Stages of change and weight loss among rural African American women

Protocol of Randomized Controlled Community Trial (RCCT) for obesity management in Brazilian primary health care

BACKGROUND

Obesity is a chronic disease characterized by excess body fat and is a risk factor for other chronic non-communicable diseases. Its multifactorial and complex nature makes its management a challenge for health services. This manuscript presents an investigation protocol that aims to analyze the effectiveness of collective nutritional interventions for obesity management applicable to primary health care.

METHODS

Randomized Controlled Community Trial (RCCT) in a representative sample of users of the Programa Academia de Saúde (PAS), in Belo Horizonte, Minas Gerais, Brazil, with obesity. The research consists of four phases: (1) Screening to identify the participants eligible for the nutritional interventions (individuals with obesity, readiness for change to lose body weight, and willingness and interest to participate in a group activity for six months or more); (2) Baseline to characterize the participants; (3) Implementation of collective nutritional interventions; (4) Reassessment of the participants. Participants in the control group (CG) will receive the usual health service care, and participants in the intervention group (IG) will participate in collective nutritional interventions based on Therapeutic Group 1 (TG1) or Therapeutic Group 2 (TG2) of the "Instructive of Collective Approach for the obesity management in SUS".

DISCUSSION

The strengths of the study include its robust RCCT design, which allows for longitudinal analyses and is suitable for investigating causal hypotheses and applying strategies to improve adherence to interventions. Furthermore, the study included a representative sample of a public health service and aims to evaluate therapeutic proposals from the Brazilian Ministry of Health, which can contribute to implementation and extension in the national territory.

TRIAL REGISTRATION

RBR-3vzsyqq and RBR-6pg682m.

Qualitative inquiry with primary care providers and specialists about adult weight management care and referrals

Obesity is a highly prevalent disease and providers are expected to offer or refer patients for weight management yet increasingly fewer clinical visits address obesity. Challenges to offering care are known but less is known about referrals and how specialists who treat obesity-related comorbidities address care and referrals. This study explored perceptions of primary care providers (PCPs) and specialty providers regarding care and referrals for weight management, specifically referrals to programs in the community setting. A qualitative design was used to interview 33 PCPs (mean age 54 years) and 31 specialists (cardiology, gynecology, endocrinology, and orthopedics [mean age 62 years]) in the USA during 2019. Each interview was conducted by telephone, audio-recorded, and transcribed verbatim. Inductive analysis was used and followed the constant comparative method. Four themes emerged from the data including (a) Clinical guidelines and provider discretion influence obesity care; (b) Facilitators and barriers to discussing weight and small step strategies; (c) Informal referrals are made for weight management in community settings; and (d) Opportunities and challenges for integrating clinical and community services for weight management. Facilitating referrals to effective programs, ideally with a feedback loop could coordinate care and enhance accountability, but education, compliance, and cost issues need addressed. Care may be offered but not be well-aligned with clinical guidelines. Knowledge gaps regarding community programs' offerings and efficacy were evident. Referrals could be systematically promoted, facilitated, and tracked to advance weight management objectives.

Association between Actual and Perceived Obesity Weaker among Black than White Children

Although actual obesity is expected to be associated with perceived overweight, some recent studies in adults have suggested that this link may be smaller for Blacks than Whites. It is unknown, however, whether the same trend holds for children or not. This study explored the heterogeneity of the association between actual and perceived obesity in a national sample of American children by race, gender, and their intersection. Health Behavior in School-Aged Children (HBSC), 2009–2010, is a national study of children 17 years or less in the United States. This analysis included a total number of 8860 children, including 6581 (74.28%) White and 2279 (25.72%) Black children. Actual obesity, defined as a body mass index (BMI) greater than 95% of the age- and gender-percentile, was the independent variable. Perceived overweight was the main outcome. We ran linear regression models with and without interaction terms between race, gender, and actual obesity. We also ran race- and gender-specific linear regression models. In the pooled sample, actual obesity was positively associated with perceived overweight. We found an interaction between race and obesity, suggesting stronger association between actual obesity and perceived overweight for White than Black children. Gender or intersection of race and gender did not alter the association between actual obesity and perceived overweight. The link between actual obesity and perceived overweight depends on race of the child. Inaccurately perceived weight may be one of many mechanisms behind the disproportionately higher rate of obesity burden among Black children in the United States. As perceived overweight plays a salient role for weight control behaviors, Black children with obesity may need some help to perceive themselves as obese. Training programs should target Blacks to increase the accuracy of their weight and body size evaluation and perception as an essential step for reducing the burden of obesity among Black children.

