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.