingly, modelling of disordered eating behaviour was a direct predictor of disordered eating behaviour regardless of age group. As expected internalisation of the thin-ideal mediated between perceived pressure to be thin and body dissatisfaction for all age groups. Surprisingly, media exposure had few effects on internalisation, but was more strongly related to social comparison for the late adolescent and young adult age groups. Social comparison played a less significant role in predicting body dissatisfaction in preadolescent girls. However, for all other participants, social comparison predicted internalisation of the thin-ideal, body dissatisfaction and disordered eating behaviour. As expected, BMI predicted body dissatisfaction, and body dissatisfaction predicted disordered eating behaviour. The models accounted for between 60-64% of the variance in disordered eating behaviour. Implications for prevention programs are discussed in light of these findings.

Introduction: Currently, 1 in 7 children are classified as obese, which represents an obesity rate two times higher than that of the last 25 years. Part of the solution to address the positive energy balance underlying weight gain is to target the specific eating behaviours and factors that lead to food intake. One widely used tool to measure eating behaviour is the Three-Factor Eating Questionnaire (TFEQ). Objective: The primary objective of this study was to validate scores of the 21-item Child version of the Three-Factor Eating Questionnaire (TFEQ-R21 C), by examining validity evidence and reliability of TFEQ-R21 C responses in a sample of Canadian children and adolescents. The secondary aim was to examine the associations between the TFEQ-R21 C factors and body mass index (BMI) z-scores and food/taste preferences. Methods: The participants consisted of a sample of 158 children, 63 boys (mean age: 11.5 ± 1.6 years) and 95 girls (mean age: 11.9 ± 1.9 years), recruited from English schools in the Ottawa area. To assess eating behaviour, participants filled out the TFEQ-R21 C, the Power of Food Scale, and the Leeds Food Preference Questionnaire. Height and weight measurements were taken using a stadiometer and a digital scale. An exploratory factor analysis with oblique rotation and an item analysis were conducted to determine the factor structure and validity of the questionnaire. A median split on Cognitive Restraint (CR), Internal Uncontrolled Eating (UE 1), External Uncontrolled Eating (UE 2), and Emotional Eating (EE) was used to dichotomize factor-based scores into high and low categories for each factor, to allow for group comparisons. Bivariate correlations explored relationships between weight, BMI and BMI z-score, and food and taste preference, by sex and age group. To determine if BMI, BMI z-scores, and food/taste preferences were associated with factor scores of the TFEQ-R21 C, two-way ANOVAs were conducted. Results: The exploratory factor analysis replicated the Emotional Eating (EE) and Cognitive Restraint (CR) scales of the original TFEQ-R21, whereas the global factor of Uncontrolled Eating (UE) produced two subscales: Internal Uncontrolled Eating (UE 1) and External Uncontrolled Eating (UE 2). Item 17 did not load onto any of the factors and was subsequently removed. The four-factor model, with item 17 removed (FFEQ-R21 C: 20-item Child version Four-Factor Eating Questionnaire), accounted for 41.2% of the common variance in the data and showed good internal consistency (α= 0.81). The factors of UE 1 (r= 0.27, p<0.001), UE 2 (r= 0.36, p<0.0001), and CR (r= 0.20, p= 0.04) correlated significantly with EE. Younger children reported higher UE 1 scores [F(1,143)= 3.99, p=0.048, f2= 0.028] and CR scores [F(1,143)= 3.99, p= 0.001, f2= 0.089]. Boys who reported a high UE 1 scores had a significantly higher weight [F(1,58)= 6.44, p=0.014, f2= 0.117 ] and BMI z-scores [F(1,58)= 4.45, p=0.039, f2=0.083], compared to those who reported low UE 1 scores. Children with overweight or obesity [F(1,143)= 2.75, p<0.001. f2= 0.035] reported higher EE scores, compared to children of normal weight. Children with high UE 1 scores reported greater preference for high protein and fat foods, and high fat savoury (HFSA) and high fat sweet (HFSW) foods, compared to those with low UE 1 scores. Higher preference for high protein, fat, and carbohydrate foods, and HFSA, HFSW, and low fat savoury foods (LFSA) foods was found in children with high UE 2 scores, compared to those with low UR 2 scores. Children and adolescents with low CR scores reported greater preference for high protein, carbohydrate, and fat foods, compared to those who reported high CR scores. Discussion: This study showed adequate reliability and validity evidence of the TFEQ-R21 C scores, and that the questionnaire is best represented by a 20-item four-factor model in our sample. The FFEQ-R21 C was able to identify relevant eating behaviour traits associated with higher BMI z-scores and food preferences in both sexes and age groups, which were mainly in accordance with previous findings in children and adolescents. These results support the utility of the questionnaire for the assessment and identification of problematic eating behaviour and food preferences in the Canadian pediatric population. Younger children reported higher influence of the psychological constructs of eating behaviour (CR, UE 1, UE 2, and EE), compared to older children. This study provides preliminary evidence that FFEQ-R20 is a reliable and valid self-report tool to measure eating behaviour in children and adolescents to characterize those at higher risk for excess weight. However, further research is needed to examine the validity of the questionnaire in larger samples and in other geographical locations across Canada, as well as the inclusion of extraneous variables such as parental eating behaviour, socioeconomic status, and physical activity levels.

