Obesity Screening and Assessment of Patient Readiness for Weight Loss
American Journal of Clinical Nutrition, June Motivation and autonomy in counseling, psychotherapy, and behavior change: Do you have fatty acid deficiency? Sign-up now and receive regular exclusive offers and news from Go Light Bariatrics. Processes and stages of change as process and predictor variables. Your body needs some dietary fat to function.
At this level, the change has become part of their life and they are less likely to relapse than in the previous stages, although relapse prevention is still advisable Prochaska and Velicer, ; Redding et al. Questionnaires assessing TTM constructs in weight management are frequently adapted from other tools designed to measure RTC in addictive disorders Greene and Rossi, ; Marshall and Biddle, In the context of weight management, the assessment of RTC and SOC has generally been carried out with separate evaluations of dietary behavior change and physical exercise.
According to Horwath , using specific measures of both dietary behavior and exercise can contribute to provide a reliable and efficient assessment in weight-management, according to the TTM constructs.
Many clinician-rated and patient-rated instruments have been developed to measure RTC in the clinical setting during the last 20 years. However, a motivational assessment in obese hospitalized in-patients does not always correspond to an early, accurate use of suitable tools.
This work intends to provide an in-depth comparison between these tools, identifying which one is more suitable in detecting RTC in weight-management within obese hospitalized in-patients. The selection of the three measures was based upon specificity regarding SOC, processes of change and motivation in weight management and more generally, the decision of whether or not to maintain weight according to the SOC of the TTM model.
Thus, strengths and weakness of these three sets of questionnaires analyzed in this brief review will be pointed out and the most recommendable tool will be clearly identified. It is important to verify which instrument is more useful to evaluate motivational levels in weight-management amongst obese or overweight individuals.
This is because an efficient appraisal in this context could be fundamental in later providing patients with the best possible psychological support and most suitable weight-loss treatment.
The URICA is the most widely studied measure of readiness for change designed for an adult target population. The questionnaire was originally used for patients in psychotherapy reporting on their specific problem in treatment McConnaughy et al. The URICA has been successfully used with other problematic behaviors including obesity, diet and weight management Prochaska et al. Responses are given on a 5-point Likert scale ranging from 1 strong disagreement to 5 strong agreement.
The test contains eight items for each of the subscales. The latter can be combined arithmetically by summing up scores on the Contemplation, Action, and Maintenance subscales and by subtracting the score on the Precontemplation subscale to yield a second-order continuous RTC score assessing RTC at treatment entrance Prochaska et al. The URICA is designed to be a continuous measure; subjects can obtain high scores on more than one of the four stages. Higher total scores indicate a greater RTC.
For each subscale, individuals can score from a minimum of 1 to a maximum of 40 and a total test score ranging from a minimum of 1 to a maximum of can be obtained. Good reliability, construct validity and psychometric properties of the URICA have been established for a range of behavioral conditions Willoughby and Edens, ; Pantalon et al. The construct validity of the URICA has been supported through factor and cluster analyses demonstrating that the SOC are associated with different behavioral profiles McConnaughy et al.
The latter reflect the possibility that respondents are likely to engage in actions and behavior representing more than one stage at a time. Moreover, the correlations between the questionnaire subscales suggest that adjacent stages are more strictly linked than non-adjacent ones Rossi et al.
There is consistent evidence supporting the transtheoretical four-factor structure of the URICA given by both principal component analysis PCA and structural equation modeling McConnaughy et al. Furthermore, the measure showed a good predictive validity, in foreseeing attendance and weight-loss in a study carried out by Prochaska et al. In fact, the authors found that attendance was significantly predicted by higher scores on the Action subscale and by lower Precontemplation and Maintenance subscales scores.
Additionally, the URICA can also be used to measure processes and outcome variables for a range of health and addictive behaviors. Nonetheless, because the relationships among subscales shift as individuals move into Action and Maintenance, particular attention should be paid in assessing changes in pre-post design studies Prochaska et al.
The questionnaire is very easy to administer since it only requires 5—10 min for completion and it can also be self-administered. Furthermore, no specific training is required for administration and the scoring can be carried out by any staff member by hand, in 5—10 min.
The authors particularly recommend applying the questionnaire to evaluate progress during treatment and the outcome of specific interventions such as weight-loss and weight-maintenance Andrés et al. In fact, the tool demonstrated to be reliable in a study on hospital staff members engaged in a week treatment program for weight-control Prochaska et al.
However, the structure and internal consistency of the scale on weight-control samples is still somewhat unclear. Moreover, the questionnaire scale scores relate to simple unit weighting of items and thus involve either a total score or a mean scale score, which may require cluster analysis and standardized scoring if used in large sample sizes Prochaska and Norcross, The S-Weight consists of five mutually exclusive items; respondents are asked to choose one of the five SOC to be allocated to among Precontemplation, Contemplation, Preparation, Action, and Maintenance Di Clemente et al.
The S-Weight is designed to measure the SOC as applied to weight management asking respondents to choose the answer that best corresponds to their current weight-loss situation Andrés et al. The questionnaire is based on the hypothesised processes which individuals use across the SOC in order to manage their body weight Andrés et al.
On the P-Weight, answers are given on a five-point Likert scale ranging from 1 strong disagreement to 5 strong agreement. The four processes of change measured by the P-Weight that are implicated in weight management are: The EmR process scale is comprised of 13 items, the WMA process scale is assessed by seven items, and the WCE process scale consists of nine items while the EnR process scale is evaluated by five items.
Scores for each of the four processes of change can be calculated by summing up the scores obtained on items belonging to the same subscale. None of the items are reverse scored Andrés et al. The measurement structure has four freely correlated first-order factors as revealed by the PCA and the confirmatory factor analysis CFA. Four scores corresponding to the four processes of change can therefore be obtained from this questionnaire.
