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Reliability and validity of the abbreviated version of the Mindful Eating Questionnaire in Turkish adults

Confiabilidade e validade de uma versão abreviada do questionário de alimentação consciente em adultos turcos

ABSTRACT

Objective

To adapt the abbreviated version of the Mindful Eating Questionnaire to Turkish for the Turkish adult population.

Methods

This cross-sectional study includes 709 participants aged between 18-65 years living in the province of Elazig. The data was collected through a voluntary face-to-face survey. The questionnaire was included their general characteristics and the Mindful Eating Questionnaire -18 and Eating Attitude Test-26. Confirmatory factor analysis was used to test the validity of the Mindful Eating Questionnaire -18. Statistical analyzes were conducted using the R-Project program and IBM®SPSS® version 26.0.

Results

The overall content validity index was 0.93. A confirmatory factor analysis was conducted for the two sub-scales and reduced the abbreviated of Mindful Eating Questionnaire to 18 items. The Cronbach’s alpha coefficient was 0.718 for the Mindful Eating Questionnaire-18 total factor scores and Cronbach alpha values for awareness, and disinhibition were found to be 0,843 and 0,789, respectively. The minimum discrepancy per degree of freedom=4.914 and the fit indices were at an acceptable level (RMSEA=0.074, CFI=0.934, SRMR=0.079, TLI=0.925, GFI=0.968, AGFI=0.959).

Conclusion

The findings of study showed that the psychometric properties of the abbreviated Mindful Eating Questionnaire adapted into Turkish were acceptable through construct and internal consistency reliability for adults.

Keywords
Adaptation; Confirmatory factor analysis; Mindful eating; Reliability; Validity

RESUMO

Objetivo

Adaptar e validar uma versão abreviada do Mindful Eating Questionnaire para a língua turca para uma população turca adulta.

Métodos

Este estudo transversal incluiu 709 participantes com idades compreendidas entre os 18 e os 65 anos, residentes na província de Elazig. Os dados foram recolhidos através de um inquérito presencial voluntário. O questionário incluía as suas caraterísticas gerais e o Mindful Eating Questionnaire-18 e o Eating Attitude Test-26. Foi utilizada a análise fatorial confirmatória para testar a validade do Mindful Eating Questionnaire-18. As análises estatísticas foram efectuadas utilizando o programa R-Project e o IBM®SPSS® versão 26.0.

Resultados

O índice geral de validade de conteúdo foi de 0,93. Uma análise fatorial confirmatória foi realizada para as duas subescalas e reduziu a abreviação do Mindful Eating Questionnaire para 18 itens. O coeficiente alfa de Cronbach foi de 0,718 para os escores de fatores totais do Mindful Eating Questionnaire-18 e os valores alfa de Cronbach para consciência e desinibição foram 0,843 e 0,789, respectivamente. A discrepância mínima por grau de liberdade = 4,914 e o modelo geralmente se ajustam bem à estrutura (RMSEA=0,074, CFI=0,934, SRMR=0,079, TLI=0,925, GFI=0,968, AGFI=0,959).

Conclusão

Os resultados do estudo mostraram que as propriedades psicométricas do Mindful Eating Questionnaire abreviado adaptado para o turco eram aceitáveis por meio da confiabilidade de construção e consistência interna.

Palavras-chave
Adaptação; Análise fatorial confirmatória; Alimentação consciente; Confiabilidade; Validade

INTRODUCTION

Mindfulness involves the ability to acknowledge one’s awareness and focus on the present without judgment [11 Bishop SR, Lau M, Shapiro S, Carlson L, Anderson ND, Carmody J, et al. Mindfulness: a proposed operational definition. Clin Psychol: Sci Pract. 2004;11(3):230. https://doi.org/10.1093/clipsy.bph077
https://doi.org/10.1093/clipsy.bph077...
]. Mindfulness-based treatments have been applied and successful results have been obtained in many psychiatric diseases such as depression [22 Goldberg SB, Tucker RP, Greene PA, Davidson RJ, Kearney DJ, Simpson TL. Mindfulness-based cognitive therapy for the treatment of current depressive symptoms: A meta-analysis. Cogn Behav Ther. 2019;48(6):445-62. https://doi.org/10.1080/16506073.2018.1556330
https://doi.org/10.1080/16506073.2018.15...
], attention deficit/hyperactivity disorder [33 Cairncross M, Miller CJ. The effectiveness of mindfulness-based therapies for ADHD: A meta-analytic review. J Atten Disord. 2020;24(5):627-43. https://doi.org/10.1177/1087054715625301
https://doi.org/10.1177/1087054715625301...
], anxiety [44 Hofmann SG, Sawyer AT, Witt AA, Oh D. The effect of mindfulness-based therapy on anxiety and depression: A meta-analytic review. J Consult Clin Psychol. 2010;78(2):169. https://doi.org/10.1037/a0018555
https://doi.org/10.1037/a0018555...
], schizophrenia [55 Hodann-Caudevilla RM, Díaz-Silveira C, Burgos-Julián FA, Santed MA. Mindfulness-based interventions for people with schizophrenia: A systematic review and meta-analysis. Int J Environ Res Public Health. 2020;17(13):4690. https://doi.org/10.3390/ijerph17134690
https://doi.org/10.3390/ijerph17134690...
], and substance use disorders [66 Chiesa A, Serretti A. Are mindfulness-based interventions effective for substance use disorders? A systematic review of the evidence. Subst Use Misuse. 2014;49(5):492-512. https://doi.org/10.3109/10826084.2013.770027
https://doi.org/10.3109/10826084.2013.77...
]. Many studies show that mindfulness-based treatments can also be effective for eating disorders and obesity [77 Godsey J. The role of mindfulness based interventions in the treatment of obesity and eating disorders: An integrative review. Complement Ther Med. 2013;21(4):430-9. https://doi.org/10.1016/j.ctim.2013.06.003
https://doi.org/10.1016/j.ctim.2013.06.0...

8 Mantzios M, Wilson JC. Mindfulness, eating behaviours, and obesity: A review and reflection on current findings. Curr Obes Rep. 2015;4(1):141-6. https://doi.org/10.1007/s13679-014-0131-x
https://doi.org/10.1007/s13679-014-0131-...
-99 O’Reilly GA, Cook L, Spruijt-Metz D, Black DS. Mindfulness-based interventions for obesity‐related eating behaviours: A literature review. Obes Rev. 2014;15(6):453-61. https://doi.org/10.1111/obr.12156
https://doi.org/10.1111/obr.12156...
]. In addition, mindfulness-based treatments is recognized as a psychological control mechanism that has received significant attention in the literature on healthy eating and weight control as a possible strategy for addressing mindless overconsumption [1010 Fuentes Artiles R, Staub K, Aldakak L, Eppenberger P, Rühli F, Bender N. Mindful eating and common diet programs lower body weight similarly: Systematic review and meta-analysis. Obes Rev. 2019;20(11):1619-27. https://doi.org/10.1111/obr.12918
https://doi.org/10.1111/obr.12918...
].

