Objective: The aim of this study was to investigate associations of stage of behavior change across four weight-related behaviors (dietary calorie reduction, fruit and vegetable intake, dietary fat reduction, and physical activity) with longitudinal weight change among Veterans at the Atlanta VA.
Methods: Data from two linked data sources were used. The Screening for Diabetes and Prediabetes in Primary Care study assessed stages of behavior change for all participants at baseline collected between 2009-2012. Overweight participants with follow up care at the VA, with at least 2 recorded weights in primary care health records through December 2020, were included in the present analysis. Associations between stage of change and longitudinal weight changes, measured using body mass index (BMI), were analyzed, adjusted for other demographic (age, race, sex) and baseline clinical factors (diabetes status, family history of diabetes, and obesity status).
Results: A total of 886 individuals reported being overweight with complete stage of change and weight data; a majority of participants were clinically defined as obese (66.8%, BMI ³ 30 kg/m2), but actively trying to make healthy behavior changes. Controlling for age and diabetes status, BMI significantly decreased (p<0.05) among participants in the action stage of change. However, the rate of decrease was not significantly different between the stages of change; except for fat reduction where reduction in BMI for participants in the precontemplation and contemplation stages was significantly greater compared to those in the action stage. The annual rate of decrease in BMI was significantly faster among participants who were 65 and older and among those with diabetes.
Conclusions: The BMI of participants who were actively trying to make diet and exercise changes did not decrease at a faster rate compared to those who were not trying. Older individuals, and those with diabetes, are losing more weight compared to younger individuals without diabetes. Further research is required to determine the benefits of utilizing a stage of change assessment when initiating weight loss efforts.
Table of Contents
Table of Contents
Chapter I: Background Literature Review 1
OBESITY IN THE UNITED STATES 1
OBESITY AND TYPE II DIABETES 1
THE TRANSTHEORETICAL MODEL AND STAGES OF CHANGE THEORY 4
EFFECTS OF TRANSTHEORETICAL-BASED INTERVENTIONS ON DIET 5
EFFECTS OF TRANSTHEORETICAL MODEL-BASED INTERVENTIONS ON PHYSICAL ACTIVITY 6
OBESITY AND DIABETES AT THE VA 9
Chapter II: Stages of Behavior Change and Longitudinal Weight Trends in Atlanta Veterans 12
Longitudinal Study Design and Measures 14
Data Analysis 16
Participant Characteristics 18
Multilevel Modeling Stage of Change 19
Chapter III: Public Health Implications and Future Research 26
PUBLIC HEALTH IMPLICATIONS 26
FUTURE RESEARCH 27
About this Master's Thesis
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