However, the scores from the different subscales should be transformed onto a scale from 0 to from a minimum of 0 reflecting no use of a given process of change to a maximum of being full-use of that process , in order to be comparable with one another.
A higher use of a process is represented by scores above 50 Andrés et al. Corrected item-total correlations of the measure are also adequate, ranging from 0.
The four subscales of the P-Weight positively correlate with other scales measuring concern with dieting. This has been demonstrated by the original validation study conducted on University students and on overweight and obese patients enrolled in a hospital-based weight management program Andrés et al. The S-Weight and the P-Weight questionnaires are thus able to assess the relationship between stages and processes of change in weight-management.
In this respect, the two measures allow identifying which processes of change individuals use the most according to the stage of change they are in, for what concerns weight-control Andrés et al. The P-Weight questionnaire is very easy to administer since it requires less than 10 min for completion and it can be self-administered.
No trained staff is necessary for administration and the scoring can be carried out by hand, in around 15 min time. However, in order to obtain the processes of change scores from the P-Weight , across the SOC from the S-Weight , more complex data analytic processes are needed, and the use of a statistical software is advisable. Part of the decision to move from one stage to the next is based on the relative weight given to the pros and cons of changing the target-behavior.
Factor analytic studies Prochaska et al. The two-factor structure of the test has been confirmed by PCA Prochaska et al. The scoring is very simple and straightforward: Thus, the range of possible total scores on each subscale ranges from a minimum of 10 to a maximum of A total DB score is calculated by subtracting the cons score from the pros one. Findings revealed that the cons of weight-loss were significantly higher than the pros in the precontemplation stage, while in the contemplation, action and maintenance stages the trend was reversed.
Such results were also found in several other studies on various health behavior problems Prochaska et al. Up to date, the most recent validation of the DBI has been carried out in a study on the pros and cons of reducing dietary fat consumption in a large sample of adolescents Rossi et al.
Though the instruments described earlier may appear to be homogeneous in their strengths and weaknesses, the S-Weight and the P-Weight are more efficient toward a sound RTC assessment for what concerns weight-control, for several reasons. All three sets of questionnaires are appreciable given their short time completion and the unnecessary presence of trained personnel for administration.
However, the S-Weight and the P-Weight are the only questionnaires among the abovementioned which at present, have been fully validated on overweight and obese in-patients. Moreover, these instruments seem to adequately and accurately detect specific RTC associated with weight-management, by measuring both processes of change and SOC according to the TTM Andrés et al. The test global RTC score can be obtained by combining the scores from each of the four subscales. However, classifying participants into specific stages simply on the basis of the subscale scores can be difficult Di Clemente and Hughes, ; Carney and Kivlahan, This could under report the number of respondents who are nearly ready to consider a move to make a meaningful change in their behavior Blanchard et al.
Moreover, the scale does not account for the processes of change which are important elements influencing behavior modification. In addition, the questionnaire is not appropriate for a pre-post evaluation of treatment because some of the subscales change in direction and strength of endorsement as individuals abandon their dysfunctional behavior Carney and Kivlahan, ; Di Clemente et al.
Thus, while results from the URICA provide adequate data by placing respondents into a representative category of a target-behavior and it is therefore a strong predictor at pre-treatment, this linear combination of subscales does not function well in post-treatment evaluations. This is due to the fact that time in treatment and recovery seems to change the relationships of the subscales outcomes Carney and Kivlahan, ; Di Clemente et al.
Since the URICA is still being validated within the weight-management context, it is advisable to mainly utilize it for research purposes. Therefore, to date there have been no cut-off norms established to determine what constitutes high, medium or low on a particular stage in weight-control McConnaughy et al.
Many motivational measures specifically developed for weight-management have not been adequately tested, while others may present some weaknesses Palmeira et al. Amongst the ones selected and described by this paper, the S-Weight and P-Weight appear to be more useful and straightforward in evaluating RTC for weight-control, with the advantages regarding brevity and the constructs they analyze.
Firstly, the S-Weight and P-Weight are able to measure both SOC that focus on when people change, as well as the processes of change which refer to how people change Andrés et al.
In fact, the S-Weight and P-Weight are able to measure not only the corresponding motivational stage of the TTM model for weight-control, but they also focus on overt and covert activities that individuals engage in when they attempt to manage their weight, represented by the processes of change Di Clemente et al.
In fact, these are powerful predictors of behavior change and they can give crucial information on weight-management interventions efficacy Prochaska et al. Hence, assessing the processes of change can reveal how the patient is tackling his or her weight problem while the SOC classification complements the motivational evaluation by identifying when behavior change occurs.
Finally, it must be considered that contrarily to the URICA and the DBI, the the S-Weight and P-Weight have been clinically validated in a sample of overweight and obese patients enrolled in a hospital-based weight-loss treatment.
In other words, a stage-matched intervention for at-risk participants such as overweight and obese individuals can contribute to increase the chances of becoming more physically active and to decrease dietary fat intake, compared to a non-stage matched intervention Steptoe et al. Promptly identifying stages and processes of change in weight-management can therefore help clinicians and other professionals developing a more suitable weight-specific intervention in order to determine which behaviors an individual should target for change, at various points during treatment.
In this respect, the S-Weight and P-Weight seem to be more advantageous compared to the DBI and the URICA, considering their specificity and their psychometric properties in obese and overweight hospitalized in-patients. If yes, how many cups per day?: Do you drink carbonated beverages: If yes, how many?: Have you ever had any surgery: List all surgeries you have had, including place and date of surgery and surgeon: Type of Surgery - 1. Type of Surgery - 2. Current prescription and over-the-counter medication: If yes, list all prescription and over-the-counter medications you currently take: How often medication is taken.
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