Yes / Purpose. The aim of this study was to develop and validate a Romanian version of the three factor eating questionnaire-r21 for children and adolescents (ctfeqr21), and to assess its psychometric properties and factor structure. Associations between this version of the ctfeqr21 and anthropometric measures as well as body composition were also examined. Design and methods. 153 children and adolescents (68 boys and 95 girls; 10.8 ± 3.5 years) took part in this study (bmi of 17.7 ± 3.1 kg/m²). The participants were first interviewed to ascertain their understanding of the ctfeq-r21 and were then asked to self-complete the questionnaire. Height and weight were measured and body composition assessed using bio impedance analyzers (Tanita MC 780). Results. The CTFEQr21 showed satisfactory internal consistency (cronbach’s α=0.78). Cronbach’s alpha coefficients were 0.55 for CR, 0.75 for UE, and 0.76 for EE separately. UE and EE were found to be significantly correlated (r=0.54, p<0.05). The three factors explained 43% of the total variance. Correlation between CR, UE and EE with body weight, BMI and FFM were significant but low to moderate with coefficients ranging from 0.20 to 0.37. The higher the CR, UE and EE tertiles, the higher the weight, fat mass (kg) and fat-free mass values. Conclusions. According to the psychometric analysis of the questionnaire, the proposed version of the CTFEQr21 proposed here is a satisfactory tool to assess eating behaviors in Romanian child population that remains to be further developed.

Prevalence rates of overweight and obesity in Maltese adolescents are amongst the highest in the world. Stress-induced eating and dysfunctional coping skills have been linked to overeating and obesity. This study was undertaken in two phases. Phase 1 examined the relationship between perceived stress, coping and eating behaviours in Maltese adolescents and devised a model to guide the development of an effective Internet-based intervention. Based on the findings, Phase 2 developed ACES – a novel online intervention for the reduction of perceived stress and emotional eating in Maltese adolescents – and assessed its feasibility. In Phase 1, cross-sectional data were gathered from 79 Maltese adolescents using an online questionnaire with 6 self-report measures examining perceived stress, coping responses, eating behaviours, self-efficacy, physical exercise and social support. Findings suggested that emotional eating behaviours can be decreased by reducing perceived stress and dysfunctional coping strategies (self-controlling and escape-avoidance) and increasing self-efficacy and functional coping strategies (seeking social support and planful problem solving). In Phase 2, ACES was developed and a feasibility study, with a one-group pretest-posttest design, carried out to assess the functionality, usability, perceived utility and acceptability of ACES and to test the design of a definitive randomized controlled trial. Forty-six out of 125 participants completed ACES. Findings suggested that ACES is feasible and well-received by participants. Preliminary effectiveness results provide additional support for the Phase 1 findings concerning the variables that need to be taken into account to decrease emotional eating behaviours. This study has made significant contributions to the literature and offered insights into specific functional and dysfunctional coping strategies impacting perceived stress and eating behaviours. It has produced an online intervention, which is a feasible avenue for the reduction of perceived stress and emotional eating, that could be built upon by practitioners and researchers, with potential implications for obesity prevention.

Obesity, a common health condition in adolescence leading to severe medical complications, is assumed to be influenced by temperament factors. This paper investigates associations between reactive and regulative temperament, problematic eating behaviours, and excess weight. Several self-report instruments were completed by 130 adolescents (mean age 14.13 ± 0.61 years), including 27 overweight and obese individuals (20.8%). Bootstrap analysis revealed a mediating effect of restrained eating on the relation between reactive temperament and body mass index percentile, which differed according to gender: Restrained eating, which predicted weight gain, was more present in girls having a higher sensitivity to reward and in boys showing a higher sensitivity to punishment. No effect of regulative temperament was found. These results have important implications for weight management programs, as they suggest that reducing restrained eating by working on temperament may help to control weight.

