Abstract
Obesity is prevalent but undertreated in primary care. Family practice volunteer outpatients (N=454) were administered the Stage of Change for Weight (URICA), the Brief Symptom Inventory (BSI), and the Diet Readiness Test (DRT) to assess the relationship between these variables and obesity. The body mass index (BMI) was used to classify obesity revealing 197 patients with elevated BMI's. There was no significant difference between the obese and the nonobese on any of the psychological measures. The obese reported significantly more difficulty setting diet goals and less control over their eating, ate more to emotional situations, and exercised less than the nonobese. The obese sample (46.7%) reported being in the Action stage of change for weight management. Implications for intervention in primary care include targeting attitudes (DRT) and dispelling physician attitudes that obese individuals have increased levels of psychological distress. Addressing Stage of Change for weight management can facilitate tailoring the appropriate intervention when used in concert with the DRT variables.
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Amenson, C., & Lewinsohn, P. (1981). An investigation into the sex difference in prevalence of unipolar depression.Journal of Abnormal Psychology, 90 1–13.
American Psychiatric Association (1994).Diagnostic and statistical manual of mental disorders, DSM-IV. Washington, DC: Author.
Barrett, J., & Hurst, M. (1982). Short-term symptom change in outpatient psychiatric disorders.archives of General Psychiatry, 39 849–854.
Brown, P. J. (1993). Cultural perspectives on the etiology and treatment of obesity. In A. J. Stunkard & T. A. Wadden (Eds.),Obesity: Theory and therapy (2nd ed., pp. 179–193). New York: Raven Press.
Brownell, K. D. (1982). Obesity: Understanding and treating a serious, prevalent and refractory disorder.Journal of Consulting and Clinical Psychology, 50 820–840.
Brownell, K. D. (1984). The psychology and physiology of obesity: Implications for screening and treatment.Journal of the American Dietetic Association, 84(4), 406–413.
Brownell, K. D. (1990). Dieting readiness.Weight Control Digest, 1 1–9.
Brownell, K. D. (1994).The Learn Program for weight control (6th ed.), Dallas, Texas: American Health Publishing Company.
Brownell, K. D., & Stunkard, A. J. (1980). Exercise in the development and control of obesity. In A. J. Stunkard (Ed.),Obesity (pp. 300–324). Philadelphia: W. B. Saunders.
Brownell, K. D., & Wadden, T. A. (1992). Etiology and treatment of obesity: Understanding a serious, prevalent, and refractory disorder.Journal of Clinical and Consulting Psychology, 60(4), 505–517.
Brownell, K. D., Marlatt, G. A., Lichtenstein, E., & Wilson, G. T. (1986). Understanding and preventing relapse.American Psychologist, 41(7), 765–782.
Cabanac, M. (1991). Open-loop methods to study the ponderostat. In M. I. Friedman, M. G. Tordoff, & M. R. Kare (Eds.),Appetite and nutrition. New York: Marcel Dekker.
Campbell-Kramish, M., DeVellis, B. M., Strecher, V. J., Ammerman A. S., DeVillis, R. F., & Sandler, R. S. (1994). Improving dietary behavior: The effectiveness of tailored messages in primary care settings.American Journal of Public Health, 84 (5), 783–786.
Coyne, J. C., Fechner-Bates, S., & Schwenk, T. L. (1994). Prevalence, nature, and comorbidity of depressive disorders.General Hospital Psychiatry, 16(4), 267–276.
Derogatis, L. R. (1977).The SCL-90 manual: Scoring, administration and procedures for the SCL-90. Baltimore: Clinical Psychometric Research.
Derogatis, L., & Melisaratos, N. (1983). The Brief Symptom Inventory: An introductory report.Psychological Medicine, 13 595–605.
DiClemente, C. C., & Hughes, S. (1990). Stages of change profiles in outpatient alcoholism treatment.Journal of Substance Abuse, 2 217–235.
Faubel, M. (1988). Body image and depression in women with early and late onset obesity.The Journal of Psychology, 123(4), 385–395.
Faulkner, K. K., & Dueker, S. J. (1989). Stress, time distortion, and failure to recover among obese individuals: Implications for weight gain and dieting.International Journal of Eating Disorders, 8 247–250.
Fitzgibbon, M. L., Stolley, M. R., & Kirschenbaum, D. S. (1993). Obese people who seek treatment have different characteristics than those who do not seek treatment.Health Psychology, 12(5), 342–345.
Foreyt, J. P. (1987). Issues in the assessment and treatment of obesity.Journal of Consulting and Clinical Psychology, 55 677–684.
Frank, A. (1993). Futility and avoidance: Medical professional in the treatment of obesity.Journal of the American Medical Association, 269(16), 2132–2133.
