Readiness To Do The Right Thing?

One of the most pervasive behavioural modification paradigms is Prochaska and DiClemente’s stages of change: precontemplation, contemplation, preparation, action, and maintenance.

It is therefore not surprising, that the recent Scientific Statement on New and Emerging Weight Management Strategies for Busy Ambulatory Settings From the American Heart Association, recommends the use of this paradigm in obesity management.

As the Statement points out:

“…providers should ask whether they want to lose weight and whether they believe they are ready to make changes to promote weight loss.”

The statement describes the use of a simple 5-item questionnaire, used in a descriptive study in a primary care setting, in which patients were asked to choose which of 5 statements best described their readiness for weight loss:

“I have not really thought about it” (pre-contemplation)

“I mean to lose weight but I don’t actually get around to it” (contemplation)

“From time to time, I go on a diet/exercise, but then I stop after a few days” (preparation)

“I have been working on losing weight for the past 6 months” (action)

“I have been working on losing weight for over 6 months, or I have kept my weight I lost off for over 6 months” (maintenance)

According to this study,

“Patients who were in the latter 4 stages of readiness were more likely to recall having received counseling for weight loss than those in the precontemplation stage.”

Based on this and similar studies, the Statement goes on to suggest

“…that although assessing readiness to change adds an extra step in caring for overweight and obese adults, it is a useful indicator of whether any accompanying weight loss counseling will be recalled by the patient. A patient who at least recalls weight loss counseling is better equipped to take steps toward weight loss than one who does not.”

While there is certainly nothing wrong with the ‘Readiness for Change’ paradigm in that someone in the ‘pre-contemplation’ or ‘contemplation’ stage may not be ready to embark on weight management, I often encounter patients, who are more than ready and are already ‘preparing’ or even ‘acting’, but just not preparing for or doing the right thing.

So for e.g., it is not uncommon at all, to meet patients ready to ‘lose weight’ and anxious to follow a diet or exercise plan but completely unready to actually deal with the underlying psychological or other issues that would really need to be tackled for any chance at keeping the weight off.

We see patients ready to exercise but not ready to give up their daily supply of pop, patients ready to eat more fruit and vegetables but not ready to have breakfast, patients ready to join a commercial weight loss program but not ready to tackle their abusive marriage, patients ready to go on a low-calorie diet but not ready to consider treatment for their depression.

These are patients, who are ‘ready’ to do the wrong thing but far from ready to do what is really necessary.

So being ‘ready’ alone is hardly a measure or predictor of ‘success’.

I am also not comfortable with how the ‘Readiness for Change’ model is presented in this Statement, as the focus is clearly on weight-loss, which, I cannot emphasize enough, IS NOT A BEHAVIOUR!

To be useful as a behavioural change model, the focus should be on changing a behaviour (keeping a food diary, turning off my lights at 10 pm, adding 20 mins of relaxation exercises to my daily routine, etc.).

A key challenge for health professionals, thus, is not just helping clients across the Stages of Change, but also, ensuring that their readiness is indeed focussed on doing the right thing – this, of course, is easier said than done.

Edmonton, Alberta

Rao G, Burke LE, Spring BJ, Ewing LJ, Turk M, Lichtenstein AH, Cornier MA, Spence JD, Coons M, & on behalf of the American Heart Association Obesity Committee of the Council on Nutrition, Physical Activity and Metabolism, Council on Clinical Cardiology, Council on Cardiovascular Nursing, Council on the Kidney in Cardiovascular Disease, and Stroke Cou (2011). New and Emerging Weight Management Strategies for Busy Ambulatory Settings: A Scientific Statement From the American Heart Association * Endorsed by the Society of Behavioral Medicine. Circulation, 124 (10), 1182-1203 PMID: 21824925