Compensatory Health Motivations and Behaviors Scale

Abstract

The Compensatory Health Motivations and Behaviors (CHMB) Scale, developed by Kalista Sedemedes, Bärbel Knäuper, Gentiana Sadikaj, Trista Yue Yuan, Carsten Wrosch, Sylvia Santosa, Angela S. Alberga, and Lisa Kakinami (2023), is a psychometric instrument designed to assess and quantify weight-related compensatory health motivations and behavioral strategies. Grounded in self-regulation and health psychology paradigms, compensatory health behaviors refer to cognitive and behavioral adjustments—such as dietary restriction, fasting, or acute bouts of exercise—undertaken to neutralize or preempt the caloric and psychological impact of perceived dietary indulgences. The instrument was developed from an initial pool of 34 candidate items derived from open-ended qualitative inquiry and adaptations of the Drunkorexia Motivations and Behaviors Scale. Following rigorous item reduction and psychometric evaluation in a representative sample of Canadian adults, the CHMB Scale was established as a 17-item questionnaire with an empirical four-factor latent structure: (1) General Compensatory Use, (2) Food-Related Compensatory Health Behaviors, (3) Motivations for Using Compensation, and (4) Compensatory Use for Special Occasions.

Responses are recorded on a standardized 5-point Likert scale. Exploratory factor analysis (EFA) employing oblique promax rotation, in conjunction with confirmatory factor analysis (CFA), demonstrated robust structural validity across competing models, with the final single-order four-factor configuration exhibiting excellent fit indices (CFI, GFI, SRMR, RMSEA, and Bentler-Bonett NFI meeting conservative psychometric standards). The subscales demonstrated sound internal consistency, with Cronbach’s alpha coefficients ranging between 0.776 and 0.882. Construct and convergent validity analyses revealed significant positive associations with cognitive restraint in eating, independent of chronological age and biological sex. The CHMB Scale offers researchers, behavioral epidemiologists, and clinical psychologists an empirically validated assessment tool for studying self-regulatory compensatory mechanisms, dietary balance strategies, and eating pathology risks across adult populations.

Keywords

Compensatory Health Behaviors, Compensatory Health Motivations, Eating Behavior, Weight Management, Cognitive Restraint, Self-Regulation, Physical Activity Compensation, Dietary Restriction, Psychometrics, Factor Analysis, Health Psychology, Appetite Regulation.

Authors

The Compensatory Health Motivations and Behaviors (CHMB) Scale was developed and validated through an interdisciplinary collaboration among researchers in psychology, nutrition, kinesiology, and behavioral epidemiology across Canadian academic institutions:

• Kalista Sedemedes — Department of Psychology, Concordia University, Montreal, Quebec, Canada.
• Bärbel Knäuper — Department of Psychology, McGill University, Montreal, Quebec, Canada.
• Gentiana Sadikaj — Department of Psychology, McGill University, Montreal, Quebec, Canada.
• Trista Yue Yuan — Faculty of Land and Food Systems, Food, Nutrition and Health, The University of British Columbia, Vancouver, British Columbia, Canada.
• Carsten Wrosch — Department of Psychology, Concordia University, Montreal, Quebec, Canada.
• Sylvia Santosa — Department of Health, Kinesiology and Applied Physiology, Concordia University, Montreal, Quebec, Canada.
• Angela S. Alberga — Department of Health, Kinesiology and Applied Physiology, Concordia University, Montreal, Quebec, Canada.
• Lisa Kakinami (Corresponding Author) — School of Health and Department of Mathematics and Statistics, Concordia University, 1455 de Maisonneuve West, Montreal, Quebec, Canada, H3G 1M8. Email: [email protected].

Purpose

The primary purpose of the Compensatory Health Motivations and Behaviors (CHMB) Scale is to provide a reliable, valid, and multidimensional measure of the cognitive motivations and behavioral strategies adults utilize to balance caloric intake and expenditure. In contemporary food environments characterized by the ubiquitous availability of energy-dense, hyper-palatable foods, individuals frequently encounter self-regulatory dilemmas wherein immediate hedonic desires conflict with long-term health and weight maintenance goals. When dietary transgressions occur or are anticipated, individuals often engage in compensatory strategies—such as skipping meals, severely restricting carbohydrate intake, or performing excessive physical exercise—to counteract the perceived physiological or aesthetic consequences of overindulgence.

Prior to the introduction of the CHMB Scale, existing psychometric measures exhibited notable limitations in scope and generalizability. Several instruments focused exclusively on specialized populations or clinical eating disorder cohorts (e.g., assessing purging and non-purging bulimic behaviors via the Eating Disorder Examination-Questionnaire). Other inventories concentrated on narrow behavioral phenotypes, such as “drunkorexia”—the practice of restricting caloric consumption prior to alcohol intake to prevent weight gain or expedite intoxication. While the Compensatory Health Beliefs (CHB) Scale measured cognitive rationalizations (i.e., the belief that the negative effects of an unhealthy behavior can be neutralized by participating in a healthy behavior), it did not assess the actual behavioral implementation or the emotional and motivational drivers that trigger compensation.