Mindful eating focuses on the process of eating rather than what is eaten, as well being a new dietary approach. In mindful eating, the first step involves being aware of all the flavors, smells and textures of the food consumed. The second is to be aware of what you are eating if several tasks are being done at the same time while eating, and staying away from the habit of eating automatically. The third is to be aware of what triggers starting and stopping eating [1111 Albers S. Eat, drink, and be mindful: How to end your struggle with mindless eating and start savoring food with intention and joy. Oakland: New Harbinger Publications; 2009.]. Through the practice of all these processes, it is enabled to internalise the concept of physical hunger-fullness and focus on the food to be consumed at the moment, without being affected by environmental factors, judging food choices and being aware of the effect of emotions and thoughts [1212 Framson C, Kristal AR, Schenk JM, Littman AJ, Zeliadt S, Benitez D. Development and validation of the mindful eating questionnaire. J Am Diet Assoc. 2009;109(8):1439-44. https://doi.org/10.1016/j.jada.2009.05.006
https://doi.org/10.1016/j.jada.2009.05.0...
]. Mindful eating is among the conscious behavioral factors related to food selection and consumption in relation to mental well-being [1313 Khan Z, Zadeh ZF. Mindful eating and it’s relationship with mental well-being. Procedia Soc Behav Sci. 2014;159:69-73. https://doi.org/10.1016/j.sbspro.2014.12.330
https://doi.org/10.1016/j.sbspro.2014.12...
]. Mindful eating may be important in health-related behavioral changes by distracting people from uncontrolled eating behavior [88 Mantzios M, Wilson JC. Mindfulness, eating behaviours, and obesity: A review and reflection on current findings. Curr Obes Rep. 2015;4(1):141-6. https://doi.org/10.1007/s13679-014-0131-x
https://doi.org/10.1007/s13679-014-0131-...
]. Therefore, being aware of what you eat and how much is eaten, especially the portion size consumed, is a modifiable determinant of energy expenditure and an important factor to be addressed in both the prevention and treatment of overweight and obesity [1414 Berg C, Lappas G, Wolk A, Strandhagen E, Torén K, Rosengren A, et al. Eating patterns and portion size associated with obesity in a Swedish population. Appetite. 2009;52(1):21-6. https://doi.org/10.1016/j.appet.2008.07.008
https://doi.org/10.1016/j.appet.2008.07....
,1515 Livingstone MBE, Pourshahidi LK. Portion size and obesity. Adv Nutr. 2014;5(6):829-34. https://doi.org/10.3945/an.114.007104
https://doi.org/10.3945/an.114.007104...
].

In literature, it was shown that the mindful eating intervention has a positive effect on weight loss randomly assigned 36 obese women followed a six-week mindful eating program [1616 Smith BW, Shelley BM, Sloan AL, Colleran K, Erickson K. A preliminary randomized controlled trial of a mindful eating intervention for post-menopausal obese women. Mindfulness. 2018;9(3):836-49. https://doi.org/10.1007/s12671-017-0824-9
https://doi.org/10.1007/s12671-017-0824-...
]. As a result of the study, it was determined that there were decreases in Body Mass Index (BMI), Waist-To-Hip Ratio (WHR), binge eating, interleukin-6 (IL-6) and C-Reactive Protein (CRP) in the intervention group [1616 Smith BW, Shelley BM, Sloan AL, Colleran K, Erickson K. A preliminary randomized controlled trial of a mindful eating intervention for post-menopausal obese women. Mindfulness. 2018;9(3):836-49. https://doi.org/10.1007/s12671-017-0824-9
https://doi.org/10.1007/s12671-017-0824-...
]. Another study randomized 75 overweight and obese participants to the new mindfulness weight loss program or a standard behavioral weight loss program. Those on the new mindfulness weight loss program were found to have significantly better scores on mindful eating and binge eating at six-month follow-up. In addition, it was determined that more weight loss was predicted in the intervention group [1717 Carpenter KM, Vickerman KA, Salmon EE, Javitz HS, Epel ES, Lovejoy JC. A randomized pilot study of a phone-based mindfulness and weight loss program. Behav Med. 2019;45(4):271-81. https://doi.org/10.1080/08964289.2017.1384359
https://doi.org/10.1080/08964289.2017.13...
]. It was shown that a mindful eating intervention in patients with type 2 diabetes gives better results in meeting the self-care needs of the patients [1818 Miller CK, Kristeller JL, Headings A, Nagaraja H. Comparison of a mindful eating intervention to a diabetes self-management intervention among adults with type 2 diabetes: A randomized controlled trial. Health Educ Behav. 2014;41(2):145-54. https://doi.org/10.1177/1090198113493092
https://doi.org/10.1177/1090198113493092...
]. It has been determined that mindful eating intervention in African American breast cancer patients can be effective on weight loss [1919 Chung S, Zhu S, Friedmann E, Kelleher C, Kozlovsky A, Macfarlane KW, et al. Weight loss with mindful eating in African American women following treatment for breast cancer: A longitudinal study. Support Care Cancer. 2016;24(4):1875-81. https://doi.org/10.1007/s00520-015-2984-2
https://doi.org/10.1007/s00520-015-2984-...
].

To our knowledge, there has been a growing trend in research on mindful eating recently. In light of these promising studies, it is very important to have reliable and valid tools to measure the change in which mindful eating interventions targeted. Therefore, mindful eating tools have been developed to assess conscious eating [1212 Framson C, Kristal AR, Schenk JM, Littman AJ, Zeliadt S, Benitez D. Development and validation of the mindful eating questionnaire. J Am Diet Assoc. 2009;109(8):1439-44. https://doi.org/10.1016/j.jada.2009.05.006
https://doi.org/10.1016/j.jada.2009.05.0...
,2020 Carrière K, Shireen SH, Siemers N, Preißner CE, Starr J, Falk C, et al. Development and Validation of the Four Facet Mindful Eating Scale (FFaMES). Appetite. 2022;168:105689. https://doi.org/10.1016/j.appet.2021.105689
https://doi.org/10.1016/j.appet.2021.105...

21 Hulbert-Williams L, Nicholls W, Joy J, Hulbert-Williams N. Initial validation of the mindful eating scale. Mindfulness. 2014;5(6):719-29. https://doi.org/10.1007/s12671-013-0227-5
https://doi.org/10.1007/s12671-013-0227-...

22 Kawasaki Y, Akamatsu R, Omori M, Sugawara M, Yamazaki Y, Matsumoto S, et al. Development and validation of the Expanded Mindful Eating Scale. Int J Health Care Qual Assur. 2020;33(4/5):309-21. https://doi.org/10.1108/IJHCQA-01-2020-0009
https://doi.org/10.1108/IJHCQA-01-2020-0...
-2323 Peitz D, Schulze J, Warschburger P. Getting a deeper understanding of mindfulness in the context of eating behavior: Development and validation of the Mindful Eating Inventory. Appetite. 2021;159:105039. https://doi.org/10.1016/j.appet.2020.105039
https://doi.org/10.1016/j.appet.2020.105...
], and validity and reliability studies have been conducted in different sample groups [2424 Abdul Basir SM, Abdul Manaf Z, Ahmad M, Abdul Kadir NB, Ismail WNK, Mat Ludin AF, et al. Reliability and Validity of the Malay Mindful Eating Questionnaire (MEQ-M) among overweight and obese adults. Int J Environ Res Public Health. 2021;18(3):1021. https://doi.org/10.3390/ijerph18031021
https://doi.org/10.3390/ijerph18031021...

