The Stages of Change model, which defines the six stages to making a sustained health-related behavior change, was originally developed to help people quit smoking. Applying the model to single behaviors, like smoking, drinking alcohol or fastening a seat belt, is relatively simple because the focus is limited to one specific behavior. Applying the Stages of Change model to weight loss is not simple, however, because achieving lasting weight loss requires multiple behavior changes in several areas of life, including physical activity and eating.
Stages of Change: Exercise
One area that has demonstrated positive results to use of the Stages of Change model is exercise. Tools have been developed to determine a person's stage of readiness and stage-specific guidelines have been established to reach the desired goal of making physical activity a part of daily life.1,2
Stages of Change: Eating Behaviors
The Stages of Change model has also been applied to eating behaviors. This is more difficult because of the complexity that eating involves. Altering usual food portions, changing meal patterns, making different food choices and altering food preparation methods are all distinct food behaviors. Because of this complexity, the results in studies focused on using the model to change eating behaviors have been mixed and are difficult to interpret.3
Like all models, the Stages of Change has limitations. Because it is not specifically measurable or defined, it can be difficult to clearly determine what stage a person is in at any given time. Moreover, an absolute linear progression through the stages has not been established.4 This is particularly true in the area of weight loss, most likely because of the multiple behaviors involved.
For example, in a review of studies looking at eating behaviors, it was determined that it was not possible to predict progression from the preparation stage into the action stage. Because these two stages mark the transition from "getting ready to make a change" to "making a change," the ability to assess the person's status is especially important. 5
From Change to Commitment
Readiness to change is one aspect of weight loss; staying the course once a weight loss program is started is another. Quitting a weight-loss attempt is common. New techniques are being developed and tested to address this problem.
Motivational interviewing is an emerging area of study that has shown some promise. Specifically geared to deal with the natural ambivalence that is part any lifestyle change, motivational interviewing is a method used to enhance motivation and bolster commitment to the change process. 6
The Stages of Change (also called the transtheoretical model of behavior change) was developed by James Prochaska and Carlo DiClemente in the mid-1980s. The model is based on a finding that people go through six stages of change on their way to making a sustained health-related behavior change.
Stages and Description of the Change Model1
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Precontemplation
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Does not recognize that there is a problem
Denies there is a problem
Does not see the problem as serious |
Contemplation
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Recognizes the need for behavior change
Is thinking about the pros and cons of changing the behavior |
Preparation
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Experimenting with small pieces of the behavior change
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Action
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Making definitive changes in aspects of the behavior
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Maintenance
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Maintaining new behavior over time
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Relapse
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Full or partial return to previous behaviors,
often accompanied by negative feelings
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Matching the Next Step
At the core of the model is the need to determine the person's stage of change and to match the "next step" to get them to the next stage.2 For example, a person in the precontemplation stage would be guided to learn about the health consequences of engaging in the desired behavior change with a goal of getting her to think about it (i.e., contemplation) as opposed to providing specific "do this now" instructions, an appropriate guidance for those in the action stage. Such tailored behavior change programs have been shown to increase progression to the action stage.3
In addition, research has shown that people are likely to be at different stages of change for different behaviors. One review looked at the stages of change for three different health behaviors: exercise, protection from sun exposure, and smoking cessation. Among studies examined, people were in different stages of change for each behavior and those who progressed through the stages of change were more successful in improving health behaviors.4