The CHMB Scale addresses this methodological gap by quantifying both the cognitive-affective motivations (e.g., guilt reduction, regaining perceived control, anxiety alleviation) and the concrete behavioral mechanisms (e.g., pre-event food restriction, post-event exercise compensation, meal skipping) employed across everyday scenarios and special occasions. In clinical settings, the scale helps identify subclinical disordered eating patterns and maladaptive exercise routines before they progress to diagnostic-threshold conditions such as bulimia nervosa or other specified feeding and eating disorders (OSFED). In behavioral medicine and public health research, the instrument allows researchers to dissect how compensatory strategies impact sustained weight maintenance, psychological well-being, dietary quality, and long-term metabolic markers.

Psychological Construct

The overarching construct captured by the CHMB Scale is compensatory health self-regulation within the context of dietary consumption and energy expenditure. Compensatory health self-regulation operates as a dynamic cognitive-behavioral feedback loop wherein individuals monitor their caloric intake against perceived standards, detect discrepancies, and initiate corrective actions to restore perceived equilibrium. The scale captures this construct across four distinct, correlated dimensions:

1. General Compensatory Use

The General Compensatory Use dimension assesses habitual, recurring cognitive and behavioral compensations integrated into an individual’s everyday lifestyle. Rather than being confined to singular festivals or planned indulgences, these behaviors reflect chronic post-transgression correction. Individuals scoring high on this subscale routinely modulate their physical activity intensity, exercise duration, or subsequent food portions following regular dietary non-adherence. For example, individuals may extend their scheduled workout by 30 minutes specifically to “burn off” an unplanned confection or reduce carbohydrate intake across consecutive meals to offset an energy surplus.

2. Food-Related Compensatory Health Behaviors

The Food-Related CHBs subscale isolates dietary manipulation strategies deployed without the requirement of physical exercise. This facet reflects caloric banking, meal skipping, prolonged fasting, and fluid ingestion to suppress somatic hunger signals. Psychologically, food-related compensation often mirrors intermittent restriction, where an individual intentionally refrains from morning meals or excludes entire macronutrient groups following an evening of perceived overconsumption. This subscale measures behaviors that exist along the continuum between sensible dietary moderation and rigid dietary restraint.

3. Motivations for Using Compensation

The Motivations for Using Compensation factor evaluates the underlying psychological, emotional, and cognitive drivers of compensatory actions. Grounded in negative reinforcement and affect regulation models, this dimension taps into the neutralization of negative affect—specifically guilt, shame, and somatic anxiety—induced by breaking internalized dietary rules. Furthermore, it measures cognitive justification mechanisms (e.g., believing that high-intensity exercise “earns” the right to consume high-calorie foods) and the subjective necessity of compensatory behaviors for maintaining perceived self-control and weight self-efficacy.

4. Compensatory Use for Special Occasions

The Compensatory Use for Special Occasions subscale measures anticipatory and retroactive behavioral shifts surrounding discrete social gatherings, holidays, celebrations, and celebratory meals. Anticipatory compensation represents proactive cognitive planning, wherein individuals drastically minimize caloric intake throughout the day or across preceding days in explicit anticipation of a high-calorie social event. Post-event compensation involves stringent dietary deficits or compensatory workouts on the morning immediately following such gatherings. This dimension isolates event-triggered compensatory behaviors that may remain dormant during standard routine days.

Theoretical Framework

The conceptual foundation of the CHMB Scale synthesizes principles from self-regulation theory, cognitive dissonance theory, and the Compensatory Health Beliefs (CHB) model originally proposed by Knäuper and colleagues (2004). At its theoretical core, the model posits that individuals possess dual motivation: the pursuit of immediate hedonic pleasure (e.g., eating palatable foods) alongside the preservation of long-term health, physical fitness, and aesthetic body standards.

The Compensatory Health Beliefs Model and Moral Licensing

According to the CHB model, when an individual engages in an unhealthy behavior (or anticipates doing so), an internal cognitive conflict emerges between their desired health goals and their actual conduct. This psychological tension corresponds to cognitive dissonance (Festinger, 1957). To alleviate the resulting discomfort without sacrificing hedonic satisfaction, the individual activates a compensatory belief: the premise that the physiological harm of one unhealthy behavior can be neutralized, offset, or “canceled out” by performing a healthy behavior either beforehand or afterward.

