Citation: Darcy AM, Robinson AH, Adler S, Pajarito S, Osipov L, et al. Psychometric Evaluation of the Dietary-Adherence Intake and Eating Test (DIET): A Measure for Early Detection of Maladaptive Eating Behaviors after Bariatric Surgery. J Obes Bariatrics. 2015;2(1): 6. J Obes Bariatrics February 2015 Volume 2, Issue 1 © All rights are reserved by Safer et al. Psychometric Evaluation of the Dietary-Adherence Intake and Eating Test (DIET): A Measure for Early Detection of Maladaptive Eating Behaviors after Bariatric Surgery Keywords: Bariatric surgery; Post-bariatric dietary adherence; Post-bariatric assessment; Maladaptive eating behaviors; Disordered eating; Suboptimal weight loss outcomes Abstract Background: Poor dietary adherence to post-bariatric eating guidelines and associated maladaptive eating behaviors predict suboptimal post-bariatric weight loss outcomes. Psychometrically- evaluated measures that reliably detect such maladaptive behaviors are lacking. Objectives: To describe the Dietary-adherence Intake and Eating Test (DIET), a brief self-report measure to detect post-bariatric maladaptive eating behaviors that have been previously associated with suboptimal weight loss post-bariatric surgery. Methods: Preliminary psychometrics properties, including temporal stability, were examined in 109 patients within their frst year post- bariatric surgery. Results: The 13-item measure demonstrated good test-retest reliability (p<0.001), internal consistency (α=0.86), and factor analysis results suggested all items load onto a single component solution. Conclusion: The DIET is a brief, reliable, and internally consistent self-report measure with good psychometric properties that assesses the presence and frequency of a range of maladaptive post-bariatric eating behaviors. The DIET flls an important gap in the literature as it is, to our knowledge, the frst psychometrically-valid questionnaire to assess the range of maladaptive eating behaviors shown by previous research to be associated with greater risks of suboptimal post-bariatric weight loss. The DIET, which can be easily administered post-bariatric surgery, possesses valuable clinical utility in that the maladaptive eating behaviors it captures can serve as the target of early, post- surgical intervention, thus potentially improving post-bariatric surgery weight loss outcomes. Abbreviations DIET: Dietary-adherence Intake and Eating Test; LOC: Loss of Control; EFA: Exploratory Factor Analysis; PA: Horn’s Parallel Analysis; MAP: Velicer’s Minimum Average Partial Introduction Bariatric surgery is the most efective treatment for morbid obesity [1]. However, while approximately 70% of patients achieve successful outcomes, up to 30% do not [1]. Post-surgical weight loss failure (commonly defned as a loss of less than 50% of one’s excess initial weight [2], has been associated with lessened improvements in psychiatric and medical comorbidities [1]. Suboptimal weight losses from poor initial weight loss and/or weight regain tend to occur by 24 months post-bariatric surgery [3]. From a clinical standpoint, intervening at the point when suboptimal weight outcomes have been observed (i.e., by 24 months post-bariatric surgery) may be too late; by that point maladaptive post-bariatric eating behaviors may already be engrained. Stated diferently, waiting too long to intervene may miss a critical period for intervention during which patients may more readily adopt, practice, and sustain healthful post-bariatric eating behaviors. Tus, a psychometrically valid measure that detects early onset of maladaptive post-bariatric eating behaviors associated with sub-optimal outcomes is necessary to identify patients in need of targeted interventions that address these behaviors and promote optimal weight loss. In addition, such a measure could be used as part of longitudinal studies to further assess the short- and longer-term relationship between maladaptive post-bariatric eating behaviors and suboptimal weight outcomes. Increasing evidence demonstrates that poor adherence to the recommended post-bariatric dietary guidelines [4] and associated maladaptive post-bariatric eating behaviors (i.e., loss of control over eating) [5] are robust predictors of suboptimal weight-loss outcomes. Although such behaviors have been previously studied, their measurement has been problematic. A recent systematic review identifed 35 self-report measures that assess disordered eating following bariatric surgery. Of these, only 20% included psychometric evaluation within post-bariatric samples [6], and almost exclusively included assessments originally developed using a traditional eating disorder theoretical framework intended for patients with primary eating disorders. One signifcant limitation of such assessments, even when modifed for the post-bariatric population, is their focus on determining whether loss of control (LOC) and/or distorted weight or shape concerns are present. Tis theoretical focus fails to 1) acknowledge that LOC and/or distorted weight and shape concerns may manifest diferently within the bariatric population and thus require nuanced defnitions within this sub-group or 2) detect maladaptive eating behaviors that may or may not be accompanied by LOC or distorted weight or shape concerns, yet are highly relevant Alison M Darcy, Athena H Robinson, Sarah Adler, Sarah Pajarito, Lilya Osipov and Debra L Safer* Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California, USA *Address for Correspondence Debra L. Safer, MD, Department of Psychiatry and Behavioral Sciences, Stanford, University School of Medicine, 401 Quarry Road, Stanford, California, USA, Tel: +1(650)723-7928; E-mail: dlsafer@stanford.edu Submission: 27 January 2015 Accepted: 09 February 2015 Published: 13 February 2015 Reviewed & Approved by: Dr. Hope Landrine, Director of the Center for Health Disparities, East Carolina University, USA Case Report Open Access Journal of Obesity and Bariatrics Avens Publishing Group Invi ting Innovations Copyright: © 2015 Darcy AM, et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.