1. DPT 844 Health Behaviors By: Meghan Zidonis
Addressing Weight Concerns through the Transtheoretical (Stages of Change) Model: A Case Study
DPT 844 Health Behaviors
By: Meghan Zidonis

2. Demographics 51 year-old White female Catholic 3 adult children
Highest education: Master’s degree
Current job: Financial Analyst
Enjoys traveling, gardening, and swimming
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3. Initial Meeting Health Behavior: Concerned about her weight
Developed this problem: 5 years ago
Co-morbidities: HTN and Type 2 Diabetes
Height: 5’2” Weight: 159 lbs. BMI: 29.1
% Body Fat: 25%
BP: 130/64 mmHg
RHR: 82 bpm
RR: 14 breaths/min
BMI = overweight
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4. Transtheoretical (Stages of Change) Model
Individual recognizes she is overweight and is seeking help to lose weight
Unsure how to change, failed previous attempts (decreased self-efficacy)
Can enter and exit at any stage
Able to provide support through education and motivation
Application of theory results in improved physical activity and dietary habits.1
Strengths: Tailored to individual, easy to use for PA.2 Many processes to facilitate progression through stages
Weaknesses: Ambiguity with applying time to operationalize stages.3
5 distinct stages, instead of a continuous process
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5. Pre-Assessment
Score: 0-8 precontemplation, 9-19 contemplation, preparation ready to move toward action

6. Plan of Action Face-to-face meetings once a week for 4 weeks
“Individual Readiness for Change Questionnaire” screening tool (previous slide) at initial & 5th meeting.4
Starting in Contemplation stage.
Intends to take action in next 6 months.
Collect baseline info (height, weight, etc.) at initial meeting and 5th meeting for comparison.
Provide Nutritional/Activity log to track food and water intake, as well as physical activity.
Encourage and motivate individual to reevaluate feelings about losing weight to establish appropriate goals.

7. Process of Intervention
Given clear week-to-week schedule to track:
Minutes and type of exercise
Nutrition log
Ounces of water
Sedentary lifestyle (inactivity) and obesity coexist.5
Poor diet and nutrition lead to higher rates of obesity, diabetes, and cardiovascular disease.6
Education is important to prevent or decrease obesity.
Personalize and create specific POA and goals
Increasing factors of weight loss maintenance: monitoring, PA, self-efficacy/empowerment, internalization, complementarity of social support, and accommodation7

8. Goals
Long term
Will perform 30 mins. of exercise 5x/week by the end of 4 weeks.
Will demonstrate understanding of healthy weight by verbalizing operational definition of BMI within 4 weeks.
Will verbalize AHA recommendations for exercise by the end of 4 weeks.
Will demonstrate understanding of nutrition by verbalizing healthy food and beverage choices according to Dietary Guidelines by the end of 4 weeks.
Weekly
Will perform 30 mins. of exercise 3x/week.
Will lose 1 pound a week.
Will log dietary (food & water) intake every day.
Will get up and off computer hourly at work and perform activity of choice.

9. Information Obtained at Meetings
Baseline info presented above
Meeting 2-4
Reviewed logs
Discussed how she felt about the week & her change
Took weight
Meeting 5
Repeat baseline info for comparison
Re-administered readiness to change questionnaire
Overall feelings about 4 week intervention

10. Sample Nutrition/Activity Log
6/16/17
Bowl of cheerios, ½ cup milk, banana
Turkey sandwich on wheat w/ cheese, pretzels, yogurt
BBQ chicken, baked potato w/ butter, and zucchini w/ ranch.
Pudding, strawberries w/ rediwhip, 4 cookies, 2 Ben and Jerry IC bars
✓ = 8 oz. of water
From American Diabetes Association ✓ ✓ ✓
10 – walked dog

11. Post-Assessment

12. Results Final stage: Preparation stage (initially Contemplation)
Weight- M1: 159 M2: 159 M3: 160 M4: 159 M5: 158
BMI: 28.9 (vs. 29.1), Body Fat: 25%
BP: 120/71 (vs. 130/64), HR: 70 (vs. 82)
Logged dietary intake every day, with demo of healthier food choices and increased water intake by meeting 5
Exercised 30 mins. 3x/wk. during mtgs 1-3, 5x/wk. mtgs 4-5
Lost 1 pound total
Signed up for American Diabetes Association newsletter and MyFitnessPal without instruction to do so
**Interventions were effective in helping individual reach her goals established for this time period!**
M = meeting

