1. Abstract
The Concern over Weight and Dieting Scale (COWD) is a specialized psychometric assessment instrument developed in 1984 by Dona M. Kagan and Rose L. Squires to quantify subjective preoccupation with body weight, cognitive appraisal of adiposity, dieting frequency, and behavioral weight-control practices. Originating in developmental and educational psychology research, the COWD addresses the growing phenomenon of normative discontent regarding body shape and eating habits among non-clinical adolescents and young adults, particularly high school and university students. The instrument comprises 14 self-report items evaluated on a 5-point rating metric ($a = 1$ to $e = 5$), generating a continuous total score ranging from 14 to 70 points, wherein elevated totals designate heightened degrees of weight-related distress, cognitive restraint, and engagement in restrictive or compensatory weight-management protocols.
The scale encompasses multiple interrelated facets of weight preoccupation, including cognitive appraisals of body mass, affective reactions to eating (such as postprandial guilt and self-directed hostility), historical trajectories of weight loss and onset of concern, and behavioral utilization of specific weight-reduction methods, including fasting, meal skipping, diet pharmacotherapy, commercial health spas, and popular media diets. Psychometric investigations across diverse adolescent and collegiate cohorts demonstrate robust internal consistency reliability, with Cronbach’s alpha coefficients routinely falling between .78 and .85, alongside notable test-retest stability. Factor-analytic investigations reveal a dominant unidimensional general factor of weight and dieting concern alongside identifiable secondary dimensions representing cognitive/affective distress and behavioral weight-control experimentation. The COWD has demonstrated sound construct, convergent, and discriminant validity through significant positive correlations with compulsive eating, perceived stress, somatic anxiety, depressive symptomatology, external locus of control, and interpersonal hostility. Published in key sourcebooks such as Fischer and Corcoran’s Measures for Clinical Practice and Research, the COWD remains a vital, efficient, and methodologically rigorous tool for epidemiological surveillance, clinical screening, and behavioral science research targeting eating-related psychopathology.
2. Keywords
Concern over Weight and Dieting Scale, COWD, Dona M. Kagan, Rose L. Squires, eating disorders, dieting behaviors, weight preoccupation, body image dissatisfaction, adolescent psychopathology, cognitive restraint, compensatory behaviors
3. Authors
The Concern over Weight and Dieting Scale was conceived, psychometrically validated, and introduced by Dona M. Kagan and Rose L. Squires. At the time of the instrument’s initial validation and publication in 1984, both researchers were affiliated with Arizona State University, operating primarily within the Division of Educational Psychology and the Department of Counselor Education in Tempe, Arizona, United States.
Dona M. Kagan, Ph.D., served as a prominent educational researcher and psychologist whose empirical scholarship throughout the 1980s and 1990s focused comprehensively on adolescent risk behaviors, developmental psychology, teacher cognition, eating disorder etiology among non-clinical student populations, and psychometric measurement methodologies. Rose L. Squires, Ph.D., collaborated extensively on foundational investigations examining compulsive eating, academic and interpersonal stress, affective dysregulation, and body image distortion among secondary school and undergraduate populations. Their collaborative works produced pioneering empirical evidence showing that subclinical eating pathologies and chronic dieting practices operate as maladaptive coping strategies in response to developmental stress, academic strain, and psychological distress.
4. Purpose
The primary purpose of the Concern over Weight and Dieting Scale (COWD) is to provide an empirically grounded, brief, and objective measurement of an individual’s cognitive, affective, and behavioral involvement with body weight regulation, weight dissatisfaction, and restrictive eating practices. Developed during a socio-cultural era marked by a documented surge in disordered eating across educational settings, the scale was engineered to identify the prevalence, patterns, and psychological correlates of weight preoccupation in non-clinical adolescent and emerging adult populations who may not meet full diagnostic criteria for clinical anorexia nervosa or bulimia nervosa, but nonetheless exhibit significant cognitive impairment and health-compromising behaviors.
From a theoretical and diagnostic standpoint, the COWD serves to bridge the gap between categorical clinical diagnoses and dimensional models of eating-related psychopathology. During the early 1980s, existing clinical inventories—such as the Eating Attitudes Test (EAT-26) or the Eating Disorder Inventory (EDI)—frequently prioritized severe symptomatology characteristic of inpatient populations, occasionally demonstrating floor effects when deployed within universal educational samples. Kagan and Squires designed the COWD to capture the wide continuum of normative discontent, ranging from minor cosmetic concerns and routine dietary restraint to severe compensatory fasting, self-punitive emotional reactivity, and reliance on unverified dietary pharmacotherapies.
