According to Skolnik (2016), the Stages of Change model of precontemplation, contemplation, decision, action, and maintenance was originally used to inform the analysis and treatment of alcohol and substance abuse treatment (p.150). The model could also be used, however, to address the need for weight loss. Weight loss is one of the most challenging health goals for many patients, but particularly for patients who come from socio-economic and cultural backgrounds where food scarcity is a significant issue, and ideal body types are heavier than what is healthy. A lack of priority given to lifestyle-related disorders associated with excess weight can further complicate weight loss. The Stages of Change model views change as a complex, multidimensional process, and by encouraging the patient with sensitivity to the change phase at which he or she is located, change is more likely to be forged.
For example, the first stage of precontemplation is when the patient is unaware of the fact that he or she needs to undertake a significant life change to improve his or her health, or will refuse to acknowledge that any type of change will result in positive improvement. Even if the patient’s BMI clearly places his or her status in the category of overweight or obese, the patient may apply personal standards and deny this fact, or make a fatalistic pronouncement that he or she is going to be killed by something. According to the data, African-American girls are at highest risk for being overweight or obese, and when a significant number of individuals within a particular setting are of a particular BMI, this can normalize even an unhealthy body weight (Barr-Anderson et al., 2014). The nurse can help motivate a shift to the next stage—contemplation—by pointing out the risks if the health behaviors remain unchanged, and also demonstrating how the change is both feasible and can be enacted by the patient.
It is most critical, according to the Stages of Change model, that there is support to motivate the decision to change. Community-based anti-obesity initiatives can help provide weight loss support, and also create a culture around the adolescent that shifts cultural perceptions of what is possible around weight loss. Community-informed programs are also more likely to offer economically feasible meal and exercise plans and contain role models which mirror the suggested change in their own behaviors. This creates a cultural perception that the change is coming from within the community, versus being imposed upon from without. In the interventions examined in the systematic review of Barr-Anderson et al. (2014), some anti-obesity programs for African-American youths were church-based as well as based in extracurricular programs. Intensity, frequency, and length were found to be the most important determining factors of success, rather than the specific community arena of the program, so long as the program was community-driven.
Action must be committed to by the individual, of course, but there is strong evidence to support that students in low-income or minority communities exhibit “substantial declines in fitness after the3-month summer break, erasing any gains made during the school year,” in fitness, indicating the extent to which actions require follow-up and lifestyle changes must be supported by the cultural and social environment (Barr-Anderson et al., 2014, p.41). This is also why the Stages of Change model is useful because of its conceptualization of change as an ongoing endeavor that must be maintained. Weight loss is a lifestyle change requiring a shift in attitudes to weight, particularly if there are many economic and social influences which counteract rather than support healthy eating and exercise. Maintenance and support from community programs and ideally community-orchestrated environmental changes (such as supporting public parks and stocking healthier foods at local supermarkets) are required to make the changes stick.
Barr-Anderson, D., Singleton, C., Cotwright, C., Floyd, M., & Affuso, O. (2014). Outside of school time obesity prevention and treatment interventions in African American youth. Obesity Reviews, 4:26-45. Retrieved from: https://onlinelibrary.wiley.com/doi/epdf/10.1111/obr.12204
Skolnik, B. (2016). Global health 101. Burlington, MA: Jones & Bartlett.