This dynamic is closely related to the psychological phenomenon of moral licensing and caloric accounting, wherein positive self-regulatory behaviors generate “credits” that grant psychological permission to indulge in subsequent lapses. Conversely, engaging in compensatory behaviors after an indulgence serves as an act of psychological restitution, neutralizing guilt and restoring perceived self-integrity.

Dual-Process and Negative Reinforcement Perspectives

The CHMB operationalizes compensation within dual-process frameworks of health behavior. The automatic, impulsive desire to consume energy-dense foods is counterbalanced by reflective, executive-control mechanisms that calculate caloric expenditure versus intake. Within this framework, compensatory physical activity and extreme dietary restriction often serve as negative reinforcement mechanisms: performing the compensatory behavior terminates the aversive internal state of guilt or distress triggered by perceived overeating. Over time, this negative reinforcement cycle can entrench compensatory habits, creating a rigid psychological dependency on compensatory rituals to manage food-related distress.

Validity

The psychometric validation of the CHMB Scale by Sedemedes et al. (2023) established construct, convergent, and discriminant validity across a representative sample of Canadian adults. Construct validation confirmed that the instrument reliably differentiates between cognitive rationalizations, motivational affect regulation, and tangible behavioral actions across domains of exercise and nutrition.

Convergent and Criterion Validity

Convergent validity was rigorously evaluated by examining associations between the four CHMB factors and established constructs of eating self-regulation, most notably cognitive restraint in eating. Cognitive restraint—defined as the conscious effort to limit food intake to control body weight—was assessed using validated dietary behavior instruments. Multiple linear regression analyses, controlling for chronological age and biological sex, demonstrated that higher scores on all four CHMB subscales (General Compensatory Use, Food-Related CHBs, Motivations for Using Compensation, and Compensatory Use for Special Occasions) were significantly associated with increased levels of cognitive restraint.

Unadjusted bivariate correlations between the CHMB factors and cognitive restraint were moderately positive, consistent with theoretical expectations. This pattern indicates that while compensatory behaviors align closely with the overarching construct of dietary monitoring and restraint, the CHMB Scale retains distinctive variance. It captures reactive and proactive balancing maneuvers rather than static, continuous dietary restriction alone. Furthermore, regression models demonstrated that CHMB factors accounted for significant variance in eating attitudes linked to body mass index (BMI) variations, selective food cravings (such as sweet and fatty food cravings), and subjective health perceptions.

Divergent and Discriminant Validity

Discriminant validity was established by showing that the four subscales, while interrelated, maintain distinct latent identities rather than collapsing into a unidimensional eating pathology measure. The magnitude of factor intercorrelations in exploratory and confirmatory modeling supported the distinctness of behavioral compensation (exercising or restricting food) from the underlying motivational and emotional mechanisms (e.g., guilt alleviation, feelings of control). Additionally, the instrument demonstrated divergent validity against unrelated demographic variables, confirming that it measures a specific behavioral-motivational profile rather than broader generalized distress.

Reliability

The CHMB Scale exhibits robust internal consistency across its factors, verified in psychometric testing with adult populations. Internal consistency was evaluated utilizing Cronbach’s alpha (α) coefficients across the extracted factor structures:

• Subscale Alpha Coefficients: The internal consistency coefficients across all subscales ranged from α = 0.776 to α = 0.882. These values surpass the recognized benchmark of 0.70 for acceptable psychometric reliability, reflecting high inter-item homogeneity within each domain.
• General Compensatory Use: Demonstrated high reliability (α > 0.80), indicating that items assessing daily, habitual post-indulgence exercise and dietary adjustments consistently reflect the same underlying latent variable.
• Motivations for Using Compensation: Exhibited strong internal consistency (α > 0.85), showing that items measuring affect relief, guilt reduction, and control restoration operate with high precision.
• Food-Related CHBs and Special Occasions: Yielded alpha values consistently exceeding 0.77, confirming reliable measurement across targeted situational contexts (e.g., holiday events, proactive meal skipping).

Item-total correlations across the validation analyses supported item retention, with all retained items demonstrating robust correlations with their assigned factors. The instrument exhibits low standard errors of measurement across adult male and female demographic strata.

Factor Analysis

The structural composition of the CHMB Scale was derived and validated using sequential exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) protocols on representative Canadian adult data.

Exploratory Factor Analysis (EFA)

Initial item pool refinement began with 34 candidate items developed via qualitative item-generation protocols and adaptations from the Drunkorexia Motivations and Behaviors Scale (Ward & Galante, 2015). The item pool was subjected to an exploratory factor analysis employing an oblique promax rotation to allow for theoretical correlations among underlying health behaviors. Inspection of eigenvalues, scree plot inflection points, and parallel analysis identified a clean four-factor latent structure comprising 17 high-performing items. Items with substantial cross-loadings or inadequate primary loadings (< 0.40) were eliminated, maximizing structural parsimony.