Ganley, R. M. (1989). Emotion and eating in obesity: A review of the literature.International Journal of Eating Disorders, 8(3), 343–361.
Garrow, J. (1991). Importance of obesity.Behavioral Medicine Journal, 303 704–706.
George, V. (1990). Effect of dietary fat content on total and regional adiposity in men and women.International Journal of Obesity, 14 1085–1094.
Goldstein, D. J. (1992). Beneficial health effects of modest weight loss.International Journal of Obesity, 16 397–415.
Halmi, K. A., Long, M., Stunkard, A. J., & Mason, E. (1980). Psychiatric diagnosis of morbidly obese gastric bypass patients.American Journal of Psychiatry, 137 470–472.
Harris, S. S., Caspersen, C. J., DeFriese, G. H., & Estes, H. (1989). Physical activity counseling for healthy adults as a primary preventative intervention in the clinical setting. Report for the US Preventative Services Task Force.Journal of the American Medical Association, 261(24), 3590–3598.
Hoebel, B. G., & Hernandez, L. (1993). Basic neural mechanisms of feeding and weight regulation. In A. J. Stunkard & T. A. Wadden (Eds.),Obesity: Theory and therapy (pp. 43–62). New York: Raven Press.
Jeffery, R. W. (1991). Population perspectives on the prevention and treatment of obesity in minority populations.American Journal of Clinical Nutrition, 53 1621S-1624S.
Keesey, R. E. (1993). Physiological regulation of body energy: Implications for obesity. In A. J. Stunkard & T. A. Wadden (Eds.),Obesity: Theory and therapy (pp. 77–96). New York: Raven Press.
Kendall, A., Lezitsky, D. A., Strupp, B. J., & Lissner, L. (1991). Weight loss on a low-fat diet: Consequences of the imprecision of the control of food intake in humans.American Journal of Clinical Nutrition, 53 1124–1129.
Keys, A. (1955). Obesity and heart disease [Editorial].Journal of Chronic Disease, 1 456–460.
Leon, G. R., & Roth, L. (1977). Obesity: Psychological causes, correlations, and speculations.Psychological Bulletin, 84 117–139.
Logue, E., Gilchrist, V., Bourguet, C., & Bartos, P. (1993). The recognition and management of obesity in a family practice setting.Journal of the American Board of Family Practice, 6 457–63.
Logue, E., Smucker, W., and the Nutrition, Exercise, and Obesity Group (1994).Central obesity and beliefs regarding diet, exercise, and weight loss in a primary care setting. Paper presented at the 22nd annual meeting of the North American Primary Care Research Group, Toronto, Canada, Oct.
Logue, E., Smucker, W. D., & Bourguet, C. C. (1995). Identification of obesity: Waistlines or weight?Journal of Family Practice, 41(4), 357–363.
Maddox, G. L., & Liederman, V. (1969). Overweight as a social disability with medical implications.Journal of Medical Education, 44 214–220.
Marcus, B. H., Rakowski, W., & Rossi, J. S. (1992). Assessing motivational readiness and decision making for exercise.Health Psychology, 11(4), 257–261.
Marcus, B. H., Rossi, J. S., Selby, V. C., Niaura, & Abrams, D. B. (1992). The stages and processes of exercise adoption and maintenance in a worksite sample.Health Psychology, 11(6), 386–395.
Marlatt, G. A., & Gordon, J. R. (Eds.). (1985).Relapse prevention: Maintenance strategies in the treatment of addictive behaviors. New York: Guildford Press.
McConnaughy, E. A., Prochaska, J. O., & Velicer, W. F. (1983). Stages of change in psychotherapy: Measurement and sample profiles.Psychotherapy, 20 368–375.
Perri, M. G., Shapiro, R. M., Ludwig, W. W., Twentyman, C. T., & McAdoo, W. G. (1984). Maintenance strategies for the treatment of obesity: An evaluation of relapse prevention training and posttreatment contact by mail and telephone.Journal of Consulting and Clinical Psychology, 46 463–469.
Prochaska, J. O. (1994). Strong and weak principles for progressing from precontemplation to action on the basis of twelve problem behaviors.Health Psychology, 13(1), 47–51.
Prochaska, J. O., & DiClemente, C. C. (1992). Stages of change in the modification of problem behaviors. In M. Hersen, R. M. Eisler, & P. M. Miller (Eds.),Progress in behavior modification. Syacamore, IL: Sycamore.
Prochaska, J. O., & Norcross, C. C. (1992). Attendence and outcome in a work site weight control program: Processes and stages of change as process and prediction variables.Addictive Behaviors, 17 35–45.