Mindfulness as a complementary intervention in the treatment of overweight and obesity in primary health care: study protocol for a randomised controlled trial

Background

Mindfulness has been applied in the United States and Europe to improve physical and psychological health; however, little is known about its feasibility and efficacy in a Brazilian population. Mindfulness may also be relevant in tackling obesity and eating disorders by decreasing binge eating episodes—partly responsible for weight regain for a large number of people—and increasing awareness of emotional and other triggers for overeating. The aim of the present study protocol is to evaluate and compare the feasibility and efficacy of two mindfulness-based interventions (MBIs) addressing overweight and obesity in primary care patients: a general programme called Mindfulness-Based Health Promotion and a targeted mindful eating protocol called Mindfulness-Based Eating Awareness Training.

Methods/design

A randomised controlled trial will be conducted to compare treatment as usual separately in primary care with both programmes (health promotion and mindful eating) added to treatment as usual. Two hundred forty adult women with overweight and obesity will be enrolled. The primary outcome will be an assessment of improvement in eating behaviour. Secondary outcomes will be (1) biochemical control; (2) anthropometric parameters, body composition, dietary intake and basal metabolism; and (3) levels of mindfulness, stress, depression, self-compassion and anxiety. At the end of each intervention, a focus group will be held to assess the programme’s impact on the participants’ lives, diet and health. A feasibility study on access to benefits from and importance of MBIs at primary care facilities will be conducted among primary care health care professionals and participants. Monthly maintenance sessions lasting at least 1 hour will be offered, according to each protocol, during the 3-month follow-up periods.

Discussion

This clinical trial will result in more effective mindfulness-based interventions as a complementary treatment in primary care for people with overweight and obesity. If the findings of this study confirm the effectiveness of mindfulness programmes in this population, it will be possible to improve quality of life and health while optimising public resources and reaching a greater number of people. In addition, on the basis of the evaluation of the feasibility of implementing this intervention in primary care facilities, we expect to be able to suggest the intervention for incorporation into public policy.

Trial registration

ClinicalTrials.gov, NCT02893150. Registered retrospectively on 30 March 2017.

Electronic supplementary material

The online version of this article (10.1186/s13063-018-2639-y) contains supplementary material, which is available to authorized users.

Discrepancy in Motivation for Weight Loss and Exercise in Rural Patients

OBJECTIVES

We explored the extent to which discrepancy between motivation for weight loss and exercise is related to obesity among rural patients with chronic disease, and identified the psychosocial correlates of this discrepancy.

METHODS

497 patients with diabetes and/or hypertension were recruited from a network of Federally Qualified Health Centers in the rural South and completed a battery of assessments.

RESULTS

Most persons in the sample (83.1%) were overweight and 65.0% were obese. For motivation for change, 70.8% reported being in the Action stage or higher for weight loss, whereas only 24.9% reported being in the Action stage or higher for motivation for exercise. When controlling for age, education level, income, sex, and race/ethnicity, individuals who were motivated for weight loss but not exercise were twice as likely to be obese (p = .005). Race and sex were significantly associated with this discrepancy, with African-American patients 1.7 times as likely (p = .05) and women 2.3 times as likely to be discrepant (p = .001).

CONCLUSIONS

Findings underscore the importance of focusing not simply on weight loss among rural patients with chronic disease, but rather to incorporate specific activities designed to build simultaneous motivation for engaging in exercise.

