Health  Vol.9 No.1 , January 2017
Measuring Factors Influencing Progression across the Stages of Readiness to Lose Weight among Overweight and Obese Adolescents
Abstract: Epidemic incidence of obesity has become one of the public health priorities in disease control prevention. The study aims to determine the prevalence of readiness stages to lose weight among the overweight and obese adolescents and its influencing factors. A cross-sectional study was conducted on 631 adolescents of body mass index for age with z-score > 1 SD based on World Health Organization growth reference chart. The stages of readiness to lose weight were assessed using Trans-Theoretical Model. Intrinsic and extrinsic factors were collected using self-administered questionnaire. Majority of the respondents were in the action stage (40.3%) followed by contemplation (26.5%), preparation (15.5%), maintenance (11.4%) and pre-contemplation (6.3%). Ordinal regression analysis identified significant factors influencing progression across the stages of readiness to lose weight: no junk foods sold in school canteens (p = 0.005), TV viewing time ≤2 hours (p = 0.001), high physical activity means score (p < 0.001) and family encouragement on healthy eating (p = 0.010). Majority of adolescents who were overweight and obese were at the action stage of weight reduction. Focusing on extrinsic factors help to improve the effectiveness of weight management intervention.
Cite this paper: Sutan, R. , Johari, A. , Hod, R. and Azmi, M. (2017) Measuring Factors Influencing Progression across the Stages of Readiness to Lose Weight among Overweight and Obese Adolescents. Health, 9, 153-171. doi: 10.4236/health.2017.91011.

[1]   Ogden, C.L., Carroll, M.D., Curtin, L.R., Lamb, M.M. and Flegal, K.M. (2010) Prevalence of High Body Mass Index in US Children and Adolescents, 2007-2008. Journal of American Medical Association, 303, 242-249.

[2]   WHO (2003) Obesity and Overweight Facts. World Health Organization, Geneva.

[3]   Wolk, R. and Somers, V.K. (2006) Obesity-Related Cardiovascular Disease: Implications of Obstructive Sleep Apnea. Diabetes, Obesity and Metabolism, 8, 250-260.

[4]   International Obesity Task Force (2002) Childhood Obesity.

[5]   Jitnarin, N., Kosulwat, V., Rojroongwasinkul, N., Boonpraderm, A., Haddock, C.K. and Poston, W.S. (2011) Prevalence of Overweight and Obesity in Thai Population: Results of the National Thai Food Consumption Survey. Eating Weight and Disorder, 16, e242-e249.

[6]   Ji, C.Y. and Cheng, T.O. (2009) Epidemic Increase in Overweight and Obesity in Chinese Children from 1985 to 2005. International Journal of Cardiology, 132, 1-10.

[7]   Tee, E.S. (1999) Nutrition in Malaysia: Where Are We Heading? Malaysian Journal of Nutrition, 5, 87-109.

[8]   Kashmini, K. (1997) Prevalence of Overweight and Obesity among School Children Who Were Aged between 7-16 Years amongst the 3 Major Ethnic Groups in Kuala Lumpur, Malaysia. Asia Pacific Journal of Clinical Nutrition, 6, 172-174.

[9]   Lekhraj Rampal, G.R., Sidik, S.M., Rampal, S., Jie, D.W.Y., Lee, C.P., Shya, L.J. and Shun, S.Y. (2007) Prevalence of Overweight among Secondary School Students in Klang District, Selangor. Malaysian Journal of Nutrition, 13, 1-8.

[10]   Poh, B.K., Ismail, M.N., Ong, H.F., Norimah, A.K., Safiah, M.Y. and Zafrullah, S. (2004) Energy Requirements of Malaysian Adolescents. Final Report for IRPA 06-02-02-0096 Research Project, Kuala Lumpur: Department of Nutrition and Dietetics, Faculty of Allied Health Sciences, Universiti Kebangsaan Malaysia.

[11]   Narayanan, P., Ong, L.M. and Omar, M. (2011) Do the Prevalence and Components of Metabolic Syndrome Differ among Different Ethnic Groups? A Cross-Sectional Study among Obese Malaysian Adolescents. Metabolic Syndrome and Related Disorders, 9, 389-395.

[12]   Hazreen, M.A., Su, T.T., Jalaludin, M.Y., Dahlui, M., Chinna, K., Ismail, M., Murray, L., et al. (2014) An Exploratory Study on Risk Factors for Chronic Non-Communicable Diseases among Adolescents in Malaysia: Overview of the Malaysian Health and Adolescents Longitudinal Research Team Study (The MyHeART Study). BMC Public Health, 14, S6.

[13]   Jelalian, E. and Hart, C.N. (2009) Pediatric Obesity. In: Roberts, M.C. and Steele, R.G., Eds., Handbook of Pediatric Psychology, Vol. 4, Guilford Press, New York, 446-463.

