Office-Based Motivational Interviewing to Prevent Childhood Obesity: A Feasibility Study

Harvard University, Cambridge, Massachusetts, United States
Archives of Pediatrics and Adolescent Medicine (Impact Factor: 5.73). 06/2007; 161(5):495-501. DOI: 10.1001/archpedi.161.5.495
Source: PubMed


To determine whether pediatricians and dietitians can implement an office-based obesity prevention program using motivational interviewing as the primary intervention.
Nonrandomized clinical trial. Fifteen pediatricians belonging to Pediatric Research in Office Settings, a national practice-based research network, and 5 registered dietitians were assigned to 1 of 3 groups: (1) control; (2) minimal intervention (pediatrician only); or (3) intensive intervention (pediatrician and registered dietitian).
Primary care pediatric offices.
Ninety-one children presenting for well-child care visits met eligibility criteria of being aged 3 to 7 years and having a body mass index (calculated as the weight in kilograms divided by the height in meters squared) at the 85th percentile or greater but lower than the 95th percentile for the age or having a normal weight and a parent with a body mass index of 30 or greater.
Pediatricians and registered dietitians in the intervention groups received motivational interviewing training. Parents of children in the minimal intervention group received 1 motivational interviewing session from the physician, and parents of children in the intensive intervention group received 2 motivational interviewing sessions each from the pediatrician and the registered dietitian.
Change in the body mass index-for-age percentile.
At 6 months' follow-up, there was a decrease of 0.6, 1.9, and 2.6 body mass index percentiles in the control, minimal, and intensive groups, respectively. The differences in body mass index percentile change between the 3 groups were nonsignificant (P=.85). The patient dropout rates were 2 (10%), 13 (32%), and 15 (50%) for the control, minimal, and intensive groups, respectively. Fifteen (94%) of the parents reported that the intervention helped them think about changing their family's eating habits.
Motivational interviewing by pediatricians and dietitians is a promising office-based strategy for preventing childhood obesity. However, additional studies are needed to demonstrate the efficacy of this intervention in practice settings.

Download full-text


Available from: Gema G Dumitru, Jan 13, 2014
  • Source
    • "It could be explained by the dietetic patterns, the lack of physical activity, and the sedentary behavior of studied subjects. Our results agree with those that have reported nutritional and physical activity and motivational interviewing training interventions in similar populations [33,34]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Background: The beneficial effects of the Mediterranean diet have been amply proven in adults with cardiovascular risk factors. The effects of this diet have not been extensively assessed in pediatric populations with obesity, insulin resistance (IR) and metabolic syndrome (MetS). The aim of this study was to assess the efficacy of the Mediterranean style diet (MSD) to decrease cardiovascular risk factors in children and adolescents with obesity. Methods: Participants were randomly assigned to a MSD rich in polyunsaturated fatty acids, fiber, flavonoids and antioxidants (60% of energy from carbohydrate, 25% from fat, and 15% from protein, (n = 24); or a standard diet (55% of carbohydrate, 30% from fat and 15% from protein, (n = 25), the caloric ingest was individualized. At baseline and 16-week of intervention, the glucose, triglycerides (TG), total cholesterol (TC), HDL-C, LDL-C were measured as well as the body composition and anthropometric data. The diet compliance was determined by the 24-hour recalls.Paired Student's t and Macnemar's test were used to compare effects in biochemical, body composition, anthropometric, and dietary variables. Results: The MSD group had a significantly decrease in BMI, lean mass, fat mass, glucose, TC, TG, HDL-C and LDL-C. (p < 0.05); the diet compliance increased consumption of omega 9 fatty acids, zinc, vitamin E, selenium, and decreased consumption of saturated fatty acids (p < 0.05). The standard diet group decrease in glucose levels and frequency of glucose >100 mg/dL (p < 0.05). Conclusion: The MSD improves the BMI, glucose and lipid profile in children and adolescents with obesity and any MetS component.
    BMC Pediatrics 07/2014; 14(1):175. DOI:10.1186/1471-2431-14-175 · 1.93 Impact Factor
  • Source
    • "Studies presenting outcomes, however, are still few. A feasibility study in which pediatricians and dieticians applied motivational interviewing to parents of overweight children showed no significant change in the children's weights (Schwartz et al., 2007). Three study design articles were published from randomized clinical trials on motivational interviewing for childhood overweight and obesity, as yet with no outcomes (Bean et al., 2011; Dalton et al., 2011; Taylor et al., 2010). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Motivational interviewing is a counseling method used to bring about behavior change; its application by school nurses for preventing obesity in children is still new. This study, based on in-depth interviews with 12 school nurses, shows how school nurses adapted motivational interviewing and integrated it into their daily practice along with other methods they knew from the past. Three dilemmas for school nurses were revealed: when the child was severely overweight and the parents did not perceive this as a problem, when the child and the parents were at different stages of motivation to change, and when applying an individualized approach such as motivational interviewing for preventing a complex societal problem, in this instance obesity. The study raises an important issue to consider, with implications for school nursing and obesity prevention: motivational interviewing as either a counseling method or a prevention strategy.
    The Journal of School Nursing 01/2014; 30(6). DOI:10.1177/1059840514521240 · 1.11 Impact Factor
  • Source
    • "In 2007, a U.S. expert committee recommended that obesity counseling be conducted in the primary care setting, specifically suggesting that pediatricians use patient-centered techniques such as motivational interviewing to counsel patients about improving health behaviors [2]. The use of motivational interviewing techniques in clinical settings has been reported to be programmatically feasible and effective in improving health behaviors [3,4], but it is also important to assess the time and financial resources needed to implement such programs. Decision makers such as health providers, health care payers, and policymakers can use analyses of the costs of health interventions to assess the affordability of interventions and to prioritize resources among competing programs. "
    [Show abstract] [Hide abstract]
    ABSTRACT: United States pediatric guidelines recommend that childhood obesity counseling be conducted in the primary care setting. Primary care-based interventions can be effective in improving health behaviors, but also costly. The purpose of this study was to evaluate the cost of a primary care-based obesity prevention intervention targeting children between the ages of two and six years who are at elevated risk for obesity, measured against usual care. High Five for Kids was a cluster-randomized controlled clinical trial that aimed to modify children's nutrition and TV viewing habits through a motivational interviewing intervention. We assessed visit-related costs from a societal perspective, including provider-incurred direct medical costs, provider-incurred equipment costs, parent time costs and parent out-of-pocket costs, in 2011 dollars for the intervention (n = 253) and usual care (n = 192) groups. We conducted a net cost analysis using both societal and health plan costing perspectives and conducted one-way sensitivity and uncertainty analyses on results. The total costs for the intervention group and usual care groups in the first year of the intervention were $65,643 (95% CI [$64,522, $66,842]) and $12,192 (95% CI [$11,393, $13,174]). The mean costs for the intervention and usual care groups were $259 (95% CI [$255, $264]) and $63 (95% CI [$59, $69]) per child, respectively, for a incremental difference of $196 (95% CI [$191, $202]) per child. Children in the intervention group attended a mean of 2.4 of a possible 4 in-person visits and received 0.45 of a possible 2 counseling phone calls. Provider-incurred costs were the primary driver of cost estimates in sensitivity analyses. High Five for Kids was a resource-intensive intervention. Further studies are needed to assess the cost-effectiveness of the intervention relative to other pediatric obesity interventions.Trial registration: Identifier: NCT00377767.
    BMC Health Services Research 01/2014; 14(1):44. DOI:10.1186/1472-6963-14-44 · 1.71 Impact Factor
Show more