Integrative Nutrition (IN) is defined as “Integrative nutrition combines the principles of traditional nutrition guidelines and functional nutrition to provide a more individualized approach to eating and living. It goes beyond basic dietary guidelines to empower people to get more curious about how their food choices impact their unique body, which often supports them in discovering root causes for various illnesses and maladies” [1] [2] . Research has been directed towards preventive medicine and integrating holistic approaches to prevent chronic illnesses such as cardiovascular disease and obesity [3] . Thus, identifying roots and factors associated with poor eating habits and lifestyles, is essential [2] . Research have been directed toward identifying lifestyle factors associated with obesity. The Circle of Life (CoL) has been created based on the primary food concept by Joshua Rosenthal, Founder, Director, and Primary Teacher of the Institute for Integrative Nutrition describes it as follow: “turns out that the food on your plate, what I call secondary food, is not always the most important thing. Primary food overrides it, and includes a fulfilling career, nurturing relationships, an exercise routine you love, and an enriching spiritual practice”. For example, previous research has found that obesity is prevalent among working people, which may be due to long hours and sedentary lifestyle withing the offices [4] . With regards to spirituality, yoga and any other religious practices was seen to have a role in supporting behavioral changes and weight management [5] . Also, healthy relationships and maintaining strong social bonds in the community has been proved to support health and wellbeing [6] . Furthermore, physical activity and sports have been confirmed for decades to play a role in reducing stress and maintain health, which include lowering risks of obesity and metabolic syndrome. Thus is essential to enhance role of health care providers and health-coaches to enforce physical activity with their clients [7] . More importantly, diet and eating patterns as it is the ultimate goals of health and wellbeing. Findings from previous studies have shown that nutrition education has significant role in improving eating habits, for example in a study, nutrition education has supported the improving fruit and vegetables intakes among obese individuals [8] . The is still a lack of support to nutrition education among children’s schools, which may influence health in later years [9] . This can be achieved by implementing Integrative Nutrition Health coaching which has been seen. Previously to exhibit an impact on Health and wellbeing as seen previously in a pilot study [10] .

Thus, assessment of Quality of life (QoL) requires specific and validated tools, which can be used to identify factors associated with obesity, such as the physical, emotional, and social well-being. This includes the Short Form Health Survey (SF-36), which measures the overall health status and (QoL) [11] . Also, the World Health Organization Quality of Life (WHOQOL) that focus on several aspects of life quality, including physical, psychological, social, and environmental domains [12] . In addition to the Impact Weight on Quality of Life (IWQOL) and the Quality of Life Inventory (QOLI) which are specific tools that assesses the impact of obesity on various life domains, including self-esteem, physical functioning, and social interactions [13] [14] . Thus, the Weight-related Quality of Life (WRQoL) [15] , which targets specific issues faced by individuals with obesity, examining how weight impacts various areas of life, such as health, self-esteem, and social interactions. These tools help clinicians and researchers evaluate the effectiveness of weight management interventions, providing a more comprehensive understanding of how obesity affects quality of life. Thus, there is no validated and Arabic translated tool that is associated with the Circle of Life component to support health coaching in weight management interventions.

The current study aimed to design an assessment tool that covers the Circle of Life Component, which we were names as “Circle of Life Satisfaction Scale”, to be able to assess lifestyle factors associated with clients that want to lose weight to improve their health and lifestyle. The main objective of the study is to develop, validate and translate a newly developed assessment tool, which included content validity, data collection, reliability and consistency of the tool among participants who have joined a telenutrition weight loss program supported with telehealth coaching.

The current study aim was to design, validate a translate the Circle of Life Satisfaction Scale, to be used as a tool for integrative nutrition health coaching in weight management interventions. According to the content validity, experts in the filled and in both English and Arabic languages have scored a high score with regards to the content validity. Followed by using the Col a satisfaction scale assessment tool by participants enrolled in the study, where satisfaction rates were successfully collected. In addition, we applied a test to ensure reliability and

consistency of results using the multilevel analysis and we confirmed consistency in between CoL variables and weight measurements across all individuals in a similar correlational pattern. According to previous research. several tools have been used to assess quality of life, such as the COSMIN checklist. Data obtained from the COSMIN checklist showed that Laval questionnaire is suitable for measuring the quality of life among obese patients but again in consistency with our tool it may not be suitable for all the populations, with different cultures and lifestyles [19] . Our tool was not suitable with clients who have no control on the type of cooked food at home or have no control on the time spent at work sitting in the offices. Some of our participants did not even work and made the tool not applicable in some of the Circle of Life components. Furthermore, studies have identified the development of another Quality of Life assessment tool, names as the Impact of Weight on Quality of Life questionnaire (IWQOL), which was the first self-report tool to assess effects of obesity on factors contributing to quality of life. Results showed significant differences in IWQOL-Lite scale with groups that had different body mass index, supporting the utility of the IWQOL-Lite across the body mass index spectrum. This was not seen in our study, were all our participants were obese with similar BMI measures, which suggests that we apply our tool with different groups of participants to confirm variability and association with obesity or any other chronic illnesses that have an impact on quality of life [20] . A similar tool was developed previously for dietitians, named as” Quality of Life, Obesity and Dietetics (QOLOD)” was seen to be reliable and successful to be used in clinical practice to identify effects of diet on the HRQOL of obese people [21] . However, our tool is a tool that is used to assess individuals circle of life to be able to find the root of following an unhealthy diet or poor eating patterns, which supports health coaching to support dietitians. It is also used on a weekly basis to give participants space to reflect on their life in parallel with the diet, which is more practical and easier to apply. Thus, more tools are found to be qualified by the FDA as well, such as The Impact of Weight on Quality of Life-Lite (IWQOL-Lite), which is developed to assess weight-related physical and psychosocial factors in obese participants specifically in obesity clinical trials for product approval and labelling health claims [22] . Yet our tool is an assessment tool to support health professionals in their practice rather than using in in scientific research. However, this suggests drawing more attention on the tool and test it on a larger number of populations to enable it to be used for research practices as well.

Strengths and limitations

One of the main strengths is developing the Col Satisfaction Scale for the first time to support health professionals practice and in particularly integrative nutrition health coaching practice. It is also an easy and applicable tool that is suitable for the public and any patients from different backgrounds in two languages. Yet, this tool requires more research and to be tested with different target populations. It is essential to use it on a larger sample size that represents specific communities from different health issues to be able to draw conclusions and recommendations. With regards to the variables of the CoL Satisfaction Scale, it may be altered according to the targeted communities, for example job or education does not represent elderly populations, in addition to home cooking which may not be applicable on working clients. Thus, more interventions are required to support populations from different groups.

To sum up, we have developed, validated and translated a new assessment tool to be used by integrative nutrition health coaches, which is named as the Circle of Life (CoL) Satisfaction Scale Assessment Tool. Results showed success with regards to content validity and use by participants. In addition, consistency and reliability was achieved using statistical analysis. Thus, we advise all health professionals, in particularly health coaches to utilize the tool when providing their coaching sessions to improve lifestyle to a healthier and happier approach.

Institutional Fund Projects under grant no (IFPRC-206-141-2020).

This research work was funded by Institutional Fund Projects under grant no (IFPRC-206-141-2020). Therefore, authors gratefully acknowledge technical and financial support from the Ministry of Education at King Abdulaziz University, Jeddah, Saudi Arabia.