Mediating Effect of Perceived Overweight on the Association between Actual Obesity and Intention for Weight Control; Role of Race, Ethnicity, and Gender

Background:

Although obesity is expected to be associated with intention to reduce weight, this effect may be through perceived overweight. This study tested if perceived overweight mediates the association between actual obesity and intention to control weight in groups based on the intersection of race and gender. For this purpose, we compared Non-Hispanic White men, Non-Hispanic White women, African American men, African American women, Caribbean Black men, and Caribbean Black women.

Methods:

National Survey of American Life, 2001–2003 included 5,810 American adults (3516 African Americans, 1415 Caribbean Blacks, and 879 Non-Hispanic Whites). Weight control intention was entered as the main outcome. In the first step, we fitted race/gender specific logistic regression models with the intention for weight control as outcome, body mass index as predictor and sociodemographics as covariates. In the next step, to test mediation, we added perceived weight to the model.

Results:

Obesity was positively associated with intention for weight control among all race × gender groups. Perceived overweight fully mediated the association between actual obesity and intention for weight control among Non-Hispanic White women, African American men, and Caribbean Black men. The mediation was only partial for Non-Hispanic White men, African American women, and Caribbean Black women.

Conclusions:

The complex relation between actual weight, perceived weight, and weight control intentions depends on the intersection of race and gender. Perceived overweight plays a more salient role for Non-Hispanic White women and Black men than White men and Black women. Weight loss programs may benefit from being tailored based on race and gender. This finding also sheds more light to the disproportionately high rate of obesity among Black women in US.

The Association Between Obesity and Weight Loss Intention Weaker Among Blacks and Men than Whites and Women

INTRODUCTION

Although obesity is associated with weight loss intention, the magnitude of this association may differ across various populations. Using a nationally representative data of the United States, this study tested the variation of the association between obesity and weight loss intention based on race and gender.

METHODS

Data came from the National Survey of American Life (NSAL), 2001-2003, which enrolled 5,810 nationally representative sample of adults (3,516 African Americans, 1,415 Caribbean Blacks, and 879 Non-Hispanic Whites). Socio-demographics, body mass index (BMI), and weight loss intention were measured. We fitted logistic regression models in the pooled sample with weight loss intention as outcome, obesity (BMI > 30) as predictor, while the effect of covariates were controlled. To test our moderation hypotheses, we entered race * obesity and gender * obesity interactions to the model.

RESULTS

Although the association between obesity and weight loss intention was significant among both race and gender groups, the magnitude of the association between obesity and weight loss intention was larger for women than men and Whites than Blacks. That means individuals with obesity have less intention for weight loss if they are Black or men.

CONCLUSION

The link between obesity and weight loss intention depends on race and gender. Weight loss intention may not increase in response to obesity among Blacks and men, compared to Whites and women. Healthy weight programs in the United States may benefit from tailoring based on race and gender.

Your Path to Transplant: a randomized controlled trial of a tailored computer education intervention to increase living donor kidney transplant

BACKGROUND

Because of the deceased donor organ shortage, more kidney patients are considering whether to receive kidneys from family and friends, a process called living donor kidney transplantation (LDKT). Although Blacks and Hispanics are 3.4 and 1.5 times more likely, respectively, to develop end stage renal disease (ESRD) than Whites, they are less likely to receive LDKTs. To address this disparity, a new randomized controlled trial (RCT) will assess whether Black, Hispanic, and White transplant patients' knowledge, readiness to pursue LDKT, and receipt of LDKTs can be increased when they participate in the Your Path to Transplant (YPT) computer-tailored intervention.

