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Stages of change and weight loss: thoughts on the Cochrane review

We often hear the phrase, “You have to be ready to lose weight.”

But what does that really mean?

I know from personal experience that external forces didn’t have an impact. Embarassing moments in department store dressing rooms, not going out to dinner parties because I had nothing to wear except extra-large scrubs, or seeing my BMI hit 29.

It wasn’t until I cleared my internal obstacles that I was able to change my relationship with food, which went from succour to simple physical sustinance.

As I look back on my weight loss journey (43 lbs!), I wonder if this time it worked because I was ready as in stages of change ready. You know the stages of change model: precontemplation, contemplation, preparation, action, and maintenance. This model has proven effective with alcohol addiction and so it makes sense that it might also work with weight loss. Because for many of us (and I do not use us lightly or loosely), over eating is an addiction.

Initially I was surprised to read the Cochrane review that the stages of change model to implement weight loss is ineffective, but then I thought about it. I thought about it a lot.

I don’t think you can possibly lose weight if you haven’t accepted that your weight is an issue (contemplation phase) and given thought to what you are going to do about it (preparation phase); however, it is that action phase that is THE killer.

If you are like me you have fallen of the action wagon more times that you care to count. You know what I mean, you start the day with the best of intentions and then something happens 1 or 2 days (sometimes 1-2 hours) into the “plan” and you fuck up your calorie intake and then, well, in for a penny in for a pound. Since the day is a write off, you indulge in an evening of that self-loathing slow dance, changing partners from pantry to fridge and back again, and then promise tomorrow you will get back on the plan. Sometimes it takes a few days to reacquaint yourself with action. Sometimes a few months, because you feel really bad. You know you let yourself down. And facing yourself is hard.

I don’t have all the answers, but I think this Cochrane review shouldn’t discourage people from assessing their readiness for weight loss. If you don’t think your weight is a problem or you are not ready to do something about it, no plan will work for you. I don’t think we need to study that, it’s common sense.

But the lack of success with stages of change in this Cochrane review tells me that the studies are looking at the stages of change model in not quite the right way. If you look at stages of change and just apply it to your weight, you will not be successful. Because the problem you need to address is not being over weight, but rather why you over eat (and here I mean me, but maybe it applies to you as well).

Once I was ready to accept and change why I was over eating, I changed my relationship with food and the action part of the plan was actually easy.

So given my experience (yes, the dreaded n =1) the way to apply the stages of change, is not, “Are you ready to make the changes needed to lose weight?”, but rather, “Are you ready to address why you are over eating?”

It’s a subtle difference, but an important one.

Discussion

4 thoughts on “Stages of change and weight loss: thoughts on the Cochrane review

  1. I want to start off by saying I’ve literally been on every spectrum of weight from very-underweight to clinically obese. I went from being 100lbs (at 5’51/2″ and 19 years old) to be over 200lbs by the time I was 20. For me, prednisone taken for lupus was to blame. And I did everything in the phases you mentioned except the first which, in my case, was the most important.

    What happened was this: I knew I was overweight, I decided to lose weight, and then I took action.

    That seemingly normal process turned into this.

    At that time of massive weight gain, I was eating my usual 1600 calorie diet. I went to a doctor who said if I ate less, I would lose weight. So, being 20, I thought: Well, the doctor said I eat too much; I must not be strict enough with myself. I will eat less. So, I cut out all all carbs except for whole grains and ate less fat and no soda and my caloric intake dropped to around 800 or even less. I was miserable. And getting FATTER. My body went into starvation mode because food was never my problem; medication was.

    The moral of the story is, anyone who’s overweight should never skip the step of asking themselves why. Because it’s not always overeating. Some people, like me, gain on medication. Other people gain because they’re very sedentary (by choice or necessity). People gain weight for all sorts of reasons. Someone eating way too many calories should find a healthy way to reduce them. My problem was medication; I had to ask my doctor to safely take me off of prednisone. (And since then, I’ve FINALLY started to lose.)

    To put it short: I caused myself a lot of physical and emotional damage by not asking myself WHY I was gaining weight. That simple step, the beginning one, defines your whole path for reaching a better weight. And I only wish someone had told me.

    Posted by Carrie Eckles | November 2, 2011, 11:35 pm
  2. As always you leave the reader wanting more. TY.

    Posted by Mohm | November 3, 2011, 3:23 am
  3. Jen, your empathy will lead you to great success in medicine. Like you, my own personal breakthroughs have come only after extensive time spent in contemplation and preparation. I see these as ‘potential energy’ and when there’s enough, I make a ‘quantum leap’… Some will call it a paradigm shift, others a spiritual experience… I am okay with any of those terms.

    I can tell, from a health standpoint (and yes I too lost 45 pounds) that I need to get help to make the changes, but ultimately it’s about me making actual changes. I can tell when I am in the solution – when I am eating smaller quantities of food, and eating really lean clean readily identifiable items… While at other times making regrettable decisions. I call that ‘slipping into my inner teen.’ Yeah, I know about the inner child, this is different… More belligerent and stubborn.

    I have finally concluded that this may be a me thing, with respect to the actual footwork, but it’s a ‘we’ thing with respect to surrounding myself with like minded people, or others who are ahead in a time sense.

    Love the costume.

    Posted by DrK Run Fitness (@DrKRunFit) | November 3, 2011, 2:05 pm

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