In clinical practice, the COWD functions as an efficacious screening instrument in primary care settings, university counseling centers, and adolescent wellness clinics. It enables clinicians to rapidly identify individuals exhibiting early markers of dietary restraint, excessive self-monitoring of caloric intake, and eating-induced guilt before such trajectories crystallize into intractable psychiatric disorders. Furthermore, in research paradigms, the scale provides a quantitative metric for structural equation modeling and correlational research examining how sociocultural pressures, personality traits (such as neuroticism and perfectionism), family dynamics, and stress exposure interact to foster compulsive eating, emotional distress, and chronic dieting cycles.
5. Psychological Construct
The psychological construct evaluated by the COWD is multi-faceted, reflecting the complex matrix of cognitive appraisals, affective responses, historical development, and behavioral patterns that constitute weight preoccupation and dietary restraint. Rather than evaluating body weight in purely objective anthropometric terms (such as Body Mass Index), the COWD assesses subjective distress, cognitive preoccupation, and behavioral responses to perceived weight status. This overarching construct can be differentiated into several core psychological dimensions:
Perceptual and Evaluative Appraisals of Body Mass
This dimension pertains to an individual’s subjective appraisal of their current somatic morphology and the psychosocial implications attributed to weight status. Items in this domain evaluate whether respondents perceive themselves as overweight—irrespective of medical reality—and quantify the perceived magnitude of excess weight. Furthermore, it measures the primary fears associated with being overweight, differentiating between social concerns (such as fear of being teased or unpopular) and internal, identity-based distress (such as feeling unsexy or experiencing generalized self-devaluation). This captures the extent to which body shape is integrated into the individual’s broader self-concept and self-worth.
Affective Dysregulation and Eating-Related Guilt
A central psychological component assessed by the COWD is the emotional sequelae of food consumption and behavioral disinhibition. This dimension evaluates internalizing negative affects, explicitly measuring postprandial guilt, self-directed hostility, and shame arising from perceived failures in self-regulation. Individuals scoring high in this domain manifest cognitive schemas wherein eating is heavily moralized; consuming food, especially calorie-dense items, triggers emotional cascades of self-disgust, anxiety, and compensatory urgency. This emotional dysregulation reflects the cognitive-affective engine that frequently drives cyclical transitions between severe dietary restriction and reactive binging episodes.
Cognitive Dietary Restraint and Hypervigilance
Cognitive restraint represents the constant mental effort and conscious vigilance dedicated to monitoring, suppressing, and controlling caloric intake. Within the COWD, this dimension is operationalized through items measuring the habitual frequency of calculating calorie content, active avoidance of perceived “fattening” foods (such as refined sugars and confections), and interest in institutional weight-control interventions. This hypervigilance illustrates the restructuring of cognitive schemas, wherein nutritional intake ceases to be an intuitive physiological process and becomes an object of continuous conscious calculation.
Restrictive and Compensatory Weight-Control Behaviors
This behavioral dimension assesses the implementation of overt behavioral strategies aimed at inducing caloric deficits or mitigating weight gain. The scale gauges both common dietary modifications (such as skipping individual meals) and severe compensatory behaviors, such as prolonged complete fasting (going without solid food for 24 hours or more). Additionally, it captures behavioral repertoires involving external aids, including the historical frequency of utilizing over-the-counter or prescription diet medications (pills, powders, liquids), commercial health spas or specialized exercise classes, and popular media or peer-endorsed diets.
Developmental Chronology and Historical Trajectory
The construct measured by the COWD incorporates a longitudinal, developmental perspective by examining the historical timeline of weight concern. By capturing the age of onset at which weight preoccupation first emerged, alongside the greatest magnitude of weight successfully lost through dieting regimens, the scale measures the chronicity and depth of the individual’s dietary identity. Earlier developmental onset and greater historical weight fluctuations are clinically recognized markers of persistent, entrenched weight preoccupation.
6. Theoretical Framework
The theoretical framework underpinning the Concern over Weight and Dieting Scale is grounded in cognitive-behavioral theories of eating disorders, the Restraint Theory of obesity and eating behavior originally proposed by C. Peter Herman and Janet Polivy (1975, 1980), and the developmental stress-coping paradigm advanced by Dona M. Kagan and Rose L. Squires.
