THE INDIVIDUAL BASIS FOR MAKING DECISIONS

Another way to approach the matching of individuals with treatments is to identify important factors that may influence decisionmaking. We have identified three sets of such factors: (1) personal, situational, and global factors; (2) health status and weight-related risk factors; and (3) information and guidance.

Personal factors include demographic ones, such as age and gender, that cannot be changed, as well as psychosocial ones, such as motivation and readiness to change, that one can alter. Situational factors can be changed by the individual's actions; an example is using the stairs whenever appropriate rather than the elevator. Finally, global factors are those that influence the environment in which an individual lives, such as culture and views about weight; they typically change slowly over time from the efforts of large numbers of people. The ready availability and cost of a weight-loss program are two global factors that often influence a person's decision about whether or not to undertake a particular weight-loss program.

Health status and weight-related risk factors are factors that, as they worsen, may become an individual's primary motivation for losing weight. However, concerns about appearance are usually given by individuals seeking a weight-loss program, and these may conflict with actions taken on the basis of health-related considerations. For example, health considerations generally support small incremental weight losses to a level likely to be maintained over the long term, while appearance considerations predispose many to try repeatedly to achieve large weight losses at a rate requiring an unhealthy and ultimately unsustainable level of caloric restriction. Health considerations will argue against weight loss by those who consider themselves to be overweight but are not so by standards described in Chapter 2. There are strong reasons why health status should take precedence, especially in those at risk for comorbid conditions by family history or prior morbidity or those in whom comorbid conditions (e.g., diabetes, dyslipidemias, hypertension, sleep apnea, and osteoarthritis) are already present (see Chapter 2). Individuals should pay particular attention to their weight if they have a family history of premature comorbidities, increased visceral fat as indicated by waist-to-hip ratios in men of >1.0 and in women of >0.8, or BMIs associated with increased risk (>25 with one or more comorbid conditions and >27 without a comorbid condition).

Information and guidance come from a variety of sources, including the media (information and advertising); family, friends, and acquaintances



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