Skip to main content
Log in

The relationship among the transtheoretical model of behavioral change, psychological distress, and diet attitudes in obesity: Implications for primary care intervention

  • Published:
Journal of Clinical Psychology in Medical Settings Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  • Amenson, C., & Lewinsohn, P. (1981). An investigation into the sex difference in prevalence of unipolar depression.Journal of Abnormal Psychology, 90 1–13.

    Article  PubMed  Google Scholar 

  • American Psychiatric Association (1994).Diagnostic and statistical manual of mental disorders, DSM-IV. Washington, DC: Author.

    Google Scholar 

  • Barrett, J., & Hurst, M. (1982). Short-term symptom change in outpatient psychiatric disorders.archives of General Psychiatry, 39 849–854.

    PubMed  Google Scholar 

  • 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.

    Google Scholar 

  • Brownell, K. D. (1982). Obesity: Understanding and treating a serious, prevalent and refractory disorder.Journal of Consulting and Clinical Psychology, 50 820–840.

    Article  PubMed  Google Scholar 

  • 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.

    PubMed  Google Scholar 

  • Brownell, K. D. (1990). Dieting readiness.Weight Control Digest, 1 1–9.

    Google Scholar 

  • Brownell, K. D. (1994).The Learn Program for weight control (6th ed.), Dallas, Texas: American Health Publishing Company.

    Google Scholar 

  • 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.

    Google Scholar 

  • 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.

    Article  Google Scholar 

  • Brownell, K. D., Marlatt, G. A., Lichtenstein, E., & Wilson, G. T. (1986). Understanding and preventing relapse.American Psychologist, 41(7), 765–782.

    Article  PubMed  Google Scholar 

  • 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.

    Google Scholar 

  • 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.

    PubMed  Google Scholar 

  • Coyne, J. C., Fechner-Bates, S., & Schwenk, T. L. (1994). Prevalence, nature, and comorbidity of depressive disorders.General Hospital Psychiatry, 16(4), 267–276.

    Article  PubMed  Google Scholar 

  • Derogatis, L. R. (1977).The SCL-90 manual: Scoring, administration and procedures for the SCL-90. Baltimore: Clinical Psychometric Research.

    Google Scholar 

  • Derogatis, L., & Melisaratos, N. (1983). The Brief Symptom Inventory: An introductory report.Psychological Medicine, 13 595–605.

    PubMed  Google Scholar 

  • DiClemente, C. C., & Hughes, S. (1990). Stages of change profiles in outpatient alcoholism treatment.Journal of Substance Abuse, 2 217–235.

    PubMed  Google Scholar 

  • Faubel, M. (1988). Body image and depression in women with early and late onset obesity.The Journal of Psychology, 123(4), 385–395.

    Google Scholar 

  • 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.

    Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • Foreyt, J. P. (1987). Issues in the assessment and treatment of obesity.Journal of Consulting and Clinical Psychology, 55 677–684.

    Article  PubMed  Google Scholar 

  • Frank, A. (1993). Futility and avoidance: Medical professional in the treatment of obesity.Journal of the American Medical Association, 269(16), 2132–2133.

    Article  PubMed  Google Scholar 

  • Ganley, R. M. (1989). Emotion and eating in obesity: A review of the literature.International Journal of Eating Disorders, 8(3), 343–361.

    Google Scholar 

  • Garrow, J. (1991). Importance of obesity.Behavioral Medicine Journal, 303 704–706.

    Google Scholar 

  • George, V. (1990). Effect of dietary fat content on total and regional adiposity in men and women.International Journal of Obesity, 14 1085–1094.

    PubMed  Google Scholar 

  • Goldstein, D. J. (1992). Beneficial health effects of modest weight loss.International Journal of Obesity, 16 397–415.

    PubMed  Google Scholar 

  • 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.

    PubMed  Google Scholar 

  • 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.

    Google Scholar 

  • 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.

    Google Scholar 

  • Jeffery, R. W. (1991). Population perspectives on the prevention and treatment of obesity in minority populations.American Journal of Clinical Nutrition, 53 1621S-1624S.

    PubMed  Google Scholar 

  • 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.

    Google Scholar 

  • 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.

    PubMed  Google Scholar 

  • Keys, A. (1955). Obesity and heart disease [Editorial].Journal of Chronic Disease, 1 456–460.

    Article  Google Scholar 

  • Leon, G. R., & Roth, L. (1977). Obesity: Psychological causes, correlations, and speculations.Psychological Bulletin, 84 117–139.

    Article  PubMed  Google Scholar 

  • 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.

    PubMed  Google Scholar 

  • 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.

    PubMed  Google Scholar 

  • Maddox, G. L., & Liederman, V. (1969). Overweight as a social disability with medical implications.Journal of Medical Education, 44 214–220.

    PubMed  Google Scholar 

  • Marcus, B. H., Rakowski, W., & Rossi, J. S. (1992). Assessing motivational readiness and decision making for exercise.Health Psychology, 11(4), 257–261.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • Marlatt, G. A., & Gordon, J. R. (Eds.). (1985).Relapse prevention: Maintenance strategies in the treatment of addictive behaviors. New York: Guildford Press.

    Google Scholar 

  • McConnaughy, E. A., Prochaska, J. O., & Velicer, W. F. (1983). Stages of change in psychotherapy: Measurement and sample profiles.Psychotherapy, 20 368–375.

    Google Scholar 

  • 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.

    Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Google Scholar 

  • 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.

    PubMed  Google Scholar 

  • Rodin, J., Schank, D., & Striegel-Moore, R. (1989). Psychological features of obesity,Medical Clinics of North America, 73(1), 47–66.

    PubMed  Google Scholar 

  • Rosenbloom, D. (1991).A transtheoretical analysis of change among cocaine users, Unpublished doctoral dissertation. Kingston: University of Rhode Island.

    Google Scholar 

  • 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.

    PubMed  Google Scholar 

  • 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.

    Google Scholar 

  • 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.

    Google Scholar 

  • 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.

    PubMed  Google Scholar 

  • Stunkard, A. J., & Wadden, T. A. (1992). Psychological aspects of severe obesity.American Journal of Clinical Nutrition, 55 524S-32S.

    PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    PubMed  Google Scholar 

  • 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.

    Google Scholar 

  • Wadden, T. A., & Stunkard, A. J. (1985). Social and psychological consequences of obesity.Annals of Internal Medicine, 103 1062–1067.

    PubMed  Google Scholar 

  • 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.

    Google Scholar 

  • Wing, R. R. (1992a). Behavioral treatment of severe obesity.American Journal of Clinical Nutrition, 55 545S-551S.

    PubMed  Google Scholar 

  • Wing, R. R. (1992b). Weight recycling in humans: A review of the literature.Annals of Behavioral Medicine, 14 113–119.

    Google Scholar 

  • 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.

    Google Scholar 

  • 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.

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

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

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF01990880

Key words

Navigation