Assessing Dietary and Exercise Stage of Change to Optimize Weight Loss Interventions

Abstract

Res. 2003;11:641-652. Objective: According to the Transtheoretical Model (TM), tailoring interventions to patients' readiness to change can enhance patient progress and help patients use therapeutic resources more effectively. However, tailoring an intervention depends on accurate assessment of patients' stage of change (SOC). This study describes a multi-item algorithm of SOC (M-SOC) for weight loss-related behaviors that attempts to overcome some of the conceptual and methodological difficulties encountered in previously SOC assessments. Research Methods: Data were collected from participants randomly assigned to the treatment arm of a clinical trial comparing a TM-based, cognitive-behavioral intervention with enhanced usual care for weight loss. Results: The stair-step relationships hypothesized by the TM between assessed SOC and key behavioral measures were found for all algorithms (p Ͻ 0.05), indicating that the M-SOC algorithm performs as well as single item algorithms. However, 50% fewer patients were classified in action or maintenance for dietary fat intake and portion control (p Ͻ 0.05) by the multiple-item algorithms, providing staging more consistent with the clinical presentation of obese individuals. In addition, logistic regression analyses indicated that the single-item algorithms were not sufficient predictors of these behavioral domains. Discussion: To the extent that treatment is guided by assessed SOC, there is potential for a considerable variability in interventions with different approaches to staging. For weight-loss interventions that target portion control and decreased fat intake, the multi-item SOC algorithms seem to be better guides for matching treatments to SOC.

The Efficacy of Food Handler Training: The Transtheoretical Model in Focus, Brazil, 2013

“…Other instruments have been validated regarding GMP (Akutsu, Botelho, Camargo, Oliveira, & Araújo, 2005;Araújo et al, 2015;Santos, Akutsu, Botelho, & Zandonadi, 2012), instruments to determine the readiness for change stage (Cattai, Hintze, & Junior, 2010a;Sutton et al, 2003), and to evaluate the understanding, knowledge, attitudes and practice obtaining an overall confidence interval of 95% (Cunha, Stedefeldt, & Rosso, 2014). …”

“…Step 1 -Instrument Creation, Validation and Testing For the creation of the ACSFH, routine activities of the food handlers were used, as well as procedures that are present in the Brazilian current food safety legislation, RDC 216/2004 , and a literature survey to define the initial constructs of the attitude change stage (Cattai, Hintze, & Junior, 2010b;Cuprasitrut, Srisorrachatr, & Malai, 2011;Egan et al, 2007;Rahman, Arif, Bakar, & bt Tambi, 2012;Sutton et al, 2003).…”

Estágios de mudança de comportamento para a atividade física em adolescentes

“…O Modelo Transteórico também vem sendo utilizado em intervenções como uma ferramenta para medida da prontidão dos sujeitos para a mudança em comportamentos de risco à saúde (MARSHALL, BIDDLE, 2001;NAHAS et al, 2009;SUTTON et al, 2003). Nestes casos, o objetivo principal é auxiliar a compreensão acerca dos processos de mudança e, desta maneira, tornar mais efetivas as intervenções.…”

Stage of readiness to control weight and adopt weight control behaviors in primary care

“…Because of the ambiguity of constructs such as ''eating a low-fat diet'' or ''increasing physical activities,'' assessing stage of change for weight loss and related behaviors has presented methodological and conceptual challenges. 12,22 Most studies develop and use different algorithms and items making results difficult to compare across studies. Earlier studies found different stage of change distributions for weight loss, diet, and exercise than our study.…”

“…While patients at earlier stages may benefit from counseling about the harms of their current behaviors and the benefits of change, patients in the preparation, action, and maintenance stages may be more receptive to advice about specific strategies to effect or sustain behavior change. 11,12 Counseling about weight loss includes advice about weight loss, diet, and exercise. Assessing stage of change for multiple weight-related behaviors can be time consuming in clinical practice.…”