25 Apolzan JW, Myers CA, Cowley AD, Brady H, Hsia DS, Stewart TM, et al. Examination of the reliability and validity of the Mindful Eating Questionnaire in pregnant women. Appetite. 2016;100:142-51. https://doi.org/10.1016/j.appet.2016.02.025
https://doi.org/10.1016/j.appet.2016.02....
-2626 Hart SR, Pierson S, Goto K, Giampaoli J. Development and initial validation evidence for a mindful eating questionnaire for children. Appetite. 2018;129:178-85. https://doi.org/10.1016/j.appet.2018.07.010
https://doi.org/10.1016/j.appet.2018.07....
]. The most cited and first mindful eating tool in the literature was developed by Framson et al. [1212 Framson C, Kristal AR, Schenk JM, Littman AJ, Zeliadt S, Benitez D. Development and validation of the mindful eating questionnaire. J Am Diet Assoc. 2009;109(8):1439-44. https://doi.org/10.1016/j.jada.2009.05.006
https://doi.org/10.1016/j.jada.2009.05.0...
] consists of a 28 items and 5 sub-scales (disinhibition, awareness, external cues, emotional response, and distraction). Additionally, this tool developed by Framson et al. [1212 Framson C, Kristal AR, Schenk JM, Littman AJ, Zeliadt S, Benitez D. Development and validation of the mindful eating questionnaire. J Am Diet Assoc. 2009;109(8):1439-44. https://doi.org/10.1016/j.jada.2009.05.006
https://doi.org/10.1016/j.jada.2009.05.0...
] constitutes the cornerstone of mindful eating studies. Then, the researchers evaluated the psychometric properties (ie, content, structural and criterion validity, and reliability) of the short version in Italian culture as the necessity of short tools in the field of health is known [2727 Clementi C, Casu G, Gremigni P. An abbreviated version of the Mindful Eating Questionnaire. J Nutr Educ Behav. 2017;49(4):352-6. e1. https://doi.org/10.1016/j.jneb.2017.01.016
https://doi.org/10.1016/j.jneb.2017.01.0...
]. In this study, it was aimed to validity and reliability study in adult population of the abbreviated of the mindful eating questionnaire which forms the basis of mindful eating tools and is due to the necessity of short scales in the field of health, by translating it into Turkish through guides.

METHODS

Necessary permission was obtained from the author who developed the scale before starting the study [2828 Kimberlin CL, Winterstein AG. Validity and reliability of measurement instruments used in research. Am J Health Sys Pharm. 2008;65(23):2276-84. https://doi.org/10.2146/ajhp070364
https://doi.org/10.2146/ajhp070364...
]. The linguistic, semantic and cultural adaptation process between the Turkish version and the original of the mindful eating questionnaire and an abbreviated version of the mindful eating questionnaire form was completed. The translation and adaptation process was done according to the methodology of Beaton et al. [2929 Beaton DE, Bombardier C, Guillemin F, Ferraz MB. Guidelines for the process of cross-cultural adaptation of self-report measures. Spine. 2000;25(24):3186-91. https://doi.org/10.1097/00007632-200012150-00014
https://doi.org/10.1097/00007632-2000121...
]. It was translated from English to Turkish by two different translators. These two translations were compared and then, these two translation results were a back-translated into English by a third translator. Finally, all these translations were evaluated by a committee of experts with language and field proficiency.

Face validity

To assess face validity, a pilot study was conducted with 60 participants on the prefinal scale. They were asked to answer three open-ended questions regarding the possible ambiguity, intelligibility, and clarity of each item and the overall questionnaire. Minor adjustments were made as a result of the analysis of the comments. The data obtained as a result of the pilot study were not included in the main study.

Content Validity

10 academicians with language proficiency were asked to evaluate the intelligibility of the items. In this context, scale items were asked to score between 1-4. Scoring was evaluated according to the Davis technique [3030 Davis LL. Instrument review: Getting the most from a panel of experts. Appl Nurs Res. 1992;5(4):194-7. https://doi.org/10.1016/S0897-1897(05)80008-4
https://doi.org/10.1016/S0897-1897(05)80...
], and content validity scores of all items were found to be greater than 0.80 (Supplementary File 1). Experts were also consulted about the language of the scale and the suitability of the items for the purpose, and necessary adjustments were made.

Participants

This study was announced on online platforms via university and city’s social media (e.g. Facebook, Instagram), internet panels, e-mail by the researchers between June and December 2021. Those who accepted to participates in the study announced on the online platform were recruited in the Department of Nutrition and Dietetics at Fırat University. The International Test Commission recommends reaching 500 people to reveal the factor structure of a test [3131 Gregoire J. ITC guidelines for translating and adapting tests. Int J Test. 2018;18(2):101-34.]. During this period, 760 individuals were reached and the data of 709 individuals who completed the form completely were included in the analysis. The number of people reached in the study exceeded the number recommended by the International Test Commission. Inclusion criteria of the study: 1) Adulthood (being between 18-65 years), 2) residency in Elazig, 3) being Turkish native, 4) not being pregnant/lactating. The initial sample consisted of 932 people. Missing data in the questionnaire and 223 participants (~24%) who did not meet the study criteria were completely excluded from the study. The final sample consisted of n=709 participants. This study was conducted according to the guidelines in the Declaration of Helsinki. After all participants were given verbal explanations of the study, signed informed consent was obtained. The Fırat University Non-Interventional Research Ethics Committee approved all procedures (Approved no: E-97132852-050.01.04-162850).

Measures

The Turkish questionnaire consists of three parts. In the first part, the sociodemographic characteristics of the participants (age, gender, marital status, education level, physical activity status, chronic disease, smoking and alcohol use, etc.) were evaluated. Participants were asked about their height and body weight. Then used to calculate BMI using the following formula: weight (kg)/[height (m)]2 [3232 World Health Organization. WHO Global Database on Body Mass Index. Geneva: WHO; 2011.]. In the second part, there is an abbreviated of the Mindful Eating Questionnaire (MEQ-18), and in the last part, there is the Eating Attitude Test-26 (EAT-26).

An Abbreviated of the Mindful Eating Questionnaire (MEQ-18)

The mindful eating questionnaire was first developed in the USA by Framson et al. [1212 Framson C, Kristal AR, Schenk JM, Littman AJ, Zeliadt S, Benitez D. Development and validation of the mindful eating questionnaire. J Am Diet Assoc. 2009;109(8):1439-44. https://doi.org/10.1016/j.jada.2009.05.006
https://doi.org/10.1016/j.jada.2009.05.0...
] to assess eating mindful and its validity and reliability have been demonstrated. The questionnaire consists of 28 items and five sub-scales. Then, the validity and reliability study of its short version was carried out by Clementi et al. [2727 Clementi C, Casu G, Gremigni P. An abbreviated version of the Mindful Eating Questionnaire. J Nutr Educ Behav. 2017;49(4):352-6. e1. https://doi.org/10.1016/j.jneb.2017.01.016
https://doi.org/10.1016/j.jneb.2017.01.0...
] in Italy. The scale consists of 20 items and two sub-scales. The scale is in 4-point likert type and each item is scored between 1 (never/rarely) to 4 (usually/always) points. It shows that as the total score increases, the degree of mindful eating increases.