METHODS/DESIGN

Nine hundred Black, Hispanic, and White ESRD patients presenting for transplant evaluation at University of California, Los Angeles Kidney and Pancreas Transplant Program (UCLA-KPTP) will be randomly assigned to one of two education conditions, YPT or Usual Care Control Education (UC). As they undergo transplant evaluation, patients in the YPT condition will receive individually-tailored telephonic coaching sessions, feedback reports, video and print transplant education resources, and assistance with reducing any known socioeconomic barriers to LDKT. Patients receiving UC will only receive transplant education provided by UCLA-KPTP. Changes in transplant knowledge, readiness, pros and cons, and self-efficacy to pursue LDKT will be assessed prior to presenting at the transplant center (baseline), during transplant evaluation, and 4- and 8-months post-baseline, while completion of transplant evaluation and receipt of LDKTs will be assessed at 18-months post-baseline. The RCT will determine, compared to UC, whether Black, Hispanic, and White patients receiving YPT increase in their readiness to pursue LDKT and transplant knowledge, and become more likely to complete transplant medical evaluation and pursue LDKT. It will also examine how known patient, family, and healthcare system barriers to LDKT act alone and in combination with YPT to affect patients' transplant decision-making and behavior. Statistical analyses will be performed under an intent-to-treat approach.

DISCUSSION

At the conclusion of the study, we will have assessed the effectiveness of an innovative and cost-effective YPT intervention that could be utilized to tailor LDKT discussion and education based on the needs of individual patients of different races in many healthcare settings.

TRIAL REGISTRATION

ClinicalTrials.gov, number NCT02181114.

Assessing Readiness to Lose Weight among Obese Women Attending the Nutrition Clinic

BACKGROUND

Assessing individual's readiness to change and targeting the inter-vention to the level of readiness may improve successful weight loss rates. This study aimed to assess readiness for weight loss in obese women using the trans theoretical model.

METHODS

A cross-sectional study was conducted on 90 volunteer apparently healthy obese women, in Ardabil, Iran. Participants completed the translated and validated University of Rhode Island Change Assessment questionnaire in their first visit. Subjects were categorized into one of the stages of change based on the highest of four z-transformed scale scores. The readiness to change score was calculated.

RESULTS

More than half of the participants were in early stages of weight loss and 24.5% were in the action stage. The readiness score in the precontemplation stage was significantly lower than the other stages, but no significant difference was observed among the contemplation, action and maintenance stages. The significant correlation was observed between the stages of change and waist-to-hip ratio (r=0.33, P<0.05).

CONCLUSION

Obese women attending the nutrition clinic are in different stages to change for weight loss. Understanding person specific stages of change ori-entates the dietitian to use the most appropriate counseling strategies. Hence the stages and readiness to change should be considered before implementing any intervention in clinical settings for optimal outcomes.

Rationale, design, and baseline characteristics of a community-based comparative effectiveness trial to prevent type 2 diabetes in economically disadvantaged adults: the RAPID Study

Reaching Out and Preventing Increases in Diabetes (RAPID) is a community-based randomized trial evaluating the comparative costs and effectiveness of a group-based adaption of the DPP lifestyle intervention developed and implemented in partnership with the YMCA. RAPID enrolled adult primary care patients, with BMI 24 kg/m(2) or higher and abnormal glucose metabolism (HbA1c 5.7-6.9% or fasting plasma glucose 100-125 mg/dL). 509 participants were enrolled and randomized to one of two groups: standard clinical advice plus free-of-charge access to a group-based adaption of the DPP offered by the Y, versus standard clinical advice alone. Key outcomes for future analysis will include differences in body weight and other cardiovascular risk factors over a 24-month intervention period. At baseline, RAPID participants had a mean (SD) age of 51 ± 12.1 years, weight of 225.1 ± 56.2 lbs, and BMI of 36.9 ± 8.6 kg/m(2). 70.7% were women, 57.2% were African American, 35.4% were non-Hispanic White, and 3.2% were Hispanic. Mean HbA1c was 6.05 ± 0.34%. Additionally, 55.4% of participants had a baseline systolic blood pressure of ≥130 mmHg, 33.1% had a total blood cholesterol exceeding 200mg/dL, and 74% reported a household income of <$25,000. The RAPID Study successfully randomized a large cohort of participants with a wide distribution of age, body weight, and race who are at high risk for developing type 2 diabetes.

