Development and Validation of a Filipino Eating Behavior Questionnaire among Adult Type 2 Diabetes Mellitus Patients

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Anthony Harvey Aguilar
Mark Anthony Sandoval
Cecilia Jimeno
Elizabeth Paz-Pacheco


Background. Management of type 2 diabetes mellitus requires the maintenance of self-care behaviors, which include proper nutrition.  However, diabetic patients often find that following a healthy diet is the most difficult component of self-care.  It is important to assess the eating behaviors of diabetic individuals in order to customize a dietary plan but locally clinicians are hampered by the lack of a culturally adapted or validated tool.

Objective. The goal of this study is to develop and validate a Filipino eating behavior questionnaire for adults with type 2 diabetes mellitus. 

Methodology. Literature review, expert interviews and focus group discussions among type 2 diabetic patients were done. All inputs, including pooled items from existing eating behavior questionnaires, were reviewed and categorized into corresponding eating behavior domains as determined by expert panel consensus. After translation into Filipino and pre-testing, the questionnaire was administered twice to 197 adults with type 2 diabetes.  Questionnaire reliability was determined using Cronbach’s α and Spearman’s rank correlation coefficient.

Results. A 29-item, self-administered, Filipino eating behavior questionnaire answerable by a 4-point Likert scale was initially developed. This questionnaire featured three known eating behaviors namely: uncontrolled, restrained, and emotional eating; and included two newly identified eating behaviors: social and pro-active eating. In both first and second tests, only the items in the uncontrolled (Cronbach’s α 0.739 & 0.816), social (Cronbach’s α 0.641 & 0.707), and pro-active (Cronbach’s α 0.622 & 0.665), eating domains were found to be internally consistent. One item under the restrained eating domain was deleted to improve the consistency of the items.  For the test-retest reliability, moderate to high positive correlation (coefficients ranging from 0.530 to 0.744) between scale scores in the two test runs was achieved. This indicated stable responses to the items.

Conclusion. An eating behavior questionnaire for type 2 diabetic individuals that was developed to be culturally appropriate is a generally reliable, reproducible and valid instrument to assess eating behaviors. This study identified social and pro-active eating as behaviors among Filipinos with type 2 diabetes mellitus that were not previously described in foreign literature.  The instrument may provide benefit in evaluating eating behaviors and formulating more individualized nutrition management plans.


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Aguilar, A. H., Sandoval, M. A., Jimeno, C., & Paz-Pacheco, E. . (2014). Development and Validation of a Filipino Eating Behavior Questionnaire among Adult Type 2 Diabetes Mellitus Patients. Journal of the ASEAN Federation of Endocrine Societies, 29(2), 163. Retrieved from
Original Articles


Sy RG, Morales DD, Dans AL, et al. Prevalence of atherosclerosis-related risk factors and diseases in the Philippines. J Epidemiol. 2012; 22(5): 440-447.

Diabetes Control and Complications Trial Research Group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Eng J Med. 1993; 329: 977-1036.

UK Prospective Diabetes Study Group. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (33). Lancet 1998; 352: 837-53.

Yannakoulia M. Eating behavior among type 2 diabetic patients: A poorly recognized aspect in a poorly controlled disease. Rev Diabetic Stud. 2006; 3: 11-16.

Savoca M, Miller C. Food selection and eating patterns: Themes found among people with type 2 diabetes mellitus. J Nutri Educ. 2001; 33: 224-233.

Sullivan ED, Joseph DH. Struggling with behavior changes: A special case for clients with diabetes. Diabetes Educ 1998; 24: 72-77.

Savoca M, Miller C, Ludwig D. Food habits are related to glycemic control among people with type 2 diabetes mellitus. J Am Diet Assoc. 2004; 104: 560-566.

Harris MI. Racial and ethnic differences in health care access and health outcomes of adults with type 2 diabetes. Diabetes Care. 2001; 24: 454-459.

Treatment options for type 2 diabetes in adolescents and youth (today) study group. A clinical trial to maintain glycemic control in youth with type 2 diabetes. N Engl J Med. 2012; 366: 2247-2256.

Nestle M, Wing R, Birch, et al. Behavioral and social influences on food choice. Nutr Rev. 1998; 56: S50-74.

De Lauzon B, Romon M, Deschamps V, et al. The three-factor eating questionnaire-R18 is able to distinguish among different eating patterns in a general population. J Nutri. 2004; 2372-2380.

Tuschl RJ. From dietary restraint to binge eating: Some theoretical considerations. Appetite. 1990; 14: 105-109.

Blundell JE & Gillett A. Control of food intake in the obese. Obese Res. 2001; 9 (Suppl. 4): 263S-270S.

