Nikolas Mastellos, Laura Gunn, Lamberr Felix, Josip Car and Azeem Majeed, scientists from various research institutions in Britain and America, conducted a study to examine the effects of dietary changes or physical activity interventions, or both, on sustainable weight loss in overweight and obese adults based on the trans-theoretical model (TTM) stages of change (SOC). The study took cognizance of the rising number of people with obesity or overweight issues; and the overall health impacts that obesity has had on a global scale. The authors conducted a systematic review study that combined three previous studies. The whole research evaluated 2,971 subjects where 1,467 were given either dietary interventions or physical activity interventions, or both; while the remaining 1,504 were set as control groups. The period for the studies was nine months, one year and two years (Mastellos et al. 2014).
The systematic review study found that the use of the trans-theoretical model stages of change provided inconclusive evidence with regards to weight loss impacts on the test subjects. However, the authors noted that there were positive effects realized and recorded conclusively from the study. The benefits included increased physical activity such as increased exercise duration, higher frequency of exercise; and positive physical habits such as reduced fat intake and high intake of fruits and vegetables (Mastellos et al. 2014). The study found that one trial was particularly amenable to changes in dietary intake and physical activity such that the application of the trans-theoretical model framework to assess impacts concluded that there was a significant margin of weight loss in the test subjects. Although the systematic review study was inconclusive on the effects of interventions on weight loss and managing obesity, it showed a significant positive correlation between physical activity and weight loss; and between positive dietary habits (less calories, reduced fat intake, and increased fruit intake) and weight loss (Mastellos et al. 2014).
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The systematic review study utilized the Trans theoretical model stages of change. The TTM model of change in health behavior change studies is widely used in studies involving health issues such as obesity, addiction, and chronic illness management. The TTM method in the systematic review study was used extensively; incorporating the six stages of change: pre-contemplation, contemplation, preparation, action, maintenance, and termination. The study considered the test subjects as ill-informed and ill-equipped to begin the study, and therefore, all issues were assumed to have undergone the pre-contemplation stage. Test subjects that were unwilling to undertake in any intervention program involving dietary changes or physical activity were placed in the control group and considered part of the pre-contemplation stage. Subjects were assessed using the contemplation stage, where subjects were selected based on their willingness to undertake interventions involving changes in dietary behavior or physical activity (Hashemzadeh et al. 2019).
Subjects chosen for intervention programs were given one month (30 days) to prepare themselves for the study programs. The TTM model requires that individuals have between one to 30 days of mental and physical preparation to become fully ready to undertake a behavioral change (Hashemzadeh et al. 2019). Test subjects were evaluated based on the level of their willingness to begin the difference, and the specific changes they were ready to implement. Thus, some were chosen for physical activity studies, some for dietary changes studies while those who were extremely willing were involved in the two interventions simultaneously (Hashemzadeh et al. 2019). The next stage of the TTM model involved the execution of actual change. The action was undertaken through the implementation of the intervention programs regularly depending on the study. Some subjects reported engaging in 8 to 55 minutes of exercise every week (average: 32 minutes per week) while some reported changes in dietary habits such as reducing fat intake by <30% and increasing fruit intake by +0.2 each day (Mastellos et al. 2014). The fifth stage of the TTM SOC model is the maintenance stage where individuals maintain their chosen action for a prolonged period. In the three studies, the maintenance stage was varied from 9 months, 12 months, and 24 months (Mastellos et al. 2014). This stage refers to the period that individuals become highly self-conscious about steps towards behavioral health changes, become confident in their ability to change, stabilize their routines, and are less likely to relapse. The study did not take cognizance of results on the last stage (termination) of the TTM SOC model because all reviews did not assess individual test subjects after 24 months, and most people never move past the maintenance stage in behavioral health change because of relapses.
My beliefs support the use and inclusion of the Trans theoretical model stages of change model in assessing the efficacy of behavioral health changes in individuals. However, the application of the TTM SOC model in this systematic review study by the authors is unacceptable and has proven to be ineffective in assessing the impacts of weight loss programs on individuals.
The model implemented in the study resulted in inconclusive data regarding the effects of interventions such as physical activity and dietary changes in weight loss. The theoretical framework used has significant severe flaws that were not considered in the study. The model provides a step-to-step change analysis in individuals; which is rarely the case. Most individuals are often between two stages as proposed, while some tend to revert to previous stages. Also, the model assesses impacts on a single health behavior at a time without taking cognizance of another confounding, and at times overriding, health behaviors (Hashemzadeh et al. 2019). Finally, the model does not provide clear guidelines on how much time each individual requires to stay in one stage. Although the study analyzed more than 1000 subjects, it is unlikely they progressed from one stage to another uniformly.
References
Hashemzadeh, M., Rahimi, A., Zare-Farashbandi, F., Alavi-Naeini, A. M., & Daei, A. (2019). Transtheoretical Model of Health Behavioral Change: A Systematic Review. Iranian Journal of Nursing and Midwifery Research , 24 (2), 83–90.
Mastellos, N., Gunn, L. H., Felix, L. M., Car, J. & Majeed, A. (2014). Transtheoretical model stages of change for dietary and physical exercise modification in weight loss management for overweight and obese adults (Review). Cochrane Database of Systematic Reviews, 5 (2): 1-87.
