Motivation for lifestyle change among literate obese patients in an out patient department

Abstract

Background: Obesity is a chronic multifactorial disease which significantly contributes to increased morbidity and mortality from non-communicable diseases. Nutritional transition as a result of urbanization, adoption of western lifestyles and demographic transition are thought to contribute to this problem in Nigeria. Primary care physicians should be actively involved in prevention of obesity, early detection and motivating people for life style change. Motivation is an important first step towards any action or behaviour change and clinicians can assess and enhance a person's motivation to change well before extensive damage is done to health, relationships, reputation, or self-image. This study was aimed at determining the pattern of motivation to change and predictive factors among literate obese patients in a primary care setting.

Methods: A cross-sectional study was conducted between July and October 2012, among literate obese patients in the outpatient setting of an urban hospital, as a first step towards a behavioural intervention in primary care. Obese patients based on BMI, were identified by clinical examination in the OPD. Readiness to change was measured with the University of Rhode Island Change Assessment (URICA) score.

Results: Prevalence of obesity among literate patients in the outpatient setting was 17.43%. Most of the subjects were married (83.8%), female (76.5%) had tertiary education (64.7%) and were of the professional cadre (54.4%) while 41.1% were self-employed. Mean age was 43.5±9.2. Most earned more than forty thousand naira per month, and majority (69.1%) felt that they were motivated (self- perception) to lose weight, but most (58%) were not confident that they could lose weight (self-efficacy). Most of them had at least one co-morbidity at presentation. Based on the URICA readiness to change score, most of the literate obese patients were contemplators (73.5%), 25% were pre-contemplators, while 1.5% were in the preparation for action stage. There were no significant relationships between occupation, gender, marital status, ethnic group, age, education, income, self-perception of motivation, selfefficacy, and illness presentation, with the stage of change.

Conclusion: Obesity is fairly common among literate patients in the outpatient setting. The mean readiness to change URICA score was 8.68±1.68, and most (73.5%) were in the contemplation stage.

Keywords: Obesity, weight loss, lifestyle, stages of change, URICA