Allison DB & Heshka S. Emotion and eating in obesity? A critical analysis. Int J Eat Disord. 1993; 13: 289-295. 10.1002/1098-108X(199304)13:3<289:AID-EAT2260130307>3.0.CO;2-X.

Stunkard AJ, Messick S. The three-factor eating questionnaire to measure dietary restraint, disinhibition and hunger. J Psychosom Res. 1985; 29: 71-83.

Karlsson J, Perssom L-O, Sjostrom L, et al. Psychometric properties and factor structure of the three-factor eating questionnaire (TFEQ) in obese men and women. results from the swedish obese subjects (SOS) study. Int J Obes. 2000; 24:1715-1725.

Angle S, Engblom J, Eriksson T, et al. Three factor eating questionnaire-R18 as a measure of cognitive restraint, uncontrolled eating and emotional eating in a sample of young finnish females. Int J Behavi Nutri & Phys Act. 2009; 6:41 (1-7).

Cappelleri JC, Bushmakin AG, Gerber RA, Psychometric analysis of the three-factor eating questionnaire-R21: results from a large diverse sample of obese and non-obese participants. Int J Obes. 2009; 33:611-620.

Heatherton TF, Herman CP, Polivy J, The (mis)measurement of restraint: An analysis of conceptual and psychometric issues. J Abnorm Psychol. 1988; 97:19-28.

Williamson DA, Martin CK, York-Crowe E, et al. Measurement of dietary restraint: Validity tests of four questionnaires. Appetite. 2007; 48:183-192.

Allison DB, Gorman BS, Kalinsky LB. A comparison of the psychometric properties of three measures of dietary restraint. Psychol Asses. 1992; 4:391-398.

Laessle RG, Tuschl RJ, Kotthaus BC, Pirke KM. A comparison of the validity of three scales for the assessment of dietary restraint. J Abnorm Psychol. 1989; 4:504-507.

Chearskul S, Pummoung S, Vongsaiyat S, Thai version of three-factor eating questionnaire. Appetite. 2010; 54:410-413.

Oltersdorf U, Schlettweing-Gsell D, Winkler G. Assessing eating patterns- an emerging research topic in nutritional sciences: Introduction to the symposium. Appetite. 1999; 32:1-7.

Ogden J. "Eating behaviour." Health Psychology, 5th ed. McGraw-Hill, 2012. 133-165.

Manucci E, Tesi F, Ricca F, et al. Eating behavior in obese patients with and without type 2 diabetes mellitus. Int J Obes Relat Metab Disord. 2002. 26(6):848-853.

Kenardy J, Mensch M, Bowen K, et al. Disordered eating behaviors in women with type 2 diabetes mellitus. Eat Behav. 2001. 2(2):183-192.

Herpetz S, Albus C, Wagener R, et al. Comorbidity of diabetes and eating disorders. Does diabetes control reflect disturbed eating behavior? Diabetes Care. 1998. 21(7):1110-1116.

Crow S, Kendall D, Praus B, Thuras P. Binge eating and other psychopathology in patients with type II diabetes mellitus. Int J Eat Disord. 2001. 30(2):222-226.

Abhaya, I. "Quality considerations." Medical Biostatistics, 2nd ed. Chapman & Hall / CRC Biostatistics Series, 2008. 545-571.

De Castro JM. Family & friends produce greater facilitation of food intake than other companions. Physiol Behav. 1994; 56:445-55.

Shide DJ, Rolls BJ. Social facilitation of caloric intake in humans by friends but not strangers. Int J Obes. 1991; 15:8.

De Castro JM. Social facilitation of duration & size but not rate of the spontaneous meal intake of humans. Physiol Behav. 1990; 47:1129-35.

Bellisle F, Dalix AM. Cognitive restraint can be offset by distraction, leading to increased meal intake in women. Am J Clin Nutr. 2001; 74:197-200.

Mitchell GI, Brunstrom JM. Everyday dietary behavior & the relationship between attention & meal size. Appetite. 2005; 45:344-45.

Frier BM. How hypoglycemia can affect the life of a person with diabetes. Diabetes Metab Res Rev. 2008; 24:87-92.

Macht M. How emotions affect eating: A five-way model. Appetite. 2007; 50:1-11.

Marx RG, Menezes A, Horovitz L, et al. A comparison of two time intervals for test-retest reliability of health status instruments. J Clin Epidemiol. 2003; 56:730-735.

Thayer RE. Calm Energy – How people regulate mood with food and exercise. Oxford: Oxford University Press.

Polivy J & Herman, CP. Distress and eating: Why dieters overeat? Int J of Eat Disord. 1999; 26: 153-164.

Macht M, Roth S, & Ellgring H. Chocolate eating in healthy men during experimentally induced sadness and joy. Appetite. 2002; 39:147-158.

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