Eating Attitude Test-26 (EAT-26)

The Eating Attitude Test was developed by Garner et al. [3333 Garner DM, Olmsted MP, Bohr Y, Garfinkel PE. The eating attitudes test: psychometric features and clinical correlates. Psychol Med. 1982;12(4):871-8. https://doi: 10.1017/s0033291700049163.
https://doi.org/10.1017/s003329170004916...
] as a 40-item scale to assess food attitudes. After that, studies were found that the test is sensitive Anorexia Nervosa (AN) and Bulimia Nervosa (BN) and other eating disorders [3434 Garfinkel PE, Newman A. The eating attitudes test: twenty-five years later. Eat Weight Disord. 2001;6(1):1-21. https://doi.org/10.1007/BF03339747
https://doi.org/10.1007/BF03339747...
,3535 Gross J, Rosen JC, Leitenberg H, Willmuth ME. Validity of the eating attitudes test and the eating disorders inventory in bulimia nervosa. J Consult clin Psychol. 1986;54(6):875. https://doi.org/10.1037/0022-006X.54.6.875
https://doi.org/10.1037/0022-006X.54.6.8...
]. When 14 items were removed with a later factor analysis, it was determined that the scale had the same psychometric properties. EAT-26 was validated for the Turkish population by Ergüney-Okumuş and Sertel [3636 Ergüney-Okumuş FE, Sertel-Berk HÖ. Yeme Tutum Testi kısa formunun (YTT-26) Üniversite örnekleminde Türkçeye uyarlanması ve psikometrik özelliklerinin değerlendirilmesi. Psikoloji Çalışmaları. 2019;40(1):57-78.]. The EAT-26, a 6-point Likert-type scale, contains 26 questions with answers ranging from 0 (never, almost never, and rarely) to 3 (always). Scores equal to or higher than 21 indicate a possible abnormal eating attitude. In this regard, EAT-26 aimed to test the divergent validity of the MEQ-18.

Data Analysis

In this study, reliability and validity analyzes were applied for the MEQ-18. In the first stage, for each item or factor, a Content Validity Index (CVI) was calculated by counting the number of experts who rated them as 3 or 4 and dividing the result by the total number of experts. Frequency analysis results for the demographic characteristics of the participants are presented. Frequency (n) and percentage (%) values of the groups are given together from frequency analysis. Then, Cronbach Alpha reliability analysis was used to evaluate the internal consistency of the scale and Confirmatory Factor Analysis (CFA) was used to test its validity. Diagonal Weighted Least Squares (DWLS) technique was preferred since the data were Likert type in the estimation phase of CFA. Cronbach Alpha reliability analysis results are given together with the Mean (Mean) and Standard Deviation (SD) values of the descriptive statistics of the items.

Finally, it was evaluated whether there was a difference between the physical activity status of the participants in terms of general and sub-scales scores of the MEQ-18. For this purpose, it was evaluated whether the measurement scores were suitable for the normal distribution in the selection of the hypothesis test, and the Anova test was used to compare the independent groups. Tukey test was applied in the multiple comparisons of the groups that were significant as a result of the Anova test. In addition, the direction and degree of the relationship between the MEQ-18, the EAT-26, and BMI were examined. In the selection of the hypothesis test, the conformity of the measurement scores to the normal distribution was evaluated and the direction and severity of the relationship between the two measurement scores were found with the Pearson Correlation test.

All of the CFA findings were obtained using the R-Project program [3737 Team RC. R: A language and environment for statistical computing. Viena: R Foundation for Statistical Computing; 2013.], and the lavaan package [3838 Rosseel Y. lavaan: An R package for structural equation modeling. J Stat Softw. 2012;48:1-36. https://doi.org/10.18637/jss.v048.i02
https://doi.org/10.18637/jss.v048.i02...
]. Other analysis findings were carried out using the IBM®SPSS® 26 program [3939 Verma JP. Data analysis in management with SPSS software. Berlin: Springer Science & Business Media; 2012.]. In the study, the margin of error was evaluated at the 95% confidence level (p<0.05).

RESULTS

In this study, the data of 709 participants between the ages of 18-65 living in the city of Elazig were investigated. The frequency distributions and descriptive statistics of the demographic information of the participants are given in Table 1. 53.6% of the participants were female and 55.4% had a master’s/doctorate degree or bachelor’s degree. The rate of smokers was 24.0% and the rate of those consuming alcohol was 7.5%. The physical activity status of the majority of the participants (73.6%) was insufficiently active or lightly active. The mean age of the participants was 30.15±7.47 years and the mean BMI was 24.549±3.955 kg/m2.

Table 1
Basic demographic characteristics of study participants.

Table 2 shows the descriptive statistics and Cronbach Alpha reliability analysis results obtained from the sub-scales of the MEQ-18. According to the findings, the corrected correlation values of the sub-scales items of the MEQ-18 were found to be positive. In addition, it is seen that there is no significant increase in the reliability coefficient when the items are removed from the sub-scales of the scale. In the light of these findings, the Cronbach’s Alpha coefficients for the general and sub-scales of the MEQ-18 are 0.718, 0.843 and 0.789, respectively.

Table 2
The reliability analysis of the Mindful Eating Questionnaire-18.

The most frequently used model data fit indices in the literature are given in Supplementary file 1. The minimum discrepancy per degree of freedom (CMIN/ df) result was obtained as 4.914, indicating a good fit [4040 Kelloway EK. Using LISREL for structural equation modeling: A researcher’s guide. Whashington: Sage; 1998.]. According to the statistics related to the Root Mean Square Error of Approximation (RMSEA) (0.074), Comparative Fit Index (CFI) (0.934), standardized Root Mean Square Residual (SRMR) (0.079), Turker-Lewis Index (TLI) (0.925), Normed Fit Index (NFI) (0.935) the model generally fit well to the structure [4141 Bentler PM. Multivariate analysis with latent variables: Causal modeling. Ann Rev Psychol. 1980;31(1):419-56. https://doi.org/10.1146/annurev.ps.31.020180.002223
https://doi.org/10.1146/annurev.ps.31.02...

42 Bentler PM, Bonett DG. Significance tests and goodness of fit in the analysis of covariance structures. Psychol Bull. 1980;88(3):588. https://doi.org/10.1037/0033-2909.88.3.588
https://doi.org/10.1037/0033-2909.88.3.5...
-4343 Jöreskog KG. Testing structural equation models. Sage Focus Editions. 1993;154:294.]. The other two data fit indices [Goodness of Fit Index (GFI) and Adjusted Goodness-of-fit Index (AGFI)] were perfect (GFI=0.968; AGFI=0.959) [4343 Jöreskog KG. Testing structural equation models. Sage Focus Editions. 1993;154:294.,4444 DeVellis RF, Thorpe CT. Scale development: Theory and applications. Whashington: Sage Publications; 2021.].

