Maurice Larocque, M.D. & Stephen C. Stotland, Ph.D .

Editor's Note: Dr. Larocque, an ASBP member, operates the MLA Obesity Clinic in Montreal. Dr. Stotland is on the staff of the Cognitive-Behavior Therapy Service of Montreal General Hospital.

Introduction

The treatment of obesity requires the alteration of underlying maladaptive behavior, namely excessive food intake and insufficient activity. The success of dietary and behavioral approaches to the treatment of obesity has, however, been quite limited. A disturbing percentage of patients either drop out of treatment at an early stage, fail to reach a healthy weight, or regain the weight that they do lose.^1,2

Clearly, an effective treatment for obesity must address the psychobiological mechanisms responsible for the failure of behavioral self-management.^3,4 However, to date research has failed to uncover any psychological variables consistently associated with obesity,⁵ although there is evidence that patients often show mood variability and personality changes during weight loss and maintenance that may have clinical significance.^6,7 Furthermore, many clinicians believe that emotional factors are central to weight control, particularly as it relates to the long-term maintenance vs. relapse of behavior change.⁸

The present paper reports on a new questionnaire that measures a number of the behavioral and psychological variables that may be important in weight control. The Larocque Obesity Questionnaire was designed to be clinically useful - comprehensive, brief and easily administered by computer. These are extremely important considerations in clinical settings, and particularly in the primary care setting, where physicians see many patients suffering from obesity and where time and resources are scarce. The Larocque Obesity Questionnaire provides a time efficient and inexpensive tool for the assessment of problematic behaviors and emotions that may interfere with weight management efforts. The questionnaire also provides an individualized report indicating areas of concern and suggesting various targets for intervention. This questionnaire has been used for the past decade in a number of clinical settings with approximately 300,000 patients, but analyses of its reliability and validity have not been previously presented. We report here on a study that examined the statistical properties of the Larocque questionnaire and its relationship to other psychological measures.

Method

Subjects

Participants included 78 female patients, 18 years and older, who were engaged in weight loss treatment provided by physicians specializing in the treatment of obesity. Treatment involved low-calorie diets and exercise plans, and regular contacts with physicians dealing with medical or psychological problems relevant to weight control. The average subject was 37.0 years of age (+/- 8.7), and 183.4 (+/- 37.8) pounds. Only patients with Body Mass Index above 25 were included in the study.

Procedure

Subjects completed the Larocque Obesity Questionnaire (LOQ) and a variety of other self-report scales at varying points in treatment. Some completed the questionnaire prior to their first treatment session, while others did so at later points in treatment.

The LOQ is a 52-item self-report scale, computer administered and scored, requiring about 10 minutes to complete. The items were designed to measure a variety of behavioral, emotional and personality variables that may be associated with problems in weight control. Variables were chosen based on the authors' clinical experience in the treatment of obesity. Items inquire about problematic eating habits, emotional eating, eating as reward, weight loss goals, feelings of depression, boredom and guilt, stress responses, and traits such as aggressivity, passivity and paranoia.

A previous factor analytic study with 680 obese women (Larocque & Stotland, 1992, unpublished data) suggested that the LOQ may be divided into four subscales, which we have labeled Habits, Weight Loss Motivation, Physical Stress Reactions, and Negative Emotions. Sample items from the four subscales are presented in Table 1.

Table 1 Sample items from the Larocque Obesity Questionnaire
Subscale	Sample Items
Habits	1. Thinking of the last few meals you had, try to estimate how long it takes you to eat a meal? A. less than 5 minutes B. between 5 and 10 minutes C. between 10 and 20 minutes D. between 20 and 30 minutes D. more than 30 minutes 2. When passing by a tray of fruits, food or sweets, how often do you help yourself? A. always B. quite often C. occasionally D. never
Weight Loss Motivation	1. Deep down inside, do you really believe you can reach your desired weight and then be able to maintain it? A. not at all B. maybe C. probably D. surely 2. If you lose only half of the weight you plan to lose in the coming month do you think you will carry on with your diet? A. not at all B. maybe C. probably D. surely
Physical Stress Reactions	1. Over the past month, when not exerting yourself, have you experienced any of the following symptoms: Pounding heart, a lump in your throat or shortness of breath. A. never B. occasionally C. often (once a week on average) D. very often (several times per week) 2. During the past month, have you experienced any of the following that cannot be attributed to a disease: Headaches, backaches, sore neck. A. never B. occasionally C. once a week on average D. more than once a week
Negative Emotions	1. I have the feeling that life is getting me nowhere, and is worthless. A. This sounds just like me B. I often think that way C. I sometimes think that way D. I never think that way 2. I usually do not get involved in any activity, but if I do it's only when I'm sure I'll succeed. A. Yes, absolutely B. I often have this attitude C. I occasionally have this attitude D. No, this doesn't apply to me at all.

The Eysenck Personality Questionnaire⁹ is a 90-item scale measuring Neuroticism, Extraversion and Psychoticism. The scale has been widely used and has shown high levels of internal consistency and test-retest reliability. The Neuroticism and Extraversion scales were used in the present study. Neuroticism is described as a measure of the tendency to worry, moodiness and depression, and psychomotor complaints. Extraversion is thought to reflect sociability, need for excitement and change, and a relaxed, easygoing manner.