[14]   Thomas, H. (2006) Obesity Prevention Programs for Children and Youth: Why Are Their Results So Modest? Health Education Research, 21, 783-795.

[15]   Floodmark, C.E., Marcus, C. and Britton, M. (2006) Interventions to Prevention Obesity in Children and Adolescents: A Systematic Literature Review. International Journal of Obesity, 30, 579-589.

[16]   Brown, T. and Summerbell, C. (2009) Systematic Review of School-Based Interventions That Focus on Changing Dietary Intake and Physical Activity Levels to Prevent Childhood Obesity: An Update to the Obesity Guidance Produced by the National Institute for Health and Clinical Excellence. Obesity Review, 10, 110-141.

[17]   Halberstadt, J., Makkes, S., de Vet, E., Jansen, A., Nederkoorn, C., van der Baan-Slootweg, O.H. and Seidell, J.C. (2013) The Role of Self-Regulating Abilities in Long-Term Weight Loss in Severely Obese Children and Adolescents Undergoing Intensive Combined Lifestyle Interventions (HELIOS); Rationale, Design and Methods. BMC Pediatrics, 13, 41.

[18]   Hill, J.O. and Wyatt, H. (2002) Outpatient Management of Obesity: A Primary Care Perspective. Obesity Research, 10, 124S-130S.

[19]   Anderson, P. and Butcher, K. (2006) Childhood Obesity: Trends and Potential Causes. The Future of Children, 16, 19-45.

[20]   Caprio, S. (2006) Treating Child Obesity and Associated Medical Conditions. The Future of Children, 16, 209-224.

[21]   Goldberg, J. and Kiernan, M. (2005) Innovative Techniques to Address Retention in a Behavioral Weight-Loss Trial. Health Education Research, 20, 292-298.

[22]   Oude, L.H., Baur, L., Jansen, H., Shrewsbury, V.A., O’Malley, C., Stolk, R.P. and Summerbell, C.D. (2009) Interventions for Treating Obesity in Children. The Cochrane Database of Systematic Reviews, 21, CD001872.

[23]   American Diabetes Association (ADA) (2006) Position Statement of the American Dietetic Association: Individual-, Family-, School- and Community-Based Interventions for Pediatric Overweight. Journal of American Dietetic Association, 106, 925-945.

[24]   Zimmerman, G.L., Olsen, C.G. and Bosworth, M.F. (2000) A “Stages of Change” Approach to Helping Patients Change Behavior. American Family Physician, 6, 1409-1416.

[25]   Prochaska, J. and DiClemente, C. (1983) Stages and Processes of Self-Change of Smoking: Toward an Integrative Model of Change. Journal of Consulting and Clinical Psychology, 51, 390-395.

[26]   Prochaska, J. and Velicer, W. (1997) The Trans-Theoretical Model of Health Behaviour Change. American Journal of Health Promotion, 12, 38-48.

[27]   Berry, T., Naylor, P.J. and Wharf-Higgins, J. (2005) Stages of Change in Adolescents: an Examination of Self-Efficacy, Decisional Balance, and Reasons for Relapse. Journal of Adolescent Health, 37, 452-459.

[28]   Pirasteh, A., Hidarnia, A., Asghari, A., Faghihzadeh, S. and Ghofranipour, F. (2008) Development and Validation of Psychosocial Determinants Measures of Physical Activity among Iranian Adolescent Girls. BMC Public Health, 8, 150-160.

[29]   Norman, G.J., Sallis, J.F. and Gaskins, R. (2005) Comparability and Reliability of Paper and Computer-Based Measures of Psychosocial Constructs for Adolescent Physical Activity and Sedentary Behaviors. Research Quarterly for Exercise and Sport, 76, 315-323.

[30]   Huang, Y.-J., Wong, S.H., Salmon, J. and Hui, S.S. (2011) Reliability and Validity of Psychosocial and Environmental Correlates Measures of Physical Activity and Screen-Based Behaviors among Chinese Children in Hong Kong. International Journal of Behavioral Nutrition and Physical Activity, 8, 16.

[31]   Zabinski, M.F., Norman, G.J., Sallis, J.F., Calfas, K.J. and Patrick, K. (2007) Patterns of Sedentary Behavior among Adolescents. Health Psychology, 26, 113-120.

[32]   Institute for Public Health (IPH) (2011) National Health and Morbidity Survey 2011 (NHMS 2011) Vol. II: Non Communicable Diseases.

[33]   WHO (2009) Anthro Plus for Personal Computers Manual: Software for Assessing Growth of the World’s Children and Adolescents. WHO, Geneva.

[34]   Kowalski, K.C., Crocker, P.R.E. and Donen, R.M. (2004) The Physical Activity Questionnaire for Older Children (PAQ-C) and Adolescents (PAQ-A) Manual. College of Kinesiology University of Saskatchewan, Saskatoon, 11-15.

