Editor's Note: Dr. Larocque, an ASBP member, operates the MLA Obesity Clinic in Montreal. Dr. Stotland, a clinical psychologist, is director of PsycheSoma Health & Wellness Centre, and a lecturer in the Department of Psychology, McGill University.

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       1. Deep down inside, do you really believe you can reach your
Loss         desired weight and then be able to maintain it?
Motivation   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     1. Over the past month, when not exerting yourself, have you
Stress       experienced any of the following symptoms: Pounding heart, a
Reactions    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     1. I have the feeling that life is getting me nowhere, and is
Emotions     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.

The 13-item Beck Depression Inventory10 measures symptoms and signs of depression. Correlations of the BDI-13 with the full length BDI range from .89 to .97, and alpha coefficients consistently exceed .85. The Body Esteem Scale11 consists of three moderately intercorrelated dimensions related to self-appraisals of Sexual Attractiveness, Weight Concern, and Physical Condition. A total score reflecting Global Body Esteem was used in the present study.

The Dutch Eating Behavior Scale12 is a widely used instrument assessing tendencies to diet (Cognitive Restraint) and to overeat in response to emotional states (Emotional Eating). Both scales have high levels of internal consistency and show expected relations with variables such as caloric intake and binge eating.

To examine the discriminant validity of the LOQ scales we looked at 1 intercorrelations of the LOQ subscales and 2 relations between LOQ subscales and other variables.

Results
The reliability of LOQ subscales was assessed using Chronbach's alpha, an indication of the internal consistency of subscale items. The 17-item Habits subscale assesses a broad range of eating and exercise behaviors, thus the observed alpha coefficient of .67 was expected. The 9-item Physical Stress Reactions subscale had an alpha coefficient of .68, reflecting its broad coverage of stress-related symptoms. The 19-item Negative Emotions subscale had an alpha level of .85, suggesting that it measures a fairly coherent construct. The 5-item Weight Loss Motivation subscale had a relatively low alpha coefficient of .46. This low level of internal consistency may reflect the small number of items, or the multidimensionality of the weight loss motivation construct. However, the sum of the motivation items was considered a useful measure of global weight loss motivation, and was retained for further analyses.

The correlations among LOQ subscales are presented in Table 2. The Habits subscale was significantly related to Weight Loss Motivation (r=.37, p.01), indicating that patients reporting healthier habits also reported higher weight loss motivation, and to Negative Emotions (r=-.29, p.01), suggesting that better habits were associated with lower levels of negative affect. The strongest correlation was between Negative Emotions and Physical Stress Reactions (r=.57, p.001), consistent with typical findings linking self-reports of negative affect and stress reactions. In general, the LOQ subscales were weakly or moderately correlated, apart from the emotions/stress association just mentioned. It therefore appears that the LOQ subscales represent different psychological constructs. This was explored further in the analysis of relations between LOQ scales and other psychological measures.

Table 2
Intercorrelations among Larocque Obesity Questionnaire Subscales

                 Habits      Weight        Physical     Negative
                               Loss          Stress     Emotions
                         Motivation       Reactions
	
Habits             ---       .37***            -.10       -.29**
				
Weight 
Loss                           ---             -.10          .19
				
Physical
Stress                                         ---        .57***
Motivation			
				
Negative
Emotions                                                     --- 
Reactions
				
* p<.05
** p<.01
***p<.001

Table 3
Relations between Larocque Obesity Questionnaire Subscales and Other Measures

                  Habits       Weight       Physical      Negative
                                 Loss         Stress      Emotions
                           Motivation      Reactions
				
Body               .31**          .08        -.39***        -.27**
Esteem
				
Cognitive
Restraint         .46***         .20*            .14           .01
Of Eating
				
Emotional        -.41***         -.19            .19        .42***
Eating
				
BDI               -.32**       -.26**         .63***        .66***
				
Extraversion         .14        .27**            .17           .01
				
Neuroticism         -.18         -.13         .62***        .76*** 
				
Weight (lbs.)       -.19       -.26**            .17           .01

* p<.05
** p<.01
***p<.001

Discussion
The LOQ appears to be a reliable measure of several psychological and behavioral variables associated with obesity. This conclusion was supported by the internal consistency and convergent validity analyses. Results suggest that the LOQ measures a number of coherent and discriminably different variables, with predictable associations with other measures. Whether or not the variables measured by the LOQ are related to important clinical outcomes (e.g., weight loss or maintenance) is the subject of an ongoing investigation 13.

One of the LOQ factors, the Weight Loss Motivation subscale, appears to have rather low internal consistency. As suggested above, this may be interpreted as a reflection of the breadth of the weight loss motivation construct, since not everyone wants to lose weight for the same reasons, and it is not clear that the various sources of motivation are additive. In any case, it is clear that further work in the exploration and measurement of this variable is urgently needed, given its theoretical and potential practical importance.

The variables measured by the LOQ are not novel. Validated measures of most of these factors exist elsewhere.6 However, the real value of the LOQ is that it measures these psychological factors in a convenient and thus clinically accessible format.

The study of processes mediating long-term weight control is of great importance, given the health consequences of obesity and the failure of currently available treatments. While the obstacles to effective weight control are certainly complex, involving a variety of biopsychosocial variables, there is little doubt that psychological factors feature prominently in the equation. The results of the present study indicate that the Larocque Obesity Questionnaire may be a useful tool in the continuing effort to understand the psychological processes in weight control.

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