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. 2026 Jan;43(1):150-164.
doi: 10.1007/s12325-025-03386-2. Epub 2025 Nov 7.

Development and Content Evaluation of the Eating Behavior and Appetite Questionnaire (EBAQ) for Individuals with Obesity

Chisom Kanu  1 , Claudine Clucas  2 , Anne Skalicky  3 , Ashley Samuelson  3 , Iris Goetz  1 , Lisa M Neff  1 , Kristina S Boye  1 , Hayley Karn  4
Affiliations

Development and Content Evaluation of the Eating Behavior and Appetite Questionnaire (EBAQ) for Individuals with Obesity

Chisom Kanu et al. Adv Ther. 2026 Jan.

Abstract

Introduction: Obesity management medications can reduce body weight and have an impact on patients' appetite and eating behaviors. Existing patient-reported outcome (PRO) measures do not fully capture appetite and eating behavior concepts relevant to individuals living with obesity, including those receiving treatment. Here we describe the development and content evaluation of the Eating Behavior and Appetite Questionnaire (EBAQ), a new PRO measure to enable a comprehensive assessment of appetite and eating behaviors which are important to individuals living with obesity.

Methods: The EBAQ was developed on the basis of findings from a targeted literature review, findings from exit interviews with participants (N = 40) in a phase 2 trial for retatrutide (NCT04881760), and interviews with clinicians specializing in obesity medicine (N = 3). Cognitive interviews were conducted with USA-based adults with obesity or with overweight and ≥ 1 obesity-related complications (hypertension, dyslipidemia, cardiovascular disease) (N = 24) to evaluate the content of the EBAQ.

Results: All 24 cognitive interview participants reported a positive overall impression of the EBAQ and that they understood the instructions and recall period. Most participants (n = 23, 96%) found the response options to be clear and appropriate. Items in the EBAQ were considered clear and relevant by the participants. The 21-item EBAQ is a new PRO measure with three domains to evaluate eight appetite and eating behavior concepts relevant to obesity and which may change with obesity treatment.

Conclusion: The EBAQ may be used in clinical trials, clinical practice, or observational research to evaluate the impact of obesity and the effect of obesity treatment on appetite and eating behaviors.

Keywords: Appetite; Eating behavior and appetite questionnaire; Eating behaviors; Obesity; Obesity management medication; Patient-reported outcomes; Weight management.

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Conflict of interest statement

Declarations. Conflict of interest: Chisom Kanu, Iris Goetz, Lisa Mary Neff, and Kristina Secnik Boye are employees and shareholders of Eli Lilly and Company, which funded this study. Claudine Clucas, Hayley Karn, Anne Skalicky, and Ashley Samuelson are current employees of Evidera-PPD, which was paid by Eli Lilly and Company to conduct this study. The Eating Behavior and Appetite Questionnaire (EBAQ) is copyrighted by Eli Lilly and Company and is free for use once permission is obtained. For permission to reproduce or use the EBAQ, contact copyright@lilly.com. Ethical Approval: This study was approved by Salus IRB (Austin, Texas, USA) and conducted in accordance with the Declaration of Helsinki, Good Pharmacoepidemiology Practices, International Society for Pharmacoeconomics and Outcomes Research PRO Good Practice Task Force procedures, International Society of Quality of Life Research Translation and Cultural Adaptation Special Interest Group good practices, and all applicable laws and regulations in the USA. All participants provided written informed consent before the interviews.

Figures

Fig. 1
Fig. 1
Eating Behavior and Appetite Questionnaire (EBAQ) development overview. aExit interviews were conducted to identify the impact of obesity or treatment for obesity on appetite and eating behavior [29]. bA TLR was conducted to identify PRO measures used to assess the impact of obesity or treatment for obesity on eating behaviors. cAppetite and eating behavior concepts identified from the exit interviews were mapped against concepts from PRO measures identified in the TLR. dClinician specialists in obesity provided input on the conceptual framework of the EBAQ as well as on draft 1 of the EBAQ. eTranslatability assessments were conducted at different stages to ensure that future translations are conceptually and culturally appropriate for the target population [32]. fA revised EBAQ (draft 2) was developed on the basis of clinicians’ input to improve the content, clarity, and cohesion of concepts. gThe EBAQ (draft 2) was evaluated via cognitive interviews with adults with a BMI ≥ 30 kg/m2 or with BMI ≥ 27 kg/m2 and ≥ 1 obesity-related complication (hypertension, dyslipidemia, cardiovascular disease). BMI body mass index, EBAQ Eating Behavior and Appetite Questionnaire, PRO patient-reported outcome, TLR targeted literature review
Fig. 2
Fig. 2
Conceptual framework for the 21-item Eating Behavior and Appetite Questionnaire (EBAQ). The EBAQ includes 21 items evaluating 8 appetite and appetite concepts associated with obesity or treatment for obesity. For each EBAQ item, there are five response options (0 = “never”, 1 = “rarely”, 2 = “sometimes”, 3 = “often”, and 4 = “always”). Participants are asked to choose one response per item that best describes how they felt in the previous 7 days. EBAQ Eating Behavior and Appetite Questionnaire
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