Table 3 shows the CFA statistics of the MEQ-18. In the analysis phase, the path coefficients of the items 15 and 16 in the attitude sub-scale were negative and the item 16 was not statistically significant (p>0.05). Items 15 and 16 for the attitude sub-scale were excluded from the analysis and CFA statistics were obtained again. According to the findings, all sub-items of the MEQ-18 were found to be statistically significant. Therefore, the MEQ-18 of the two sub-scales compared to the CFA adaptation of the inventory analysis work sample structure was also confirmed in Turkey.

Table 3
Confirmatory factor analysis statistics of the Mindful Eating Questionnaire-18.

Figure 1 shows the CFA results of the participants’ Mindful Eating Questionnaire (MEQ-18). According to the graphical structure obtained as a result of CFA, it is seen that the standardized load values of all items are above 0.30.

Figure 1
Confirmatory Factor Analysis standardized factor loadings of the Mindful Eating Questionnaire-18.

Table 4 shows the results of the Anova test according to the physical activity status of the total scores and sub-scales MEQ-18. When the findings are examined, it is seen that the total scores of the participants’ awareness sub-scale and MEQ-18 differ statistically according to their physical activity status (p<0.05). When the post hoc results are examined, the awareness sub-scale scores of the participants who inactive or insufficiently active are higher than the participants who highly active. In addition, the MEQ-18 total scores of moderately active participants are higher than the highly active participants.

Table 4
Comparison of the total scores and sub-dimensions of the Mindful Eating Questionnaire-18 according to their physical activity status.

There was a statistically significant relationship between the total scores of the MEQ-18 and total EAT-26 scores (p<0.05). A negatif and moderate relationship (r=0.317) was found between the MEQ-18 and EAT-26 scores. A moderate negative correlation (r=0.310, p<0.05) was found between the awareness sub-scale and the total EAT-26 scores. In addition, a negative low-level relationship (r=0.118, p<0.05) was found between BMI and the disinhibition sub-scale (Supplementary file 1).

DISCUSSION

In this study, it was aimed to investigate the psychometric properties of an abbreviated version the Mindful Eating Questionnaire in a comprehensive and differentiated way in a heterogeneous population. This study was the first attempt to validity the original translated into Turkish language. In addition, this study contributes to the the advancement of the measuring mindful eating. The MEQ was developed and validated in the USA to assess mindful eating and has demonstrated good criterion validity and reliability [1212 Framson C, Kristal AR, Schenk JM, Littman AJ, Zeliadt S, Benitez D. Development and validation of the mindful eating questionnaire. J Am Diet Assoc. 2009;109(8):1439-44. https://doi.org/10.1016/j.jada.2009.05.006
https://doi.org/10.1016/j.jada.2009.05.0...
]. Then, an abbreviated form of MEQ was validation in Italian culture [2727 Clementi C, Casu G, Gremigni P. An abbreviated version of the Mindful Eating Questionnaire. J Nutr Educ Behav. 2017;49(4):352-6. e1. https://doi.org/10.1016/j.jneb.2017.01.016
https://doi.org/10.1016/j.jneb.2017.01.0...
]. Researchers suggested that adaptation studies should be carried out in different cultures. In addition, Moor et al. [4545 Moor KR, Scott AJ, McIntosh WD. Mindful eating and its relationship to body mass index and physical activity among university students. Mindfulness. 2013;4(3):269-74. https://doi.org/10.1007/s12671-012-0124-3
https://doi.org/10.1007/s12671-012-0124-...
] suggested investigating the relationship of mindful eating further with physical activity and BMI. In addition, this study investigated the relationship between the MEQ-18 and physical activity, BMI in the Turkish adult population. The fact that Turkish culture’s eating traditions and practices are different from Italian and American cultures reveals the originality and a unique characteristic of this study sample [4646 Güler S. Türk mutfak kültürü ve yeme içme alışkanlıkları. Dumlupınar Üniversitesi Sosyal Bilimler Dergisi. 2010;26(1):24-30.]. The fact that Turkish culture’s eating traditions and practices are different from Italian and American cultures reveals the originality and a unique characteristic of this study sample [4646 Güler S. Türk mutfak kültürü ve yeme içme alışkanlıkları. Dumlupınar Üniversitesi Sosyal Bilimler Dergisi. 2010;26(1):24-30.]. In addition, these differences may be explained by the different understanding of the scale items in Turkish culture. For example, considering the excluded items (item 15 “I stop eating when I am full even when eating something I love” and item 16 “When a restaurant portion is too large, I stop eating when I am full”), it can be concluded that the perception of portion is different in these cultures or the expression of portion size is different. When these two items were removed, the results of the psychometric analysis of the MEQ-18 showed promisingly good results.

In the cross-cultural adaptation study, a two-dimensional factor structure of the short form of the 18-item MEQ provided good cultural and semantic equivalence. During the content validity checks, some appropriate items were removed by the experts. The corrected correlation values of the subscale items of the eating awareness scale were found to be positive, and the Cronbach’s Alpha coefficients for the general and sub-dimensions of the scale were 0.718, 0.843 and 0.789, respectively. In addition, it was determined that there was no significant increase in the reliability coefficient when the items were removed from the subscales of the scale.