Confirmatory Factor Analysis (CFA)

To confirm the empirical replicability of the proposed factor structure, four alternative structural equation models were tested, including single-order and higher-order hierarchical models:

• Model 1: Unidimensional single-factor model (all items loading on a single overarching compensatory factor).
• Model 2: Correlated four-factor single-order model (the four distinct subscales freely correlating).
• Model 3: Higher-order hierarchical model with one second-order general compensatory factor explaining four first-order subscales.
• Model 4: Bi-factor model assessing a general factor alongside specific orthogonal subscales.

Goodness-of-fit indices across tested models were evaluated against established benchmarks (Hu & Bentler, 1999; Philpot et al., 2015):

• Comparative Fit Index (CFI): ≥ 0.95 indicating excellent fit.
• Standardized Root Mean Square Residual (SRMR): ≤ 0.08 indicating adequate fit.
• Root Mean Square Error of Approximation (RMSEA): ≤ 0.06 with narrow 90% confidence intervals.
• Goodness of Fit Index (GFI) and Bentler-Bonett Normed Fit Index (NFI): Meeting standard threshold criteria.

Although multiple models exhibited acceptable mathematical fit statistics, Model 2 (the correlated single-order four-factor structure) was selected as the optimal structural framework. This decision preserved substantive interpretability, allowing researchers and clinicians to analyze individual subscale profiles independently (e.g., distinguishing someone motivated primarily by guilt from someone utilizing routine exercise compensation) without assuming an invariant higher-order general construct.

Instrument / Measurement Tool

The Compensatory Health Motivations and Behaviors (CHMB) Scale is structured as an easy-to-administer self-report inventory. Its operational characteristics include:

• Test Type: Original self-report psychometric inventory / behavioral questionnaire.
• Primary Construct: Weight-related compensatory health motivations and behaviors.
• Format: All 17 items of the CHMB Scale are rated on a 5-point Likert scale.
• Number of Items: 17 items in the refined final version (derived from an initial pool of 21 authentic published survey statements).
• Subscale Breakdown:
  • Factor 1: General Compensatory Use
  • Factor 2: Food-Related CHBs
  • Factor 3: Motivations for Using Compensation
  • Factor 4: Compensatory Use for Special Occasions
• Administration Method: Electronic administration (computer-assisted web surveys, mobile data collection platforms) or paper-and-pencil delivery.
• Completion Time: Approximately 3 to 5 minutes.
• Target Population: Human adults (aged 18 years and older), across genders.
• Scoring Procedures: Subscale scores are calculated by deriving either the mean score or the sum score of items comprising each respective factor. Higher subscale scores denote a greater frequency of compensatory behavior implementation or stronger reliance on compensatory motivational mechanisms. Reverse scoring is not required for the standard item set.

Permissions & Fee and Test Year

The Compensatory Health Motivations and Behaviors (CHMB) Scale was published in 2023 in the peer-reviewed journal Appetite by Sedemedes and colleagues.

• Commercial Status: Non-commercial instrument.
• Fee: There is no fee required for academic, scientific, clinical, or non-profit research use.
• Permissions: Researchers wishing to use, translate, or adapt the CHMB Scale in academic studies should contact the corresponding author, Dr. Lisa Kakinami, at Concordia University ([email protected]). Commercial utilization or widespread distribution in proprietary clinical tools requires prior written authorization from the primary authors and copyright holders.

References

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• Knäuper, B., Rabiau, M., Cohen, O., & Patriciu, N. (2004). Compensatory health beliefs: Scale development and psychometric properties. Psychology & Health, 19(5), 607–624. https://doi.org/10.1080/0887044042000196737
• Masterson, T. D., Kirwan, C. B., Davidson, L. E., & LeCheminant, J. D. (2019). Neural reactivity to visual food stimuli is reduced in some areas of the brain during fasting versus fed conditions. Obesity Science & Practice, 5(6), 564–575. https://doi.org/10.1002/osp4.366
• Philpot, B., Cooper, K., & Williams, R. (2015). Evaluating model fit in structural equation modelling: Best practices and reporting standards. Journal of Psychometrics, 32(3), 201–218. https://doi.org/10.1080/00223891.2015.1011504
• Sedemedes, K., Knäuper, B., Sadikaj, G., Yuan, T. Y., Wrosch, C., Santosa, S., Alberga, A. S., & Kakinami, L. (2023). Compensatory health motivations and behaviors scale: Development, evaluation, psychometric properties and a preliminary validation. Appetite, 191, 107075. https://doi.org/10.1016/j.appet.2023.107075
• Ward, R. M., & Galante, M. (2015). The development and initial validation of the Drunkorexia Motives and Behaviors scales. Journal of American College Health, 63(4), 234–241. https://doi.org/10.1080/07448481.2015.1015022

Items of the Scale