Weight and Emotions Scale Validated in US Adults With Obesity

Key Takeaways

• A new 16-item Weight and Emotions Scale (WES) was developed to assess emotional functioning in adults with obesity or overweight.
• In US-based cognitive interviews (N = 20), all participants reported clear understanding of instructions, recall period, and response options.
• The WES addresses gaps in existing patient-reported outcome (PRO) measures by capturing both positive and negative weight-related emotions relevant to clinical trials and practice.

A newly developed PRO instrument—the Weight and Emotions Scale—demonstrated strong content validity in US adults with obesity or overweight. Developed in alignment with US Food and Drug Administration (FDA) guidance for PRO measures, the 16-item scale is designed to assess the emotional impact of obesity and the benefits of treatment on emotional functioning.

Study Design and Findings

The WES was developed through a multistage process incorporating qualitative exit interviews (N = 40) from participants completing a Phase 2 trial of retatrutide (NCT04881760), a targeted literature review (TLR) of existing obesity-related PRO instruments, clinician input (N = 3), and cognitive interviews with adults living with obesity or overweight (N = 20).

Exit interviews, conducted at 9 US clinical sites between November 2022 and January 2023, included adults with a body mass index (BMI) ≥ 30 kg/m² or ≥ 27 kg/m² with at least 1 obesity-related complication. Participants (mean age 51.0 years; 52.5% male; 85.0% white) described a broad range of emotional experiences associated with obesity and treatment. Frequently reported positive emotional impacts included feeling good about oneself (77.5%), happy (67.5%), self-confident (65.0%), and energetic (60.0%). Participants also reported worry about health (30.0%) and frustration with weight loss efforts (25.0%).

The TLR identified 8 existing PRO measures used in obesity research, including the IWQOL-Lite and EQ-5D-5L. However, mapping revealed that many emotion-related concepts identified in interviews—such as feeling proud, joyful, disappointed, or stressed due to weight—were not adequately represented in existing tools.

An initial 24-item draft WES was refined through clinician review and cognitive testing. Clinicians rated 22 of 24 items as moderately or very important. After revisions and removal of redundant items, the final WES included 16 items assessing 13 emotional concepts over a 7-day recall period using a 5-point Likert scale (“never” to “always”).

Cognitive interviews (mean age 48.5 years; mean BMI 37.1 kg/m²; 80% female) confirmed clarity and relevance. All 20 participants reported a positive overall impression, and most items were understood by all participants. At least 75% of respondents rated most items as moderately or very important. The 7-day recall period and response options were consistently understood. A translatability assessment further refined item wording to support future multilingual use.

Clinical Implications

Obesity is associated with substantial psychosocial burden, including anxiety, depression, stigma, and impaired health-related quality of life (HRQoL). While weight reduction of 5% to 10% is known to improve cardiovascular risk factors and HRQoL, emotional functioning has not been comprehensively captured in existing obesity-specific PRO measures.

The WES addresses this measurement gap by focusing specifically on emotional impacts linked to weight and treatment. For managed care stakeholders, validated PRO tools are increasingly relevant in value-based care models and outcomes-based contracting for obesity management medications (OMMs), including GLP-1– and GIP-based therapies.

By systematically assessing emotional functioning, the WES may support more holistic evaluation of treatment benefit in clinical trials, observational studies, and routine practice. It may also inform formulary decision-making, comparative effectiveness research, and quality improvement initiatives aimed at improving patient-centered outcomes.

Psychometric validation of the WES is planned for future research.

Conclusion

The Weight and Emotions Scale is a newly developed, content-validated PRO instrument designed to measure emotional functioning in adults with obesity or overweight. Its structured assessment of weight-related emotions may enhance evaluation of treatment impact in both clinical research and managed care settings.

Reference

Kanu C, Kimel M, Goetz I, et al. Development of the Weight and Emotions Scale (WES). Obes Sci Pract. 2026 Jan 25;12(1):e70119. doi:10.1002/osp4.70119.