This study confirmed several hypotheses regarding mindful eating, supporting the construct validity of the MEQ. As hypothesized, there were a significant inverse relationship between subscales and total score with BMI and EAT-26. A negative low-level relationship was found between BMI and attitude sub-scales. Framson et al. [1212 Framson C, Kristal AR, Schenk JM, Littman AJ, Zeliadt S, Benitez D. Development and validation of the mindful eating questionnaire. J Am Diet Assoc. 2009;109(8):1439-44. https://doi.org/10.1016/j.jada.2009.05.006
https://doi.org/10.1016/j.jada.2009.05.0...
], found a significant and strong inverse relationship between all subscales and total score with BMI. In the study of Clementi et al. [2727 Clementi C, Casu G, Gremigni P. An abbreviated version of the Mindful Eating Questionnaire. J Nutr Educ Behav. 2017;49(4):352-6. e1. https://doi.org/10.1016/j.jneb.2017.01.016
https://doi.org/10.1016/j.jneb.2017.01.0...
] obesity and eating awareness scores are inversely related. Similarly, many studies were found a negative relationship between BMI and mindful eating [2121 Hulbert-Williams L, Nicholls W, Joy J, Hulbert-Williams N. Initial validation of the mindful eating scale. Mindfulness. 2014;5(6):719-29. https://doi.org/10.1007/s12671-013-0227-5
https://doi.org/10.1007/s12671-013-0227-...
,2222 Kawasaki Y, Akamatsu R, Omori M, Sugawara M, Yamazaki Y, Matsumoto S, et al. Development and validation of the Expanded Mindful Eating Scale. Int J Health Care Qual Assur. 2020;33(4/5):309-21. https://doi.org/10.1108/IJHCQA-01-2020-0009
https://doi.org/10.1108/IJHCQA-01-2020-0...
,2424 Abdul Basir SM, Abdul Manaf Z, Ahmad M, Abdul Kadir NB, Ismail WNK, Mat Ludin AF, et al. Reliability and Validity of the Malay Mindful Eating Questionnaire (MEQ-M) among overweight and obese adults. Int J Environ Res Public Health. 2021;18(3):1021. https://doi.org/10.3390/ijerph18031021
https://doi.org/10.3390/ijerph18031021...
,4747 Palascha A, van Kleef E, de Vet E, van Trijp HC. Development and validation of the multidimensional internally regulated eating scale (MIRES). Plos One. 2020;15(10):e0239904. https://doi.org/10.1371/journal.pone.0239904
https://doi.org/10.1371/journal.pone.023...
]. Moreover, a relationship was found between awareness subscale and total score with EAT-26. In the validity and reliability study of the expanded mindful eating scale, a negative correlation was found with the eating disorder inventory [2222 Kawasaki Y, Akamatsu R, Omori M, Sugawara M, Yamazaki Y, Matsumoto S, et al. Development and validation of the Expanded Mindful Eating Scale. Int J Health Care Qual Assur. 2020;33(4/5):309-21. https://doi.org/10.1108/IJHCQA-01-2020-0009
https://doi.org/10.1108/IJHCQA-01-2020-0...
]. Our findings appear to be consistent with previous findings. In particular, there is an important relationship between eating disorders or risky eating attitudes and eating awareness. Studies have also shown that mindfulness-based interventions for eating disorders increase mindfulness [4848 Kristeller JL, Baer RA, Quillian-Wolever R. Mindfulness-based approaches to eating disorders. Mindfulness-based treatment approaches: Clinician’s guide to evidence base and applications. Cambridge: Academic Press; 2006.,4949 Proulx K. Experiences of women with bulimia nervosa in a mindfulness-based eating disorder treatment group. Eat Disord. 2008;16(1):52-72. https://doi.org/10.1080/10640260701773496
https://doi.org/10.1080/1064026070177349...
]. It is clear that clinical controlled intervention studies are needed to provide more evidence on the relationship between eating disorder symptoms and mindful eating. In our study, there was no statistically significant difference between the the highly active participants and other participants in terms of eating awareness. In a study conducted on university students, physical activity level and general mindful eating scores were not significantly related [5050 Moor KR, Scott AJ, McIntosh WD. Mindful eating and its relationship to body mass index and physical activity among university students. Mindfulness. 2013;4(3):269-74. https://doi.org/10.1007/s12671-012-0124-3
https://doi.org/10.1007/s12671-012-0124-...
]. These results also are consistent with the study conducted by Framson et al. [1212 Framson C, Kristal AR, Schenk JM, Littman AJ, Zeliadt S, Benitez D. Development and validation of the mindful eating questionnaire. J Am Diet Assoc. 2009;109(8):1439-44. https://doi.org/10.1016/j.jada.2009.05.006
https://doi.org/10.1016/j.jada.2009.05.0...
]. From these findings, it appears that those who exercise more are not more likely to be mindful eaters. Rather, it suggests that those who exercise more may be less aware of the foods they eat and may be more likely to be emotional eaters.

The study has several strengths, such as the heterogeneity of the sample and its selection to represent the Turkish population. The validity and reliability study was cautiously tested with expert opinions and pilot groups. However, this study had several limitations. First, this study design was cross-sectional so it is not possible to make inferences about temporal associations or cause and effect. Future studies should be planned as longitudinal or randomized controlled. Second, the use of self-reports may contain bias, and future studies may evaluate mindful eating more objectively. However, there is also evidence that self-reports are valid measures of perceptual structures and can be valuable behavioral indicators [5151 Wansink B. From mindless eating to mindlessly eating better. Physiol Behav. 2010;100(5):454-63. https://doi.org/10.1016/j.physbeh.2010.05.003
https://doi.org/10.1016/j.physbeh.2010.0...
]. Third, physical activity measurement was based on several items and may not be sufficiently precise to detect associations with the MEQ-18. Lastly, test-retest reliability was not measured. More research is needed to better characterize the psychometric properties of the instrument, including test-retest reliability and predictive validity, and to document the relationship of the MEQ-18 to actual dietary practices.

CONCLUSION

The study findings showed that the psychometric properties of the abbreviated MEQ adapted into Turkish were acceptable through construct and internal consistency reliability. This is the first Turkish validity and reliability study of the abbreviated MEQ to characterize and measure mindful eating as far as is known. This scale can be useful in both clinical practice and research to understand and promote healthy eating behavior in the healthy Turkish adult population aged between 18 and 65 years.

ACKNOWLEDGMENTS

We would like to thank all the participants.

  • Submitted article as preprint in Research Square. Kaya S, Açık M, Beyaz Coşkun A, Çağiran Yilma F. Validation of the an abbreviated version of the Mindful Eating Questionnaire in Turkish Adults. Research Square [Preprint]. 2022 [posted 2022 Jul 21]. https://doi.org/10.21203/rs.3.rs-1727189/v1.
  • How to cite this article: Kaya S, Açık M, Beyaz Coşkun A, Çağiran Yilma F. Reliability and validity of the abbreviated version of the Mindful Eating Questionnaire in Turkish adults. Rev Nutr. 2024;37:e230084. https://doi.org/10.1590/1678-9865202437e230084

