Objective:

To evaluate the stages and processes of change for weight loss in patients living with obesity who have had a recent stroke or TIA. 

Background:

Weight loss is recommended for patients living with obesity in the secondary prevention of stroke. Few studies, however, have examined the stages and processes of change for weight loss in stroke patients living with obesity.

Design/Methods:

Using a validated questionnaire, we assessed each patient’s stage of behavioral change according to the transtheoretical model (precontemplation, contemplation, preparation, action, and maintenance). We also examined 4 processes of behavioral change, which quantify activities and experiences that patients undergo on the way to behavioral change: emotional reevaluation (EMR), weight management action (WMA), weight consequence evaluation, and supporting relationships. Process scores were compared between patients in the action and maintenance stages and those in the precontemplation, contemplation, and preparation stages. 

Results:

44 patients met inclusion/exclusion criteria: 6 (14%) were in the precontemplation stage of change, 7 (16%) were in contemplation, 2 (5%) were in preparation, 13 (30%) were in action, and 16 (36%) were in maintenance. Those in the action and maintenance stages accounted for the majority of participants (n = 29, 66%). Patients in the action and maintenance stages (N = 29) had higher EMR scores (mean 79, SD 13 vs. mean 68, SD 19, t = 2.0, p = 0.03) and WMA scores (mean 69, SD 13 vs. mean 59, SD 19, t = 2.0, p = 0.03) as compared to those in the precontemplation, contemplation, and preparation stages (N = 15). 

Conclusions:

Without counseling or specific intervention, two-thirds of stroke/TIA patients living with obesity are in the action or maintenance stage of behavior change with respect to weight loss.  Patients who score higher in EMR and WMA are more likely to be in the action or maintenance stage of change.