Wilson Mitch, Orgass Hailey, Dearborn-Tomazos Jennifer
Division of Vascular Neurology, Department of Neurology, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Massachusetts, USA.
Department of Neurology, Yale New Haven Hospital/Yale School of Medicine, New Haven, Connecticut, USA.
Cerebrovasc Dis Extra. 2022;12(1):1-6. doi: 10.1159/000521387. Epub 2021 Dec 10.
Obesity is associated with an increased prevalence of vascular risk factors and incidence of stroke. As such 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.
The aim of the study was to evaluate the stages and processes of change for weight loss in patients living with obesity who have had a recent stroke or TIA.
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. Processes scores were compared between patients in the action and maintenance stages and those in the precontemplation, contemplation, and preparation stages.
Out of 49 patients who provided informed consent, 44 met the inclusion/exclusion criteria. Of these 44 patients, 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).
Our results suggest that without counseling or specific intervention, approximately two-thirds of stroke/TIA patients living with obesity are in the action or maintenance stage of behavior change with respect to weight loss and therefore more likely to succeed in intensive lifestyle-based interventions targeted towards weight loss. Patients who score higher in EMR and WMA are more likely to be in the action or maintenance stage of change.
肥胖与血管危险因素的患病率增加及中风发病率相关。因此，对于肥胖的中风患者，建议在二级预防中进行减肥。然而，很少有研究探讨肥胖中风患者减肥的改变阶段和过程。
本研究的目的是评估近期发生中风或短暂性脑缺血发作（TIA）的肥胖患者减肥的改变阶段和过程。
我们使用经过验证的问卷，根据跨理论模型（前意向阶段、意向阶段、准备阶段、行动阶段和维持阶段）评估每位患者的行为改变阶段。我们还研究了行为改变的4个过程，这些过程量化了患者在行为改变过程中所经历的活动和体验：情绪重新评估（EMR）、体重管理行动（WMA）、体重结果评估和支持性人际关系。比较了行动和维持阶段的患者与前意向、意向和准备阶段的患者的过程得分。
在49名提供知情同意的患者中，44名符合纳入/排除标准。在这44名患者中，6名（14%）处于改变的前意向阶段，7名（16%）处于意向阶段，2名（5%）处于准备阶段，13名（30%）处于行动阶段，16名（36%）处于维持阶段。行动和维持阶段的患者占大多数（n = 29，66%）。与前意向、意向和准备阶段的患者（N = 15）相比，行动和维持阶段的患者（N = 29）的EMR得分更高（平均79，标准差13 vs.平均68，标准差19，t = 2.0，p = 0.03），WMA得分也更高（平均69，标准差13 vs.平均59，标准差19，t = 2.0，p = 0.03）。
我们的结果表明，在没有咨询或特定干预的情况下，大约三分之二的肥胖中风/TIA患者在减肥方面处于行为改变的行动或维持阶段，因此更有可能在以生活方式为基础的强化减肥干预中取得成功。在EMR和WMA中得分较高的患者更有可能处于改变后的行动或维持阶段。