REFERENCES

  • 1
    Bishop SR, Lau M, Shapiro S, Carlson L, Anderson ND, Carmody J, et al. Mindfulness: a proposed operational definition. Clin Psychol: Sci Pract. 2004;11(3):230. https://doi.org/10.1093/clipsy.bph077
    » https://doi.org/10.1093/clipsy.bph077
  • 2
    Goldberg SB, Tucker RP, Greene PA, Davidson RJ, Kearney DJ, Simpson TL. Mindfulness-based cognitive therapy for the treatment of current depressive symptoms: A meta-analysis. Cogn Behav Ther. 2019;48(6):445-62. https://doi.org/10.1080/16506073.2018.1556330
    » https://doi.org/10.1080/16506073.2018.1556330
  • 3
    Cairncross M, Miller CJ. The effectiveness of mindfulness-based therapies for ADHD: A meta-analytic review. J Atten Disord. 2020;24(5):627-43. https://doi.org/10.1177/1087054715625301
    » https://doi.org/10.1177/1087054715625301
  • 4
    Hofmann SG, Sawyer AT, Witt AA, Oh D. The effect of mindfulness-based therapy on anxiety and depression: A meta-analytic review. J Consult Clin Psychol. 2010;78(2):169. https://doi.org/10.1037/a0018555
    » https://doi.org/10.1037/a0018555
  • 5
    Hodann-Caudevilla RM, Díaz-Silveira C, Burgos-Julián FA, Santed MA. Mindfulness-based interventions for people with schizophrenia: A systematic review and meta-analysis. Int J Environ Res Public Health. 2020;17(13):4690. https://doi.org/10.3390/ijerph17134690
    » https://doi.org/10.3390/ijerph17134690
  • 6
    Chiesa A, Serretti A. Are mindfulness-based interventions effective for substance use disorders? A systematic review of the evidence. Subst Use Misuse. 2014;49(5):492-512. https://doi.org/10.3109/10826084.2013.770027
    » https://doi.org/10.3109/10826084.2013.770027
  • 7
    Godsey J. The role of mindfulness based interventions in the treatment of obesity and eating disorders: An integrative review. Complement Ther Med. 2013;21(4):430-9. https://doi.org/10.1016/j.ctim.2013.06.003
    » https://doi.org/10.1016/j.ctim.2013.06.003
  • 8
    Mantzios M, Wilson JC. Mindfulness, eating behaviours, and obesity: A review and reflection on current findings. Curr Obes Rep. 2015;4(1):141-6. https://doi.org/10.1007/s13679-014-0131-x
    » https://doi.org/10.1007/s13679-014-0131-x
  • 9
    O’Reilly GA, Cook L, Spruijt-Metz D, Black DS. Mindfulness-based interventions for obesity‐related eating behaviours: A literature review. Obes Rev. 2014;15(6):453-61. https://doi.org/10.1111/obr.12156
    » https://doi.org/10.1111/obr.12156
  • 10
    Fuentes Artiles R, Staub K, Aldakak L, Eppenberger P, Rühli F, Bender N. Mindful eating and common diet programs lower body weight similarly: Systematic review and meta-analysis. Obes Rev. 2019;20(11):1619-27. https://doi.org/10.1111/obr.12918
    » https://doi.org/10.1111/obr.12918
  • 11
    Albers S. Eat, drink, and be mindful: How to end your struggle with mindless eating and start savoring food with intention and joy. Oakland: New Harbinger Publications; 2009.
  • 12
    Framson C, Kristal AR, Schenk JM, Littman AJ, Zeliadt S, Benitez D. Development and validation of the mindful eating questionnaire. J Am Diet Assoc. 2009;109(8):1439-44. https://doi.org/10.1016/j.jada.2009.05.006
    » https://doi.org/10.1016/j.jada.2009.05.006
  • 13
    Khan Z, Zadeh ZF. Mindful eating and it’s relationship with mental well-being. Procedia Soc Behav Sci. 2014;159:69-73. https://doi.org/10.1016/j.sbspro.2014.12.330
    » https://doi.org/10.1016/j.sbspro.2014.12.330
  • 14
    Berg C, Lappas G, Wolk A, Strandhagen E, Torén K, Rosengren A, et al. Eating patterns and portion size associated with obesity in a Swedish population. Appetite. 2009;52(1):21-6. https://doi.org/10.1016/j.appet.2008.07.008
    » https://doi.org/10.1016/j.appet.2008.07.008
  • 15
    Livingstone MBE, Pourshahidi LK. Portion size and obesity. Adv Nutr. 2014;5(6):829-34. https://doi.org/10.3945/an.114.007104
    » https://doi.org/10.3945/an.114.007104
  • 16
    Smith BW, Shelley BM, Sloan AL, Colleran K, Erickson K. A preliminary randomized controlled trial of a mindful eating intervention for post-menopausal obese women. Mindfulness. 2018;9(3):836-49. https://doi.org/10.1007/s12671-017-0824-9
    » https://doi.org/10.1007/s12671-017-0824-9
  • 17
    Carpenter KM, Vickerman KA, Salmon EE, Javitz HS, Epel ES, Lovejoy JC. A randomized pilot study of a phone-based mindfulness and weight loss program. Behav Med. 2019;45(4):271-81. https://doi.org/10.1080/08964289.2017.1384359
    » https://doi.org/10.1080/08964289.2017.1384359
  • 18
    Miller CK, Kristeller JL, Headings A, Nagaraja H. Comparison of a mindful eating intervention to a diabetes self-management intervention among adults with type 2 diabetes: A randomized controlled trial. Health Educ Behav. 2014;41(2):145-54. https://doi.org/10.1177/1090198113493092
    » https://doi.org/10.1177/1090198113493092
  • 19
    Chung S, Zhu S, Friedmann E, Kelleher C, Kozlovsky A, Macfarlane KW, et al. Weight loss with mindful eating in African American women following treatment for breast cancer: A longitudinal study. Support Care Cancer. 2016;24(4):1875-81. https://doi.org/10.1007/s00520-015-2984-2
    » https://doi.org/10.1007/s00520-015-2984-2
  • 20
    Carrière K, Shireen SH, Siemers N, Preißner CE, Starr J, Falk C, et al. Development and Validation of the Four Facet Mindful Eating Scale (FFaMES). Appetite. 2022;168:105689. https://doi.org/10.1016/j.appet.2021.105689
    » https://doi.org/10.1016/j.appet.2021.105689
  • 21
    Hulbert-Williams L, Nicholls W, Joy J, Hulbert-Williams N. Initial validation of the mindful eating scale. Mindfulness. 2014;5(6):719-29. https://doi.org/10.1007/s12671-013-0227-5
    » https://doi.org/10.1007/s12671-013-0227-5
  • 22
    Kawasaki Y, Akamatsu R, Omori M, Sugawara M, Yamazaki Y, Matsumoto S, et al. Development and validation of the Expanded Mindful Eating Scale. Int J Health Care Qual Assur. 2020;33(4/5):309-21. https://doi.org/10.1108/IJHCQA-01-2020-0009
    » https://doi.org/10.1108/IJHCQA-01-2020-0009
  • 23
    Peitz D, Schulze J, Warschburger P. Getting a deeper understanding of mindfulness in the context of eating behavior: Development and validation of the Mindful Eating Inventory. Appetite. 2021;159:105039. https://doi.org/10.1016/j.appet.2020.105039
    » https://doi.org/10.1016/j.appet.2020.105039
  • 24
    Abdul Basir SM, Abdul Manaf Z, Ahmad M, Abdul Kadir NB, Ismail WNK, Mat Ludin AF, et al. Reliability and Validity of the Malay Mindful Eating Questionnaire (MEQ-M) among overweight and obese adults. Int J Environ Res Public Health. 2021;18(3):1021. https://doi.org/10.3390/ijerph18031021
    » https://doi.org/10.3390/ijerph18031021
  • 25
    Apolzan JW, Myers CA, Cowley AD, Brady H, Hsia DS, Stewart TM, et al. Examination of the reliability and validity of the Mindful Eating Questionnaire in pregnant women. Appetite. 2016;100:142-51. https://doi.org/10.1016/j.appet.2016.02.025
    » https://doi.org/10.1016/j.appet.2016.02.025
  • 26
    Hart SR, Pierson S, Goto K, Giampaoli J. Development and initial validation evidence for a mindful eating questionnaire for children. Appetite. 2018;129:178-85. https://doi.org/10.1016/j.appet.2018.07.010
    » https://doi.org/10.1016/j.appet.2018.07.010
  • 27
    Clementi C, Casu G, Gremigni P. An abbreviated version of the Mindful Eating Questionnaire. J Nutr Educ Behav. 2017;49(4):352-6. e1. https://doi.org/10.1016/j.jneb.2017.01.016
    » https://doi.org/10.1016/j.jneb.2017.01.016
  • 28
    Kimberlin CL, Winterstein AG. Validity and reliability of measurement instruments used in research. Am J Health Sys Pharm. 2008;65(23):2276-84. https://doi.org/10.2146/ajhp070364
    » https://doi.org/10.2146/ajhp070364
  • 29
    Beaton DE, Bombardier C, Guillemin F, Ferraz MB. Guidelines for the process of cross-cultural adaptation of self-report measures. Spine. 2000;25(24):3186-91. https://doi.org/10.1097/00007632-200012150-00014
    » https://doi.org/10.1097/00007632-200012150-00014
  • 30
    Davis LL. Instrument review: Getting the most from a panel of experts. Appl Nurs Res. 1992;5(4):194-7. https://doi.org/10.1016/S0897-1897(05)80008-4
    » https://doi.org/10.1016/S0897-1897(05)80008-4
  • 31
    Gregoire J. ITC guidelines for translating and adapting tests. Int J Test. 2018;18(2):101-34.
  • 32
    World Health Organization. WHO Global Database on Body Mass Index. Geneva: WHO; 2011.
  • 33
    Garner DM, Olmsted MP, Bohr Y, Garfinkel PE. The eating attitudes test: psychometric features and clinical correlates. Psychol Med. 1982;12(4):871-8. https://doi: 10.1017/s0033291700049163.
    » https://doi.org/10.1017/s0033291700049163
  • 34
    Garfinkel PE, Newman A. The eating attitudes test: twenty-five years later. Eat Weight Disord. 2001;6(1):1-21. https://doi.org/10.1007/BF03339747
    » https://doi.org/10.1007/BF03339747
  • 35
    Gross J, Rosen JC, Leitenberg H, Willmuth ME. Validity of the eating attitudes test and the eating disorders inventory in bulimia nervosa. J Consult clin Psychol. 1986;54(6):875. https://doi.org/10.1037/0022-006X.54.6.875
    » https://doi.org/10.1037/0022-006X.54.6.875
  • 36
    Ergüney-Okumuş FE, Sertel-Berk HÖ. Yeme Tutum Testi kısa formunun (YTT-26) Üniversite örnekleminde Türkçeye uyarlanması ve psikometrik özelliklerinin değerlendirilmesi. Psikoloji Çalışmaları. 2019;40(1):57-78.
  • 37
    Team RC. R: A language and environment for statistical computing. Viena: R Foundation for Statistical Computing; 2013.
  • 38
    Rosseel Y. lavaan: An R package for structural equation modeling. J Stat Softw. 2012;48:1-36. https://doi.org/10.18637/jss.v048.i02
    » https://doi.org/10.18637/jss.v048.i02
  • 39
    Verma JP. Data analysis in management with SPSS software. Berlin: Springer Science & Business Media; 2012.
  • 40
    Kelloway EK. Using LISREL for structural equation modeling: A researcher’s guide. Whashington: Sage; 1998.
  • 41
    Bentler PM. Multivariate analysis with latent variables: Causal modeling. Ann Rev Psychol. 1980;31(1):419-56. https://doi.org/10.1146/annurev.ps.31.020180.002223
    » https://doi.org/10.1146/annurev.ps.31.020180.002223
  • 42
    Bentler PM, Bonett DG. Significance tests and goodness of fit in the analysis of covariance structures. Psychol Bull. 1980;88(3):588. https://doi.org/10.1037/0033-2909.88.3.588
    » https://doi.org/10.1037/0033-2909.88.3.588
  • 43
    Jöreskog KG. Testing structural equation models. Sage Focus Editions. 1993;154:294.
  • 44
    DeVellis RF, Thorpe CT. Scale development: Theory and applications. Whashington: Sage Publications; 2021.
  • 45
    Moor KR, Scott AJ, McIntosh WD. Mindful eating and its relationship to body mass index and physical activity among university students. Mindfulness. 2013;4(3):269-74. https://doi.org/10.1007/s12671-012-0124-3
    » https://doi.org/10.1007/s12671-012-0124-3
  • 46
    Güler S. Türk mutfak kültürü ve yeme içme alışkanlıkları. Dumlupınar Üniversitesi Sosyal Bilimler Dergisi. 2010;26(1):24-30.
  • 47
    Palascha A, van Kleef E, de Vet E, van Trijp HC. Development and validation of the multidimensional internally regulated eating scale (MIRES). Plos One. 2020;15(10):e0239904. https://doi.org/10.1371/journal.pone.0239904
    » https://doi.org/10.1371/journal.pone.0239904
  • 48
    Kristeller JL, Baer RA, Quillian-Wolever R. Mindfulness-based approaches to eating disorders. Mindfulness-based treatment approaches: Clinician’s guide to evidence base and applications. Cambridge: Academic Press; 2006.
  • 49
    Proulx K. Experiences of women with bulimia nervosa in a mindfulness-based eating disorder treatment group. Eat Disord. 2008;16(1):52-72. https://doi.org/10.1080/10640260701773496
    » https://doi.org/10.1080/10640260701773496
  • 50
    Moor KR, Scott AJ, McIntosh WD. Mindful eating and its relationship to body mass index and physical activity among university students. Mindfulness. 2013;4(3):269-74. https://doi.org/10.1007/s12671-012-0124-3
    » https://doi.org/10.1007/s12671-012-0124-3
  • 51
    Wansink B. From mindless eating to mindlessly eating better. Physiol Behav. 2010;100(5):454-63. https://doi.org/10.1016/j.physbeh.2010.05.003
    » https://doi.org/10.1016/j.physbeh.2010.05.003

