Treating obesity: can the stages of change model help predict outcome measures?

Background: The transtheoretical model of behaviour change the 'Stages of C hange' by Prochaska & Di Clemente (1982) has been advocated for enhancing d ietary counselling. It has been suggested that understanding where people a re in the stages of change model could lead to targeting of advice and impr oved outcome of dietetic management such as weight loss in the obese and re duced did not attend rates. This study assessed whether a six-question stag ing model of the stages of change could predict which patients are most lik ely to not attend an appointment and predict those who will lose weight. Methods: Prior to the start of their dietetic interview, obese outpatients completed a simple 'stages of change questionnaire' (SCQ). This assessed wh ere the patient was in the stage of change cycle, motivation to lose weight , how easy they thought this would be and attendance rate. Patients who did not attend were sent a SCQ in the post. Results: There were no significant differences in SCQ scores at visit one, between patients attending twice (group 1) and those who did not attend the ir second appointment (group 2). By visit two, 72% of group 1 who were in t he action or maintenance stage of the cycle had lost 1.5 +/- 2.4% body weig ht, and were more optimistic and committed to doing so. There was no correl ation between percentage weight loss and the first SCQ score in group 1 (r= 0.05, P=0.73). It is of interest that no subject in group 3, i.e, those who did not attend both appointments, returned any of the SCQs after the first mailing and only 17% of this group returned one after a reminder was sent. Conclusion: Evidence from this study would suggest that the stages of chang e model does not distinguish between which patients will not attend a secon d appointment or lose weight. However, it may help identify motivated patie nts if used as a postal screening tool.