Development and validation of the body-related distress scale for obesity (BDS-O): a patient-reported outcome measure for Chinese population with obesity

Body dissatisfaction has significant negative effects on Chinese individuals with obesity. However, tools used for measuring body-related distress that are culturally relevant to the condition of obesity remain underdeveloped. To address this, we developed and validated the Body-Related Distress Scale for Obesity (BDS-O), a culturally appropriate patient-reported outcome (PRO) scale for Chinese adults with BMI ≥ 28.0. An initial item pool was developed through qualitative semi-structured interviews, guided by the Symptom Experience Model and international PRO standards. These items were further refined through cognitive interviews and a Delphi procedure involving ten experts in the medical field. Following multiple revisions based on these cognitive interviews and expert feedback, the final scale was established to measure 25 individual statements. The factorial analysis process involved 415 participants to determine the constructs. The model analysis revealed that these constructs explained 70.45% of the variance. The constructs also demonstrated good model fit. The reliability measures for the body image and obesity constructs were also highly consistent, with composite reliability 0.86–0.93. Many Chinese adults with obesity feel upset and uncomfortable about their bodies, and these negative feelings can greatly affect their mental health. There are very few simple questionnaires available to measure these bad feelings about one’s body for people with obesity. We created and tested a new questionnaire for Chinese adults living with obesity. We first wrote draft survey questions by talking directly with people who have this condition. Then we improved all the questions after asking trial participants for feedback and collecting suggestions from ten medical professionals. After several rounds of edits, we finished a questionnaire containing 25 simple statements.We invited hundreds of adults with obesity to fill out the questionnaire to check its quality. Our testing showed this survey can fully capture all kinds of negative body feelings that people with obesity experience, and it always produces consistent and trustworthy results. This new questionnaire offers doctors and researchers an easy way to learn how people with obesity truly feel about their bodies.