Prochaska, J. O., DiClemente, C. C., & Norcross, J. C. (1992). In search of how people change: Applications to addictive behavior.American Psychologist, 47(9), 1102–1114.
Prochaska, J. O., DiClemente, C. C., Velicer, W. F., & Rossi, J. S. (1993). Standardized, individualized, interactive and personal self-help programs for smoking cessation.Health Psychology, 12 399–405.
Prochaska, J. O., Velicer, W. F., Rossi, J. S.,et al. (1994). Stages of change and decisional balance for 12 problem behaviors.Health Psychology, 13(1), 39–46.
Public Health Service (1991). Objectives 1.2, 2.3, 15.10 and 17.12.Health People 200: National health promotion and disease prevention objectives. Washington, DC: U.S. Government Printing Office.
Redding, C. C. (1993).The transtheoretical model applied to safer sex behavior among university students: A cross sectional investigation, Unpublished doctoral dissertation. Kingston: University of Rhode Island.
Revicki, D. A., & Israel, R. G. (1986). Relationship between body mass indices and measure of body adiposity.American Journal of Public Health, 76 992–994.
Rodin, J., Schank, D., & Striegel-Moore, R. (1989). Psychological features of obesity,Medical Clinics of North America, 73(1), 47–66.
Rosenbloom, D. (1991).A transtheoretical analysis of change among cocaine users, Unpublished doctoral dissertation. Kingston: University of Rhode Island.
Rosenfield, S. N., & Stevenson, J. S. (1988). Perceptions of daily stress and oral coping behaviors in normal, overweight, and recovering alcoholic women.Research in Nursing and Health, 11 165–174.
Rossi, S. R. (1993).Application of the Transtheoretical Model to dietary fat reduction in a naturalistic environment. Kingston: University of Rhode Island. (Published on Microfilm DAI, reference for dietary fat stage of change related measures).
Royce, D. (1984). Screening drug abuse clients with the Brief Symptom Inventory.The International Journal of Addictions, 8 849–857.
Spitzer, R. L., & Hasin, D. (1992). Is there another binge eating disorder? A review of the literature on overeating in the absence of bulimia nervosa.Special section: Eating disorders in DSM-IV, 11(4), 333–340.
Stunkard, A. J., & Penick, S. B. (1979). Behavior modification in the treatment of obesity. The problem of maintaining weight loss.Archives of General Psychiatry, 36 801–806.
Stunkard, A. J., & Wadden, T. A. (1992). Psychological aspects of severe obesity.American Journal of Clinical Nutrition, 55 524S-32S.
Thompson, J. K., Jarvie, G. J., Lahey, B. B., & Cureton, K. H. (1982). Exercise and obesity: Etiology, physiology, and intervention.Psychological Bulletin, 91 55–79.
Tremblay, A., Depres, J. P., & Leblanc, C. (1990). Effect of intensity of physical activity on body fatness and fat distribution.American Journal of Clinical Nutrition, 51 153–7.
U.S. Department of Health and Human Services (1990).Health People 2000: National health promotion and disease prevention objectives. Washington, DC: U.S. Department of Health and Human Services. Publication No. PHS 91-50212.
Wadden, T. A. (1987). Psychopathology and obesity.Annals of the New York Academy of Science, 499 55–65.
Wadden, T. A., & Stunkard, A. J. (1985). Social and psychological consequences of obesity.Annals of Internal Medicine, 103 1062–1067.
Wadden, T. A., Foster, G. D., Stunkard, A. J., & Linowitz, J. R. (1989). Dissatisfaction with weight and figure in obese girls: Discontent but not depressed.International Journal of Obesity, 13 889–897.
Wing, R. R. (1992a). Behavioral treatment of severe obesity.American Journal of Clinical Nutrition, 55 545S-551S.
Wing, R. R. (1992b). Weight recycling in humans: A review of the literature.Annals of Behavioral Medicine, 14 113–119.
Yasmura, S., Harrison, J. K., McNeal, K. G., Woodhead, A. D., & Dilmanian, F. A. (1990).In vivo body composition studies: Recent advances. New York: Plenum Press.
Zung, W. W., Broadhead, E. W., & Roth, M. E. (1993). Prevalence of depressive symptoms in primary care.Journal of Family Practice, 37(4), 337–344.
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Cowan, R., Britton, P.J., Logue, E. et al. The relationship among the transtheoretical model of behavioral change, psychological distress, and diet attitudes in obesity: Implications for primary care intervention. J Clin Psychol Med Settings 2, 249–267 (1995). https://doi.org/10.1007/BF01990880
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DOI: https://doi.org/10.1007/BF01990880