Latent class analysis of stages of change for multiple health behaviors: results from the Special Diabetes Program for Indians Diabetes Prevention Program

This study sought to identify latent subgroups among American Indian and Alaska Native (AI/AN) patients with pre-diabetes based on their stages of change for multiple health behaviors. We analyzed baseline data from participants of the Special Diabetes Program for Indians Diabetes Prevention (SDPI-DP) Program, a lifestyle intervention program to prevent diabetes among AI/ANs. A total of 3,135 participants completed baseline questionnaires assessing stages of change for multiple health behaviors, specifically exercise, healthy eating, and weight loss. Latent class analysis was used to identify subgroups of people based on their answers to stages of change questions. Covariates were added to the latent class analyses to investigate how class membership was related to sociodemographic, behavioral, and psychosocial factors. Three classes were identified based on the distributions of the stages of change variables: Contemplation, Preparation, and Action/Maintenance classes. Male and retired participants were more likely to be in more advanced stages. Those who exercised more, ate healthier diets, and weighed less were significantly more likely to be in the Action/Maintenance class. Further, the participants who had higher self-efficacy, stronger family support, and better health-related quality of life had higher odds of being in the Action/Maintenance class. In conclusion, we found that stages of change for multiple behaviors can be summarized by a three-class model in this sample. Investigating the relationships between latent classes and intervention outcomes represents important next steps to extend the findings of the current study.

The transtheoretical model as applied to dietary behaviour and outcomes

The transtheoretical model (TTM) is a behavioural theory that describes behaviour change as occurring in five stages, ranging from precontemplation to maintenance. The purpose of the present paper is to review and synthesise the literature published since 1999 on applications of the TTM to dietary behaviour so that the evidence for the use of assessment tools and interventions based on this model might be evaluated. Six databases were identified and searched using combinations of key words. Sixty-five original, peer-reviewed studies were identified and summarised in one of three tables using the following categories: population (n 21), intervention (n 25) and validation (n 19). Internal validity ratings were given to each intervention, and the body of intervention studies as a whole was rated. The evidence for using stage-based interventions is rated as suggestive in the areas of fruit and vegetable consumption and dietary fat reduction. Valid and reliable staging algorithms are available for fruit and vegetable consumption and dietary fat intake, and are being developed for other dietary behaviours. Few assessment tools have been developed for other TTM constructs. Given the popularity of TTM-based assessments and interventions, more research is warranted to identify valid and reliable assessment tools and effective interventions. While the evidence supports the validity of the TTM to describe populations and to form interventions, evidence of the effectiveness of TTM-based interventions is not conclusive.

Evaluation findings from genetics and family health history community-based workshops for African Americans

The purpose of this study was to examine the implementation and effectiveness of community education workshops to change genetics and health-related knowledge, intentions, and behavior of urban African Americans. Eight workshops were held and 183 participants consented to participate in the study. A majority of the participants were African American (97%) and female (84%) and just over half were 65 years and older (60%), and had some high school or were high school graduates (52%). The community-based workshops were standardized and comprised a 45-min PowerPoint presentation that included group discussions and interactive activities. The evaluation used a pre-post design with a 2-month follow-up. The group as a whole (and the subgroups by age and education level) significantly improved their knowledge of race and genetics from pretest to posttest as measured by their scores on the "Race", Genetics, and Health knowledge questions. Findings around intentions showed that the largest number of participants pledged to collect family health history information from family members. Findings around behavior changes showed that, along the stages of change continuum, there were more participants at maintenance (stage 5) at the 2-month follow-up than at the pre-workshop for three health-related activities. Feedback was positive as participants indicated they appreciated the information they received and audience involvement. The article discusses local and global implications for practice and research among community health educators.

African American women and weight loss: disregarding environmental challenges

In the United States, almost 80% of African American women are either overweight or obese. In this study, 46 low-income African American women struggling with weight issues participated in structured interviews using a social cognitive theory framework. Participants shared their social cognitive theory related weight loss thoughts and their perceived weight loss obstacles. Results suggest that although participants' primary weight-related obstacles were environment-based, for example, unsafe environments in which to engage in regular exercise, they more often offered individual-based solutions. The study concludes with a discussion of media advocacy as a tool that can be used to promote environmental solutions.