13. Adjustments During Process
Added a contract for individual to sign after mtg 2
Education to reduce stress eating
Instead of focusing on cognitive aspects, added behavioral and psych/affective processes to motivate and promote self-efficacy to change8
Together, came up with a list of possible exercises9
i.e. instead of just walking or swimming (b/c of bad weather) can do workout DVDs, resistance band, or clean house
Cognitive aspects (self reevaluation), behavioral (self liberation), psych/affective (environmental reevaluation)

14. Future in Mind
Final instructions: Continue to use log, increase exercise as able, call if need help or support
Plans to maintain: Buy healthy/nutritious food and limit sweets/junk food in house and at work. Suggested joining gym or program like Weight Watchers.
Future goals
Consistently perform 150 minutes of moderate exercise each week
Lose 10 lbs. to work towards healthy weight
Normal BMI would mean a weight of 136 lbs. or less
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15. Conclusion
Theory influenced instructional/educational strategies to progress individual to next stage
How modify case in future:
Simplify and organize handouts.
Alternatives to “treats” for birthdays, holidays, etc.
Tips to control work environment
How inform my future PT practice (with theory)
Take time to address health behavior concerns
Empower individuals by tailoring education10
Simplify for success
Collaborate with multiple disciplines when appropriate11
Different health behaviors can be at different stages

16. References
Bedeschi L, Santos L, Souza Lopes A, et al. Interventions directed at eating habits and physical activity using the transtheoretical model: A systematic review. Nutricion Hospitalaria [serial online]. September 2016;33(5): Available from: Academic Search Complete, Ipswich, MA. Accessed June 4, 2017.
Nigg C, Geller K, Motl R, Horwath C, Wertin K, Dishman R. A research agenda to examine the efficacy and relevance of the transtheoretical model for physical activity behavior. Psychology Of Sport & Exercise [serial online]. January 2011;12(1):7-12. Available from: Academic Search Complete, Ipswich, MA. Accessed July 9, 2017.
Menezes M, Mingoti S, Cardoso C, Mendonça R, Lopes A. Intervention based on transtheoretical model promotes anthropometric and nutritional improvements - A randomized controlled trial. Eating Behaviors [serial online]. April 2015;17: Available from: CINAHL Plus with Full Text, Ipswich, MA. Accessed June 4, 2017.
Ceccarini M, Borrello M, Pietrabissa G, Manzoni GM, Castelnuovo G. Assessing motivation and readiness to change for weight management and control: an in- depth evaluation of three sets of instruments. Frontiers in Psychology. 2015;6:511. doi: /fpsyg
Baysal H, Hacialioglu N. The effect of a transtheoretical model-based education and follow-up on providing overweight women with exercise behavior. International Journal Of Caring Sciences [serial online]. January 2017;10(1): Available from: CINAHL Plus with Full Text, Ipswich, MA. Accessed June 4, 2017.
Ghannadiasl F, Mahdavi R, Jafarabadi M. Assessing readiness to lose weight among obese women attending the nutrition clinic. Health Promotion Perspectives [serial online]. January 2014;4(1): Available from: Academic Search Complete, Ipswich, MA. Accessed June 4, 2017.
Macchi C, Russell C, White M. Shifting processes model: A conceptual model for sustainable weight management. Families, Systems & Health: The Journal Of Collaborative Family Healthcare [serial online]. December 2013;31(4): Available from: Sociological Collection, Ipswich, MA. Accessed June 4, 2017.
Cook A, O'leary F, Allman-Farinelli M. Behavioural and cognitive processes adults use to change their fruit and vegetable consumption. Nutrition & Dietetics [serial online]. December 2015;72(4): Available from: CINAHL Plus with Full Text, Ipswich, MA. Accessed June 4, 2017.
Råberg Kjøllesdal M, Hjellset V, Bjørge B, Holmboe-Ottesen G, Wandel M. Intention to change dietary habits, and weight loss among Norwegian-Pakistani women participating in a culturally adapted intervention. Journal Of Immigrant & Minority Health [serial online]. December 2011;13(6): Available from: CINAHL Plus with Full Text, Ipswich, MA. Accessed June 4, 2017.
Tuah N, Amiel C, Qureshi S, Car J, Kaur B, Majeed A. Transtheoretical model stages of change for dietary and physical exercise modification in weight loss management for overweight and obese adults. Cochrane Database Of Systematic Reviews [serial online]. February 2014;(2). Available from: CINAHL Plus with Full Text, Ipswich, MA. Accessed June 4, 2017.
Armitage C, Norman P, Noor M, Alganem S, Arden M. Evidence that a very brief psychological intervention boosts weight loss in a weight loss program. Behavior Therapy [serial online]. September 2014;45(5): Available from: Academic Search Complete, Ipswich, MA. Accessed June 4, 2017. 

17. Picture from: http://adjunctassistance
2nd picture given to me by volunteer (picture of trail she walks)