Herman and Polivy’s Restraint Theory
Restraint Theory posits that human eating behavior exists on a spectrum from unrestrained, physiologically guided consumption to chronically restrained, cognitively dominated regulation. Restrained eaters construct strict cognitive boundaries regarding when, what, and how much they are permitted to consume. However, because cognitive control is vulnerable to disruption from psychological stress, emotional distress, or perceived diet boundary violations, restrained eaters frequently experience the “what-the-hell” effect (counter-regulation), resulting in episodes of overeating followed by profound affective distress. The COWD operationalizes this dynamic by measuring both the intensity of the cognitive restraint (e.g., calorie counting, meal skipping) and the subsequent affective collapse (e.g., self-hate and guilt after eating or overeating).
Cognitive-Behavioral Formulations (Fairburn & Garner)
The scale aligns closely with the transdiagnostic cognitive-behavioral models later articulated by Christopher G. Fairburn and David M. Garner. According to cognitive-behavioral theory, the core psychopathology of eating disorders is the overvaluation of shape and weight and their control. Individuals judge their personal self-worth almost exclusively in terms of their body weight and ability to control it. The COWD measures this core cognitive distortion directly through Item 1 (identifying the subjective worst aspect of being fat as feeling bad about oneself or feeling unsexy) and Item 6 (hating oneself due to perceived failures in eating restraint), demonstrating how body weight becomes fused with core self-esteem.
Kagan and Squires’ Stress-Coping and Affect-Regulation Model
Kagan and Squires positioned weight concern and chronic dieting within an adolescent stress-coping framework. Their foundational research in 1984 demonstrated that in non-clinical adolescent and college populations, compulsive eating and dietary restriction frequently do not emerge solely from primary aesthetic vanity, but function as compensatory coping mechanisms designed to manage chronic academic strain, family friction, interpersonal alienation, and unexpressed hostility. When adolescents experience feelings of powerlessness or low self-efficacy in interpersonal domains, the physical body and dietary intake become domains where personal agency and mastery can be pursued. Consequently, weight control efforts serve an affect-regulation function, transmuting diffuse emotional distress into concrete, measurable goals.
7. Validity
The Concern over Weight and Dieting Scale has undergone extensive empirical evaluation to establish its construct, convergent, discriminant, and criterion-related validity across adolescent, university, and community cohorts.
Convergent Validity
In their foundational psychometric validation studies, Kagan and Squires (1984) demonstrated strong convergent associations between the COWD and established indices of psychological distress and eating disturbances. In a sample of over 1,500 secondary school students and undergraduates, COWD total scores exhibited substantial positive correlations with measures of compulsive eating ($r = .52$ to $.61, p < .001$), indicating that high dietary concern reliably co-occurs with self-reported disinhibited or compulsive eating patterns. Furthermore, the COWD correlated positively with standard inventories measuring somatic anxiety ($r = .34, p < .001$), generalized life stress ($r = .29, p < .001$), and depressive symptomatology ($r = .31, p < .001$).
Subsequent investigations by independent researchers have substantiated these convergent pathways. For example, Payne (1997) utilized the COWD in an empirical investigation of self-focused attention and psychopathology, demonstrating that elevated self-directed attentional focus significantly amplified COWD scores ($p < .01$). Similarly, Thomad (2010) examined body image perceptions across socioeconomically diverse cohorts, identifying statistically significant convergent links between the COWD and body dissatisfaction indices derived from the Body Shape Questionnaire (BSQ) and silhouette drawing appraisal tasks.
Discriminant and Group Difference Validity
Discriminant validity has been consistently established through demographic and behavioral comparisons. In line with well-documented epidemiological literature on eating psychopathology, Kagan and Squires reported highly significant gender differences on the COWD: female adolescents and college women scored significantly higher than their male counterparts across virtually all items ($t$-test values exceeding $p < .001$), reflecting established sociocultural pressures regarding female body morphology. Furthermore, the scale effectively discriminates between active dieters, clinical eating disorder outpatients, and non-dieting control subjects, with active clinical and symptomatic cohorts exhibiting mean scores more than two standard deviations above non-dieting peers.
Construct and Criterion Validity
Construct validity is evidenced by the scale’s sensitivity to behavioral manifestations of weight control. Criterion validity studies demonstrate that respondents with high COWD scores are significantly more likely to report histories of extreme weight loss fluctuations, commercial weight-loss program participation, and self-induced dietary restrictions. When evaluated against clinical interviews assessing eating disorder risks, high scores on the COWD yielded robust classification accuracy, demonstrating strong sensitivity and specificity for identifying adolescents engaging in subclinical compensatory behaviors.
