Weight Decisional Balance Scale

Abstract

The Weight Decisional Balance Scale is a specialized psychological assessment tool designed to quantify the perceived advantages (Pros) and disadvantages (Cons) associated with making a decision to lose weight. Developed in the context of research originating from the Transtheoretical Model (TTM) of behavioral change, the scale assesses the motivational balance that influences an individual’s readiness to act. This instrument is crucial for identifying psychological barriers and facilitators regarding weight management, allowing for targeted interventions based on an individual’s stage of change.

The scale consists of 20 items, equally divided into two subscales: Pros of Losing Weight and Cons of Losing Weight. Respondents rate the importance of each item on a 5-point Likert scale. The resulting scores are used to determine the relative strength of the arguments for and against weight loss, which, according to the TTM, must shift substantially before an individual can successfully transition into the Action stage.

Keywords

Weight loss, Decisional Balance, Transtheoretical Model, TTM, behavioral change, readiness to change, pros and cons, health psychology, motivation, obesity.

Authors

James O. Prochaska, Carlo C. DiClemente, Wayne F. Velicer, University of Rhode Island.

Purpose

The primary purpose of the Weight Decisional Balance Scale is to systematically assess the subjective value an individual places on the potential gains and losses associated with adopting weight loss behaviors. By measuring this balance, the scale serves as a diagnostic tool for researchers and practitioners to pinpoint an individual’s current stage of change (e.g., Precontemplation, Contemplation, Preparation) within the TTM framework.

Quantifying the Decisional Balance allows for the prediction of movement between the stages of change. Specifically, a successful transition from earlier, less motivated stages (like Precontemplation) to later, action-oriented stages requires a critical crossover where the perceived Pros of weight loss must significantly exceed the perceived Cons. The scale thus guides the development of stage-matched interventions aimed at shifting this cognitive balance.

Construct

The scale measures the psychological construct of Decisional Balance, which is theoretically derived from the work of Janis and Mann (1977) on conflict theory and integrated as a core component of the Transtheoretical Model. This construct operationalizes the process of weighing the perceived benefits (Pros) against the perceived costs (Cons) of altering a problematic behavior.

In the context of weight loss, the Pros subscale captures positive expectations, such as improvements in self-esteem, physical health, and social image. Conversely, the Cons subscale captures negative expectations, including sacrifices related to favorite foods, social inconvenience, financial costs, and effort expenditure. The interaction between these two factors is hypothesized to drive motivational shifts necessary for long-term behavioral change.

Validity

Decisional Balance Scales, including those adapted for weight loss, exhibit strong evidence of construct validity, confirmed by consistent findings of a two-factor structure (Pros and Cons) across diverse populations. Furthermore, the scale demonstrates high predictive validity relative to the TTM stages of change.

Empirical evidence shows a clear pattern where the Pros scores increase steadily across the stages of change (from Precontemplation to Action), while the Cons scores decrease, forming the characteristic Decisional Balance crossover point. This predictable relationship supports the scale’s ability to accurately reflect an individual’s motivational preparedness for weight loss.

Reliability

The reliability of the Decisional Balance construct is generally high. Studies assessing internal consistency often report Cronbach’s alpha coefficients for both the Pros and Cons subscales that meet or exceed acceptable standards (typically ranging from 0.70 to 0.90), indicating that the items within each factor measure a unified dimension.

Test-retest reliability is also robust, suggesting that the motivational balance, while subject to change due to intervention or life events, is stable over shorter measurement intervals. This stability makes the instrument a reliable metric for tracking motivational changes longitudinally.

Factor Analysis

Factor analysis performed on the Weight Decisional Balance Scale consistently confirms a distinct two-factor orthogonal structure. This structure separates the 20 items into the 10-item Pro factor and the 10-item Con factor. This clear separation is essential, as it validates the core TTM premise that benefits and costs are distinct psychological constructs, rather than opposite ends of a single continuum.

Research, such as that by Ward, Velicer, and Rossi (2004) on similar Decisional Balance inventories, supports the factorial invariance of this structure across different samples and populations, confirming its generalizability and theoretical purity.

Instrument

Test Type: Self-report questionnaire, psychological assessment.

Format: 20 items rated on a 5-point Likert scale.

Language Available: Primarily English, with validated translations likely available for common research languages.

Population Group: Adults concerned with weight management, obesity, or health behavior modification.

Age Group: Typically 18 years and older.

Population Details: Individuals across all stages of readiness regarding weight loss behavior change.

Test Methodology: Respondents are asked to rate “How important is this to me?” in making a decision about losing weight, using the following scale: 1=Not important at all, 2=Slightly important, 3=Moderately important, 4=Very important, 5=Extremely important. Subscale scores are derived by summing the relevant items.

Keywords

Motivation, health behavior, obesity, decisional process, psychological scale, TTM instruments, stage of change, self-efficacy, risk assessment.

Authors

Author ORCID Identifier: N/A (Information not provided in source content)

Affiliation Email addresses: N/A (Information not provided in source content)

Correspondence Address: Cancer Prevention Research Center, University of Rhode Island, Kingston, RI, USA.

Permissions & Fee and Test Year

Decisional Balance measures were initially developed and published in the mid-1980s (e.g., Velicer, DiClemente, and Prochaska, 1985), with weight-specific adaptations appearing shortly thereafter.

The instrument is associated with the University of Rhode Island. Permissions for use, especially in non-commercial academic research, should be sought from the primary authors or the URI Cancer Prevention Research Center. Commercial or clinical use may require formal licensing.

Reference’s

• Velicer, W.F., DiClemente, C.C., and Prochaska, J.O. (1985). Decisional balance measure for assessing and predicting smoking status. Journal of Personality and Social Psychology, 48, 1279-1289.
• Prochaska, J.O., Velicer, W.F., Rossi, J.S., Goldstein, M.G., Marcus, B.H., Rakowski, W., Fiore, C., Harlow, L.L., Redding, C.A., Rosenbloom, D., and Rossi, S.R. (1994). Stages of change and decisional balance for 12 problem behaviors. Health Psychology, 13, 39-46.
• Carey, K.B., Maisto, S.A., Carey, M.P., and Purnine, D.M. (2001). Measuring readiness to change substance misuse among psychiatric outpatients: Reliability and validity of self-report measures. Journal of Studies on Alcohol, 62, 79-88.
• Ward, R.M., Velicer, W.F., and Rossi, J.S. (2004). Factorial invariance and internal consistency for the decisional balance inventory – short form. Addictive Behaviors, 29, 953-958.
• Collins, Susan E., Carey, Kate B., and Otto, Jacqueline M. (2009). A New Decisional Balance Measure of Motivation to Change Among At-Risk College Drinkers. Psychol Addict Behav, 23(3): 464–471. doi: 10.1037/a0015841.

The instrument is officially available online at: http://habitslab.umbc.edu/decisional-balance-scales/

Items of the Weight Decisional Balance Scale

How important is this to me?

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

Scoring Key:

• Pros of Losing Weight: Items 2, 4, 6, 8, 10, 12, 14, 16, 18, 20
• Cons of Losing Weight: Items 1, 3, 5, 7, 9, 11, 13, 15, 17, 19