Impact of a stage-matched weight loss intervention on stage of change progression in predominantly African-American female primary care patients

Abstract

Obesity is associated with several chronic medical conditions. Certain individuals are at higher risk for obesity including low-income African American females. Despite the many benefits to weight loss, many individuals do not seek treatment. Individuals are likely to attend primary care appointments where obesity can be targeted. Although stage matched interventions based on the Transtheoretical Model (TM) have been used successfully to aid in health behavior change, few studies have examined the use of stage matched weight loss interventions in African American females. There is also a paucity of research examining the effects of stage matched weight loss interventions on TM related constructs, such as perceived stage of change (SOC), decisional balance (the perceived pros and cons of weight loss) and self-efficacy (confidence in ability to lose weight). This study examined the impact of a 6-month physician directed, stage matched weight-loss intervention on SOC, decision balance, and self-efficacy for weight loss in 158 low-income African Americans selected from primary care medical clinics. No differences in SOC, decisional balance, and self-efficacy from baseline to end of active treatment were found for the intervention group. Similarly, no differences in SOC were found between the intervention group and the usual care control (UC) group. Attempts to detect differences in SOC were greatly attenuated by the finding that 87% of participants indicated they were already in an advanced SOC prior to the start of treatment. Self-efficacy was found to be higher in the action SOC than the maintenance SOC, which was inconsistent with past research. These results suggest that stage-matched interventions work differently in this population and may not add any additional benefit to weight loss interventions. More research is needed comparing these interventions to more general weight loss techniques in primary care samples of low-income African Americans.