Assessing the Stages of Change Among African American Women in a Weight Management Program

The objective of this study was to assess the relationship between stage of change (SOC) and behavioral outcomes among African American women entering obesity treatment in two settings. Fifty-five overweight/obese (body mass index = 26.50-48.13), but otherwise healthy African American women, 23 to 56 years old, attended a 13-week weight loss-treatment program that took place at churches (n = 36) or a university (n = 19). Participants were weighed, completed SOC measures, and had a physical fitness test at pre- and posttreatment. Pretreatment measures of SOC placed 47% of the participants as actors, 31% as contemplators, and 22% as maintainers. Of the 45 women who reported posttreatment SOC, 7% regressed, 44% did not change, and 31% progressed in SOC. Pretreatment SOC predicted posttreatment weight loss in the church setting but not in the university setting. At churches, contemplators lost more weight than actors and maintainers. The church may be a more conducive setting for weight change behaviors for African American women who are categorized as contemplators in the SOC model.

Parents' stage of change for diet and physical activity: influence on childhood obesity

Highly visible public health education efforts have resulted in increased awareness of the childhood obesity epidemic but not a related decline in the number of overweight children. The Transtheoretical Model was used to examine the associations among child risk factors, parent's knowledge of factors associated with childhood obesity and their access to healthy foods in their community and parent's stage of change (SOC) in making behavior changes to improve their child's diet and level of physical activity. Parents (n = 124) of children between 6-12 years of age were surveyed. Perceived weight of the child and the child's body mass index (BMI) were found to be associated with parent's SOC for food portions and dietary fats, yet this was not observed for the fruits and vegetables or physical activity domains. Food availability and parent's childhood obesity knowledge was not found to be associated with parent's SOC. This study provides evidence that intervention efforts that stress knowledge of the causes and harmful effects of being overweight may have limited effectiveness.

Validação interna do questionário de estágio de prontidão para mudança do comportamento alimentar e de atividade física

OBJETIVO: Traduzir para a língua portuguesa e adaptar o conteúdo do questionário de avaliação dos estágios de prontidão para mudança do comportamento alimentar e de atividade física proposto por Sutton et al para a aplicação em adolescentes, além de verificar a consistência interna e a reprodutibilidade da nova versão do instrumento. MÉTODOS: A validação de conteúdo foi realizada por um grupo multiprofissional, foi consultado após a tradução e re-tradução do instrumento com o intuito de gerar uma versão coerente, seguida da adaptação cultural realizada por meio de escala Likert, que objetivou analisar a clareza e a relevância, avaliada pelos adolescentes para cada uma das afirmações. A reprodutibilidade e a consistência interna foram analisadas pelo preenchimento do questionário por 32 adolescentes obesos de ambos os sexos, ingressantes em programa de tratamento multiprofissional da obesidade, com idade média de 13,5 (±1,6) anos e peso médio de 86,1kg (±18,8). Para avaliar a consistência interna, aplicou-se o coeficiente Alpha de Cronbach e, para a reprodutibilidade, os coeficientes de correlação de Pearson, Spearman e intraclasse, além do teste t. RESULTADOS: Os resultados revelaram alta reprodutibilidade do instrumento e, no que diz respeito à consistência interna, foram demonstrados bons índices de confiabilidade para todos os domínios, tendo em vista que todos eles apresentaram valores superiores ou bem próximos a 0,70. CONCLUSÕES: O questionário apresentou boa consistência interna e reprodutibilidade para avaliar o estágio de prontidão de mudança do comportamento alimentar e de atividade física em adolescentes obesos. Contudo, para que a validade externa do instrumento seja confirmada, é oportuno que outros estudos sejam realizados.