At present, the process of parental modelling of eating behaviours and attitudes has received limited research interest. While often mentioned as a possible factor in relation to child feeding and the development of eating behaviours, only a few studies have explicitly researched parental modelling. The main aims of this thesis were to develop a new measure to assess modelling multidimensionally and to explore the relationships between parental modelling of eating behaviours with a variety of parent and child factors. Initially, a parental self-report measure (the Parental Modelling of Eating Behaviours Scale; PARM) was developed, validated and piloted as part of a series of studies exploring the associations between modelling and a range of self-reported parental and child factors. To provide further validation for the PARM, an observational coding scheme was developed, based on the newly developed modelling measure, and this was utilised in two further studies which looked at self-reported and observed parent and child factors. The key findings from this thesis suggest a number of beneficial relationships. For example, maternal modelling was positively correlated with healthy food intake in both mothers and their children. In addition, both maternal and paternal modelling were associated with children s increased enjoyment of food and lower levels of food fussiness. Observations of maternal modelling were also found to be positively related to other observed adaptive, non-directive feeding practices, such as encouragement to eat. However, less positive relationships were also identified, with modelling being related to parents mental health symptoms and to unhealthy food intake in both mothers and their children. In conclusion, this thesis has identified three distinct facets of modelling and highlighted factors which might be linked to parental role modelling around eating behaviours. While much of the research within this thesis is exploratory, and the findings require replication, they would suggest that parental modelling has the potential to positively influence children s eating behaviours. However, parents should also be made aware of the potential detrimental effect that modelling less adaptive eating behaviours may have on their children s food intake, particularly those eating behaviours that parents may be unaware of modelling.

Canada’s obesogenic environment is host to the advironment, which bombards children with advertisements for soft drinks, fast foods, confectionary, cereals and savory snacks (‘the Big 5’). Television is the primary media outlet used by advertisers to promote the Big 5 to the widest range of Canadian children. A recent trend in commercial marketing is to portray the Big 5 products in a physical activity, exercise or sport context, described here as Healthy Active Living Marketing. This study was designed to explore the relationships between Healthy Active Living Marketing and children and caregivers’ eating and physical activity perceptions and behaviors. Four caregiver-child dyads from communities of York Region, Ontario consented to collect family food receipts, complete commercial activity worksheets, one-on-one interviews and a caregiver questionnaire. A combination of descriptive statistics, content analyses and thematic analyses revealed caregiver control plays a significant role in the appropriateness of eating perceptions and behaviours.

Background: Roux-en-y gastric bypass (RYGB) surgery produces significant weight loss, however a number of patients experience some and/or complete recidivism of weight years after surgery. Limited research has investigated why patients are experiencing weight regain after surgical interventions. Our objective was to identify appetite-related measures associated with weight regain after RYGB surgery. Methods: Using a cross-sectional design, 29 participants (49.6 ± 9.1 years of age; 29-62 months post-RYGB) were divided into three weight categories; (weight maintainers, n = 9; low weight regainers, n = 10; and high weight regainers, n = 10). Appetite, smell function, eating behaviours and food reward were measured in response to a standardized meal. Results: Weight regain increased significantly in association with time after surgery (rs = 0.768, p = 0.016). High regainers gained on average 8.6 kg/year, compared to low regainers and maintainers, 3.8 ± 0.9 kg/year and 0.9 ± 0.9 kg/year, respectively (p < 0.001). Dietary restraint (using the Three Factor Eating Questionnaire) was significantly higher in weight maintainers and low regainers compared to high regainers using clinical subscales (p < 0.05). Weight regain was associated with higher “liking” of high-fat sweet foods (measured with the Leeds Food Preference Questionnaire) among high weight regainers. Conclusion: Weight regain after RYGB may be associated with higher preferences for high-fat sweet foods, whereas, higher dietary restraint may be associated with lower wanting of high-fat sweet foods among weight maintainers. Findings provide insight into why some patients after RYGB regain weight, while others maintain their weight. Future research is needed to further explore the relationships between appetite-related factors and weight regain after RYGB employing a longitudinal study design.