[35]   Sallis, J.F., Grossman, R.M., Pinski, R.B., Patterson, T.L. and Nader, P.R. (1987) The Development of Scales to Measure Social Support for Diet and Exercise Behaviors. Preventive Medicine, 16, 825-836.

[36]   Rosenberg, M. (1965) Society and the Adolescent Self-Image. Princeton University Press, Princeton, 326.

[37]   MohdJamil, B.H.Y. (2006) Validity and Reliability Study of Rosenberg Self-Esteem Scale in Seremban School Children. Malaysian Journal of Psychiatry, 15, 35-39.

[38]   Andrés, A., Saldaña, C. and Gomez-Benito, J. (2009) Establishing the Stages and Processes of Change for Weight Loss by Consensus of Experts. Obesity, 17, 1717-1723.

[39]   Hosmer, D.W. and Lemeshow, S. (2000) Applied Logistic Regression. Ed Ke-2. John Wiley and Sons, New York.

[40]   Parizkova, J. and Hills, A. (2001) Childhood Obesity: Prevention and Management. CRC Press, Boca Rotan.

[41]   Gerberding, J.L. and Marks, J.S. (2004) Making America Fit and Trim—Steps Big and Small. American Journal of Public Health, 94, 1478-1479.

[42]   Foreyt, J. (2005) Need for Lifestyle Intervention: How to Begin. American Journal of Cardiology, 96, 11-14.

[43]   Chaput, J.P., Klingenberg, L., Rosenkilde, M., Gilbert, J.A., Tremblay, A. and Sjödin, A. (2011) Physical Activity Plays an Important Role in Body Weight Regulation. Journal of Obesity, 2011, Article ID: 360257.

[44]   Stoner, L., Rowlands, D.M., Credeur, D., Hamlin, M., Gaffney, K. and Matheson, A. (2016) Efficacy of Exercise Intervention for Weight Loss in Overweight and Obese Adolescents: Meta-Analysis and Implications. Sports Medicine, 46, 1737-1751.

[45]   American Heart Association (2005) A Nation at Risk: Obesity in the United States. Robert Wood Johnson Foundation, Princeton.

[46]   Koplan, J.P., Liverman, D.T. and Draak, V.I. (2006) Committee on Prevention of Obesity in Children and Youth. Preventing Childhood Obesity: Health in the Balance. Institute of Medicine, National Academies Press, Washington DC.

[47]   Story, M., Kaphingst, K.M. and French, S. (2006) The Role of Schools in Obesity Prevention. Future Child, 16, 109-142.

[48]   O’Dea, J. (2003) Why Do Kids Eat Healthful Food? Perceived Benefits of and Barriers to Healthful Eating and Physical Activity among Children and Adolescents. Journal of the American Dietetic Association, 103, 497-501.

[49]   Booth, M.L., Wilkenfeld, R.L., Pagnini, D.L., Booth, S.L. and King, L.A. (2008) Perceptions of Adolescents on Overweight and Obesity: The Weight of Opinion Study. Journal of Paediatrics and Child Health, 44, 248-252.

[50]   Monge-Rojas, R., Garita, C., Sánchez, M. and Muñoz, L. (2005) Barriers to and Motivators for Healthful Eating as Perceived by Rural and Urban Costa Rican Adolescents. Journal of Nutrition Education and Behavior, 37, 33-40.

[51]   Karimi-Shahanjarini, A., Omidvar, N., Bazargan, M., Rashidian, A., Majdzadeh, R. and Shojaeizadeh, D. (2010) Iranian Female Adolescent’s Views on Unhealthy Snacks Consumption: A Qualitative Study. Iran Journal of Public Health, 39, 92-101.

[52]   Braithwaite, I., Stewart, A.W., Hancox, R.J., Beasley, R., Murphy, R., et al. (2013) The Worldwide Association between Television Viewing and Obesity in Children and Adolescents: Cross Sectional Study. PLoS ONE, 8, e74263.

[53]   Skelton, J.A., Buehler, C., Irby, M.B. and Grzywacz, J.G. (2012) Where Are Family Theories in Family-Based Obesity Treatment? Conceptualizing the Study of Families in Pediatric Weight Management. International Journal of Obesity, 36, 891-900.

[54]   Taveras, E.M., Sobol, A.M., Hannon, C., Finkelstein, D., Wiecha, J. and Gortmaker, S.L. (2007) Youths’ Perceptions of Overweight-Related Prevention Counseling at a Primary Care Visit. Obesity, 15, 831-836.

[55]   Golan, M. and Crow, S. (2004) Parents Are Key Players in the Prevention and Treatment of Weight-Related Problems. Nutrition Review, 62, 39-50.

[56]   Rhee, K.E. (2005) Factors Associated with Parental Readiness to Make Changes for Overweight Children. Pediatrics, 116, e94-e101.

[57]   Cobb, J.E. (2011) Child and Parent Readiness to Change in a Clinical Sample of Obese Youth. Psychology Dissertations Paper 76.