Metabolic syndrome in African Americans: views on making lifestyle changes

This study explores African American adults' understanding of metabolic syndrome (MetS) and their motivations for making lifestyle changes. African Americans have a greater risk for components of MetS, such as hypertension. Three focus groups were conducted with African American adults (n = 11) with MetS. Content analysis revealed five themes: Threat of Poor Health, Building Trust With Providers, Gaining Social Support, Seeking Culturally Acceptable Alternatives, and Getting on Track and Staying on Track. Lifestyle interventions for African Americans with MetS need to focus on building trust, developing self-monitoring skills, social support, and identifying low-cost/convenient opportunities for physical activity.

Addressing health disparities among African Americans: using the stages of change model to document attitudes and decisions about nutrition and physical activity

Physical activity (PA) and poor fruit/vegetable intake are contributors of health disparities among African Americans (AA). In order to design effective interventions to address these behaviors, it is essential to assess where individuals are in terms of their attitudes and decisions. The aim of this study was to use the Stages of Change Model to assess AA's attitudes and decisions regarding pertinent health behaviors and provide suggestions about how to address them. A survey was administered to 242 low-income, medically underserved adults (47% AA, 27% White, and 26% "Others"). The majority was in the SOC's: "contemplation" stage for PA (they were considering PA); "maintenance" stage for vegetable intake (they had consumed > or =3 vegetable servings daily for > or =6 months); and in the "contemplation" stage for fruit intake (those grouped as "Others" were significantly more likely to be in the "maintenance" stage). Although education and awareness are important, this study has implications for interventions with greater emphasis on creating environments or providing resources to promote or support behavioral change.

Establishing the stages and processes of change for weight loss by consensus of experts

The present study aimed to establish, by a consensus of experts, the stages and processes of change for weight management in overweight and obese people. The first step involved developing two questionnaires aimed at assessing stages and processes of change for weight loss in overweight and obese people. The processes-of-change questionnaire consisted of 12 subscales, and contained 107 items. A three-round Delphi study was carried out through a website, where participants were asked to give their opinion about the representativeness and clarity of the scale items. The stages-of-change questionnaire consisted of five items and was presented in the final round of the study. A team of 66 experts in the obesity field from 29 countries participated in the study. They were selected either because they belonged to the organizing committee of international associations related to obesity, or because of their research career. The required changes in the questionnaire were made according to the opinions of the participants. Some of these were the result of the group statistical response, whereas others were due to the suggestions made by the participants. A final version of the questionnaire consisting of 63 items was eventually obtained. The present study produced two questionnaires to assess stages and processes of change for weight management. The strength of the study lies in the consensus reached by the panel of experts in order to establish the required content of the questionnaires. The two measures provide useful tools for practitioners who wish to tailor weight-management interventions according to transtheoretical model constructs.

Are the stages of change socioeconomically distributed? A scoping review

OBJECTIVE

To conduct a rapid scoping review to explore the hypothesis that socioeconomic affluence is associated with a more advanced stage of change for health behaviors.

DATA SOURCE

Key-word searches of MEDline, Embase, PyschlNFO, and www.google.com were conducted.

STUDY INCLUSION AND EXCLUSION CRITERIA

Studies identified by the searches were included if they were published between 1982 and September 2003, written in English, and reported information on the distribution of the stages of change for any health behavior according to a marker of socioeconomic position (SEP).

DATA EXTRACTION

Data on the behavior studied, the sample studied, the measure of SEP used, the definitions of the stages of change used, and the distribution of the stages of change according SEP were extracted by a single reviewer.

DATA SYNTHESIS

As far as possible, data were reanalyzed by the chi-square test to determine if there was evidence that the distribution of the stages of change varied according to SEP. A formal meta-analysis was not appropriate. Results. Twenty-one studies reporting data on 30 samples and 188,850 individuals were included. Significant variations in the distribution of the stages of change were found according to SEP, in the expected direction, in 16 (53%) samples representing 171,183 (91%) individuals.

CONCLUSIONS

There is substantial published evidence that more-affluent people tend to be in more-advanced stages of change than are more-deprived people.