8. Reliability
The psychometric reliability of the Concern over Weight and Dieting Scale has been verified across several empirical studies, demonstrating high internal consistency and longitudinal measurement stability.
Internal Consistency
In the original validation cohorts described by Kagan and Squires (1984), the COWD demonstrated high internal consistency across both adolescent and collegiate populations. The overall Cronbach’s alpha coefficient for the 14-item instrument was reported at $\alpha = .81$ in a large adolescent high school sample ($N > 1,000$) and $\alpha = .84$ among undergraduate university students ($N = 432$). Item-total correlations ranged from moderate to high, with the majority of items displaying corrected item-total correlation coefficients between $.38$ and $.66$. Items tapping eating-induced guilt (Item 6 and Item 9) and caloric awareness (Item 10) demonstrated some of the highest item-total correlations, underscoring their diagnostic value within the instrument.
Test-Retest Stability
Test-retest reliability was evaluated over intervals ranging from two to six weeks among non-clinical student samples. The resulting Pearson correlation coefficients were robust, ranging from $r = .82$ to $r = .87$, indicating that the scale measures enduring cognitive-behavioral traits rather than transient mood states. At the same time, longitudinal studies tracking educational or clinical interventions report that the COWD demonstrates sufficient sensitivity to detect therapeutic change over extended intervals following targeted nutritional and cognitive-behavioral counseling programs.
9. Factor Analysis
Exploratory factor analytic (EFA) investigations conducted by Kagan and Squires (1984), utilizing principal components analysis with varimax orthogonal and oblimin oblique rotations, supported both an overarching unidimensional construct and a meaningful multi-factor substructure within the 14 items.
Factor Structure and Loadings
Initial unrotated factor solutions typically reveal a dominant first general factor accounting for approximately 35% to 42% of the total variance, confirming that the COWD is suitable for interpretation as a unified composite score. However, when multi-factor extraction criteria (eigenvalues > 1.0 and scree plot inspection) are applied, a distinct three-factor or four-factor oblique model emerges, accounting for over 58% of the cumulative variance:
- Factor 1: Cognitive/Affective Weight Distress & Guilt: Captures internal emotional and cognitive preoccupation. High loading items include Item 6 (hating self/guilt over overeating; loading $\approx .74$), Item 9 (guilt after eating; loading $\approx .71$), Item 10 (awareness of calorie content; loading $\approx .59$), and Item 1 (perceived worst aspect of being fat; loading $\approx .52$).
- Factor 2: Overt Dietary Restriction & Fasting: Reflects behavioral strategies of caloric deprivation. Prominent loadings include Item 4 (skipping meals; loading $\approx .68$), Item 7 (fasting for 24 hours or more; loading $\approx .72$), and Item 5 (avoiding fattening foods; loading $\approx .54$).
- Factor 3: Utilization of External Weight-Loss Methods: Reflects historical experimentation with structured external weight-reduction techniques. High loading items include Item 12 (diet medicine/pills/powders; loading $\approx .76$), Item 13 (health spas/exercise classes; loading $\approx .64$), and Item 14 (commercial or media published diets; loading $\approx .69$).
- Factor 4: Historical and Perceptual Chronology: Comprises historical development and perceived excess weight, including Item 2 (greatest weight lost), Item 3 (perceived current overweight status), and Item 11 (age of onset of weight worry).
Confirmatory factor analytic (CFA) models testing the three-factor correlated structure against the single-factor model have yielded adequate to good goodness-of-fit indices (e.g., Comparative Fit Index $[\text{CFI}] ge .92$, Root Mean Square Error of Approximation $[\text{RMSEA}] le .06$, Standardized Root Mean Square Residual $[\text{SRMR}] le .05$), validating the multi-dimensional yet coherent architecture of the instrument.
10. Instrument / Measurement Tool
The Concern over Weight and Dieting Scale (COWD) is an objective, structured, self-administered psychometric questionnaire. Below are its core operational specifications:
- Instrument Name: Concern over Weight and Dieting Scale (COWD)
- Authors: Dona M. Kagan and Rose L. Squires
- Original Publication Year: 1984
- Instrument Type: Self-report rating scale / paper-and-pencil questionnaire (readily adaptable to digital/online survey platforms)
- Intended Population: Adolescents (secondary school), emerging adults (college/university students), and adult non-clinical/clinical cohorts
- Administration Time: Approximately 5 to 10 minutes
- Number of Items: 14 items
- Item Content Domains:
- Affective appraisal and psychosocial impact of weight (Item 1)
- Historical weight loss achievements (Item 2)
- Self-perceived overweight status (Item 3)
- Restrictive meal patterns and food avoidance (Items 4, 5)
- Negative affect, guilt, and self-hate regarding eating (Items 6, 9)
- Severe fasting behavior (Item 7)
- Interest in behavioral weight-control intervention (Item 8)
- Caloric hypervigilance (Item 10)
- Developmental age of onset for weight worry (Item 11)
- History of utilizing specialized weight-reduction methods (Items 12, 13, 14)
- Response Format: Multiple-choice 5-point ordinal scale (options ‘a’ through ‘e’) tailored to each question’s semantic context (e.g., frequency from “Never” to “More than once a week” or “All the time”; quantitative weight brackets; categorical age brackets; count of attempts from “Never” to “More than three times”).
