Motivational Interviewing for Pediatric Obesity: Conceptual Issues and Evidence Review

University of Michigan, School of Public Health, 1420 Washington Heights (SPH II), Room 5009, Ann Arbor, MI 48109-2029, USA.
Journal of the American Dietetic Association (Impact Factor: 3.92). 01/2007; 106(12):2024-33. DOI: 10.1016/j.jada.2006.09.015
Source: PubMed


Counseling by health care professionals represents a potentially important intervention for the prevention and treatment of pediatric obesity. One promising approach to weight-control counseling in pediatric practice is motivational interviewing. This article explores conceptual issues related to the application of motivational interviewing for the prevention and treatment of pediatric obesity. Given the paucity of studies on motivational interviewing and pediatric obesity, we examine what is known about the application of motivational interviewing to modify diet, physical activity, and other behaviors in children and adolescents. We begin with a brief overview of motivational interviewing, describe some nuances of applying this approach to pediatric overweight, and conclude with research and clinical recommendations.

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Available from: Stephen Rollnick
    • "Participants of minority ethnic/racial groups (Hettema et al., 2005; Lundahl et al., 2010) and international participants (Hettema & Hendricks, 2010) have demonstrated larger effect sizes than Caucasian American participants, but the data on MI with minority groups are still limited. Few moderators of the efficacy of MI have been analyzed in the child literature thus far, and knowledge of the situations and participants that would be most likely to benefit from MI is greatly needed (Erickson et al., 2005; Resnicow, Davis, & Rollnick, 2006; Suarez & Mullins, 2008). Jensen and colleagues (2011) found that studies conducted on alcohol, tobacco, and drug interventions yielded relatively homogeneous effects (i.e., yielded a nonsignificant Q statistic). "
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    ABSTRACT: Objective: Motivational interviewing (MI) is an empirically supported intervention that has shown effectiveness in moving people toward positive lifestyle choices. Although originally designed for adult substance users, MI has since expanded to other health concerns with a range of client age groups. The present study investigated the overall effectiveness of MI in the context of child and adolescent health behavior change and health outcomes. Method: A literature search using PsycINFO, PubMed, GoogleScholar, and Social Work Abstracts was performed. Thirty-seven empirical studies were included in this meta-analysis, encompassing 8 health domains. Results: The overall effect size (Hedges's g) of MI in this population as compared to both other active treatments and no treatment was g = 0.282 (95% CI [0.242, 0.323], SE = 0.021), slightly higher than a small effect size and also slightly higher than what has been typically found in the substance literature. Effect sizes varied by health condition such that the health domains with the largest overall effect sizes were Type 1 diabetes, asthma, and calcium intake. Conclusions: The effectiveness of MI in pediatric domains was moderated by factors such as practitioner background, health domain, and the family member who participated. Unexpectedly, number of MI sessions and follow-up length were not significant moderators. MI seems to be most effective when both parent and child participate in sessions and when the cultural background of the practitioner matches the family. Overall, these findings indicate that MI is an effective and appropriate intervention for targeting child health behavior changes.
    No preview · Article · Feb 2014 · Journal of Consulting and Clinical Psychology
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    • "One intervention strategy that shows promise in establishing healthy lifestyles and could fit within the time constraints of primary care is motivational interviewing (MI) [27,28]. Using patient-centered strategies such as open-ended questions, positive affirmations and reflective listing, MI elicits internal motivation for behavior change while addressing the ambivalence and discrepancies between a person’s current values and behavior (e.g., “Heavy is healthy”) and their future goals (e.g., “I don’t want my child to get diabetes.”). "
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    ABSTRACT: Leading medical organizations have called on primary care pediatricians to take a central role in the prevention of childhood obesity. Weight counseling typically has not been incorporated into routine pediatric practice due to time and training constraints. Brief interventions with simple behavior change messages are needed to reach high-risk children, particularly Latino and Black children who are disproportionately affected by obesity and related comorbidities. Steps to Growing Up Healthy (Added Value) is a randomized controlled trial testing the efficacy of brief motivational counseling (BMC) delivered by primary care clinicians and the added value of supplementing BMC with monthly contact by community health workers (CHW) in the prevention/reversal of obesity in Latino and Black children ages 2-4 years old. Mother-child dyads (targeted n = 150) are recruited for this 12-month randomized trial at an inner-city pediatric primary care clinic and randomized to: 1) BMC delivered by clinicians and nurses at well, sick, and WIC visits with the goal of reducing obesogenic behaviors (BMC); 2) BMC plus monthly phone calls by a CHW (BMC + Phone); or 3) BMC plus monthly home visits by a CHW (BMC + Home). During BMC, the medical team facilitates the selection of a specific goal (i.e., reduce sugar sweetened beverage consumption) that is meaningful to the mother and teaches the mother simple behavioral strategies. Monthly contacts with CHWs are designed to identify and overcome barriers to goal progress. Dyads are assessed at baseline and 12 months and the primary outcome is change in the child's BMI percentile. We hypothesize that BMC + Phone and BMC + Home will produce greater reductions in BMI percentiles than BMC alone and that BMC + Home will produce greater reductions in BMI percentiles than BMC + Phone. Steps to Growing Up Healthy will provide important information about whether a brief primary care-based intervention that utilizes a motivational interviewing and goal setting approach can be incorporated into routine care and is sufficient to prevent/reverse obesity in young children. The study will also explore whether monthly contact with a community health worker bridges the gap between the clinic and the community and is an effective strategy for promoting obesity prevention in high-risk families.Trial registration: NCT01973153.
    Full-text · Article · Jan 2014 · BMC Public Health
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    • "The more common scenario, however, is simply that the provider and patient could have dedicated their time and attention to more effective preventive measures, such as motivational interviewing and focused goal-setting. The literature supporting such approaches is significantly more robust than the largely disappointing evidence on the use of genetic information to motivate behavior change (Hettema & Hendricks Dec 2010; Pollak et al. 2010; Resnicow et al. 2006). "
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    ABSTRACT: There is a growing consensus that results generated through multiplex genetic tests, even those produced as a part of research, should be reported to providers and patients when they are considered "actionable," that is, when they could be used to inform some potentially beneficial clinical action. However, there remains controversy over the precise criterion that should be used in identifying when a result meets this standard. In this paper, we seek to refine the concept of "actionability" by exploring one proposed use for genetic test results. We argue that genetic test results indicating that a patient is at risk for developing a chronic health condition should not be considered actionable if the only potential value of that result is to motivate patients to make changes in their health behaviors. Since the empirical research currently available on this question is equivocal, we explore relevant psychological theories of human motivation to demonstrate that current theory does not support the assumption that information about genetic risk will be motivating to most patients in their attempts to make changes in health behaviors.
    Full-text · Article · Aug 2013
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