Research
Review
Motivational Interviewing for Pediatric Obesity: Conceptual Issues and Evidence Review

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Abstract

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.

Section snippets

Overview of Motivational Interviewing

Motivational interviewing is an egalitarian, empathetic “way of being” that manifests through specific techniques and strategies, such as reflective listening, shared decision making, and agenda setting. One of the goals of motivational interviewing is to assist individuals in working through their ambivalence about behavior change. Motivational interviewing appears to be particularly effective for individuals who are initially less ready to change (10, 12, 24, 26, 27). The tone of motivational

Three Communication Styles: A Route to Integration

It can be challenging for practitioners to fit motivational interviewing into their everyday practice. Some view it as a highly specialized skill that is difficult for the typical physician to effectively integrate and is preferentially delivered by psychologists. Yet, it is also striking how brief consultations by skilled physicians can approach the spirit and even the “laws” of motivational interviewing. One resolution to this “intimidation factor” proposed by Rollnick and colleagues (28) is

Applying Motivational Interviewing to Pediatric Obesity: Conceptual and Pragmatic Issues

There are several aspects of obesity counseling for children and adolescents that pose unique challenges for the motivational interviewing practitioner. First, depending on the age of the patient, the intervention can occur directly with the parent(s), directly with the child, or both. There is some evidence that older obese children do not benefit from involvement of their parents, whereas parent involvement can be beneficial for younger children (33). However, it is not known at what age

Dietary Intervention Study in Children

The Dietary Intervention Study in Children was a multicenter, randomized controlled trial sponsored by the National Heart, Lung, and Blood Institute to assess the efficacy of dietary counseling to decrease elevated serum lipids (low-density lipoprotein cholesterol). Children with elevated low-density lipoprotein cholesterol entered the initial clinical trial when they were 8 to 10 years of age (21). As the intervention cohort moved into adolescence, the investigators elected to add a

Future Research Questions

The studies reviewed here indicate that motivational interviewing might be feasible with children and adolescents. However, there is insufficient data to determine the efficacy of motivational interviewing for the prevention or treatment of pediatric obesity or other domains of behavior change in children. Data from adult studies suggest that motivational interviewing can be effective in modifying diet and at least short-term physical activity. However, direct evidence of efficacy for weight

Conclusions

Ultimately, the essential question might not be whether motivational interviewing is effective for control of pediatric obesity but how effective, in what populations, at what dose, and at what cost. Which pediatric health care providers are best able to deliver motivational interviewing with sufficient fidelity, how much training is needed to raise their competence to adequate levels, and how best to impart clinical skills at various career stages should also be explored. How different health

K. Resnicow is a professor and R. Davis is a doctoral student, University of Michigan, School of Public Health, Ann Arbor.

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    K. Resnicow is a professor and R. Davis is a doctoral student, University of Michigan, School of Public Health, Ann Arbor.

    S. Rollnick is a professor, Communications Skills Unit, Department of General Practice, University of Wales College of Medicine, Cardiff, UK.

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