Supplemental File Table

Table
Model Fit Indexes.
Table
Mindful Eating Questionnaire-18 relationships with the EAT-26 and BMI scores.

Experts’ Content Validity Evaluation

Expert panel (N=10) Item Relevant Not Relevant I-CVIa Interpretation S-CVIb Awareness .93 1. Before I eat I take a moment to appreciate colors and smells of food. 10 0 1 Appropriate 2. I notice when the food I eat affects my emotional state. 10 0 1 Appropriate 3. I taste every bite of food I eat. 7 3 .70 Appropriate 4. When eating a pleasant meal, I notice if it makes me feel relaxed. 9 1 .90 Appropriate 5. I appreciate the way my food looks on my plate. 10 0 1 Appropriate 6. I notice subtle flavors in the foods I eat. 10 0 1 Appropriate 7. I recognize when I am eating and not hungry. 7 3 .70 Appropriate 8. I notice when foods and drinks are too sweet. 10 0 1 Appropriate 9. I recognize when food advertisements make me want to eat. 8 2 .80 Appropriate 10. When I eat a big meal, I notice if it makes me feel heavy or sluggish. 10 0 1   11. I notice when I am eating from a dish of candy just because it is there. 10 0 1   Disinhibition 12. If there is good food at a party, I will continue eating even after I am full. 10 0 1 Appropriate 13. If there are leftovers that I like, I take a second helping even though I am full. 10 0 1 Appropriate 14. When I eat at all you can eat buffets, I tend to overeat. 7 3 .70   17. When I am eating one of my favorite foods, I do not recognize when I have had enough. 9 1 .90   18. At a party with a lot of good food, I notice when it makes me want to eat more than I should. 10 0 1 Appropriate 19. If it does not cost much more, I get the larger size food or drink regardless of how hungry I feel. 10 0 1   20. I snack without noticing that I am eating. 10 0 1 Appropriate a
b

Editor

Luciana Bertoldi Nucci

Publication Dates

  • Publication in this collection
    04 Oct 2024
  • Date of issue
    2024

History

  • Received
    16 May 2023
  • Reviewed
    30 Apr 2024
  • Accepted
    21 Aug 2024
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