Weight Control: Decisional Balance

Each statement represents a thought that might occur to a person who is deciding whether or not to lose weight. Please indicate how IMPORTANT each of these statements might be to you if you were considering a decision to lose weight. There are FIVE possible responses to each of the items that reflect your answer to the question “How important would this be to you?” Please circle the number that best describes how important each statement would be to you if you were deciding whether or not to lose weight.

1 = Not important at all
2 = Slightly important
3 = Moderately important
4 = Very important
5 = Extremely important

1.	The exercises needed for me to lose weight would be a drudgery.
2.	I would feel more optimistic if I lost weight.
3.	I would be less productive.
4.	I would feel sexier if I lost weight.
5.	In order to lose weight I would be forced to eat less appetizing foods.
6.	My self-respect would be greater if I lost weight.
7.	My dieting could make meal planning more difficult for my family or housemates.
8.	My family would be proud of me if I lost weight.
9.	I would not be able to eat some of my favorite foods if I were trying to lose weight.
10.	I would be less self-conscious if I lost weight.
11.	Dieting would take the pleasure out of meals.
12.	Others would have more respect for me if I lost weight.
13.	I would have to cut down on some of my favorite activities if I try to lose weight.
14.	I could wear more attractive clothing if I lost weight.
15.	I would have to avoid some of my favorite places if I were trying to lose weight.
16.	My health would improve if I lost weight.
17.	Trying to lose weight could end up being expensive when everything is taken into account.
18.	I would feel more energetic if I lost weight.
19.	I would have to cut down on my favorite snacks while I was dieting.
20.	I would be able to accomplish more if I carried fewer pounds.

Scoring

Pros	all even numbered questions
Cons	all odd numbered questions

Description

Part of the decision to move from one stage to the next is based on the relative weight given to the pros and cons of changing behavior. The pros represent positive aspects of changing behavior, including facilitators of change. The cons represent negative aspects of changing behavior, and may be thought of as barriers to change. The decision-making component of the transtheoretical model is based on a model first conceptualized by Janis and Mann (1968, 1977). They assumed that sound decision making involves careful assessment of all relevant considerations, which are then evaluated in a decisional “balance sheet” of potential gains and losses. The anticipated gains (or benefits) and losses (or costs) can be categorized into eight major types of consequences: gains for self, losses for self, gains for significant others, losses for significant others, approval from significant others, disapproval from significant others, self-approval, and self-disapproval. Gains and losses for self and others represent utilitarian considerations that go into making the decision to change behavior, whereas approval and disapproval for self and others represent instrumental (non-utilitarian) considerations, such as self-esteem, social approval, internalized moreal standards and ego ideals. Thus, both individuals and normative reference groups are taken into account regarding instrumental objectives as well as value-based appraisals (Hoyt & Janis, 1975).

Although the Janis and Mann (1977) model proposed eight specific categories of decision-making, only two general dimensions, the pros and cons of behavior change, ahve been supported consistently by factor analytic studies (Marcus, Rakowski, & Rossi, 1992; O’Connell & Velicer, 1988: Rakowski et al., 1992; Redding, Rossi, Velicer, & Prochaska, 1989; Rossi & Blais, 1991; Velicer, DiClemente, Prochaska, & Brandenburg, 1985). Within the context of the transtheoretical model, the pros and cons were first examined for the problem of smoking cessation (Velicer et al., 1985). This research indicated the existence of a specific functional relationship between decision-making and an individual’s stage of change. Subsequent longitudinal research verified the relationship between the stages of change and decisional balance and established the predictive validity of the construct (Prochaska et al., 1985; Prochaska, Velicer et al., 1991). These studies and others across a wide range of problem behaviors have found that the comparative weighing of the pros and cons varies depending on the individual’s stage of change (Prochaska, Velicer, Rossi et al., in press). In general, the pros increase as a function of stage whereas the cons decrease. In the precontemplation stage, the cons of changing a problem behavior will be judged by individuals to outweigh the pros. In the action and maintenance stages, the pros outweigh the cons. The positive aspects of changing a problem behavior begin to outweigh the negative aspects of change in the contemplation stage. That the pros and cons are evaluated approximately equally in the contemplation stage is not surprising. The resulting indecision and lack of commitment are largely responsible for so many individuals becoming stuck in the contemplation stage, substituting thinking for action while continually struggling with weighing the costs and benefits of changing behavior.

The pros and cons of behavior change serve primarily as intermediate outcome variables in the transtheoretical model. The shift in decisional balance tends to be especially striking across the early stages of change, especially the increase in the pros from precontemplation to contemplation. Thus, decisional balance tends to be an excellent indicator of an individual’s decision to move out of the precontemplation stage. The relationship between the stages of change and decisional balance has been shown to remarkably consistent across a diverse set of problem behaviors (Prochaska, Velicer, Rossi, et al., in press), including alcohol use, radon gas exposure, mammography screening, HIV risk reduction, condom use, adolescent delinquent behavior, smoking cessation, and weight control (Marcus, Rakowski, & Rossi, 1992; Rakowski et al., 1992; Redding, 1993; Rossi, 1990; Rossi et al., 1993a, 1993b; Rossi & Blais, 1991; Rossi, Rossi, Prochaska, & Velicer, 1992; Velicer et al., 1985). Especially noteworthy is that it is not only the form of the relationship that has been replicated across problem behaviors, but also the magnitude of the change in decisional balance across the stages of change. In progressing from precontemplation to action, the pros of change tend to increase by about one standard deviation, whereas the cons of change tend to decrease by about one-half of a standard deviation. These results have led to the development of strong and weak principals of behavior change (Prochaska, in press).

References

O’Connell, d., & Velicer, W.F. (1988). A decisional balance measure for weight loss. The International Journal of Addictions, 23, 729-750.