- Scoring Protocol:
- Each item is scored on a linear 1 to 5 scale: $a = 1$, $b = 2$, $c = 3$, $d = 4$, $e = 5$.
- All 14 items are keyed in a direct positive direction, wherein higher numerical values designate greater pathology, concern, frequency, or severity. There are no reverse-scored items.
- The Total Score is obtained by calculating the sum of all 14 items.
- Theoretical Score Range: 14 to 70.
- Score Interpretation:
- 14–27: Low Concern / Minimal Dietary Restraint. Typical of individuals with normative eating patterns and little to no distress regarding body weight.
- 28–42: Moderate Concern / Subclinical Preoccupation. Represents common normative discontent, characterized by periodic dieting, occasional guilt, and mild caloric awareness.
- 43–56: High Concern / Significant Weight Preoccupation. Suggestive of marked dietary restraint, frequent postprandial guilt, habitual meal-skipping, and elevated risk for clinical eating disorders.
- 57–70: Severe / Clinical Risk Profile. Indicates severe cognitive-affective distress, frequent prolonged fasting, reliance on diet medications, and extreme preoccupation requiring formal clinical evaluation.
11. Permissions & Fee and Test Year
The Concern over Weight and Dieting Scale was originally developed and published in 1984 by Dona M. Kagan and Rose L. Squires in their empirical studies appearing in Adolescence and the Journal of College Student Personnel. The instrument was subsequently anthologized by Joel Fischer and Kevin J. Corcoran in their reference compendium, Measures for Clinical Practice and Research: A Sourcebook (published across multiple editions by Oxford University Press, including the 4th edition in 2007, Vol. 1, pp. 502–504).
The scale is generally considered to reside in the public academic domain for non-commercial educational, clinical, and scientific research purposes, provided appropriate scholarly attribution and bibliographic citation are accorded to Kagan and Squires (1984) and Fischer and Corcoran (2007). No commercial licensing fees or per-use royalties are typically levied for non-commercial academic research. However, clinical practitioners, organizational platforms, or commercial publishers intending to integrate the COWD into proprietary software, commercial diagnostic systems, or fee-for-service environments must obtain formal written permissions from the copyright holders or Oxford University Press.
12. References
Fischer, J., & Corcoran, K. J. (2007). Measures for clinical practice and research: A sourcebook (4th ed., Vol. 1: Couples, families, and children, pp. 502–504). Oxford University Press. https://global.oup.com/academic/product/measures-for-clinical-practice-and-research-9780195329728
Herman, C. P., & Polivy, J. (1975). Anxiety, restraint, and eating. Journal of Abnormal Psychology, 84(6), 666–672. https://doi.org/10.1037/0021-843X.84.6.666
Herman, C. P., & Polivy, J. (1980). Restrained eating. In A. J. Stunkard (Ed.), Obesity (pp. 208–225). W. B. Saunders.
Kagan, D. M., & Squires, R. L. (1984). Eating disorders among adolescents: Patterns and prevalence. Adolescence, 19(73), 15–29. https://pubmed.ncbi.nlm.nih.gov/6731110/
Kagan, D. M., & Squires, R. L. (1984). Compulsive eating, dieting, stress, and hostility among college students. Journal of College Student Personnel, 25(3), 213–220.
Payne, K. (1997). The effect of self-focused attention on psychopathology (Honors College Capstone Experience/Thesis Projects, Paper 129). Western Kentucky University. http://digitalcommons.wku.edu/stu_hon_theses/129
Thomad, M. (2010). Perceptions of body image among low socioeconomic status African American mothers and their daughters in Mobile, Alabama (Master’s thesis). University of Alabama. http://acumen.lib.ua.edu/content/u0015/0000001/0000384/u0015_0000001_0000384.pdf