ResearchReviewMotivational Interviewing for Pediatric Obesity: Conceptual Issues and Evidence Review
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.
References (57)
- et al.
The Kaiser Permanente prenatal smoking cessation trial: When more isn’t better, what is enough?
Am J Prev Med
(1999) Motivational interviewing: Research, practice, and puzzles
Addict Behav
(1996)- et al.
Motivational interviewing in health care settings: Opportunities and limitations
Am J Prev Med
(2001) Self-perception theory
- et al.
Helping smokers make decisions: The enhancement of brief intervention for general medical practice
Patient Educ Couns
(1997) - et al.
Results of an adjunct dietary intervention program in the Women’s Health Initiative
J Am Diet Assoc
(2002) - et al.
Body and soulA dietary intervention conducted through African-American churches
Am J Prev Med
(2004) - et al.
Brief motivational intervention for adolescent smokers in medical settings
Addict Behav
(2005) - et al.
National medical spending attributable to overweight and obesity: How much, and who’s paying?
Health Affairs
(2003) - et al.
Current estimates of the economic cost of obesity in the United States
Obes Res
(1998)
The disease burden associated with overweight and obesity
JAMA
Health Consequences of obesity in youth: Childhood predictors of adult disease
Pediatrics
Ambulatory management of childhood obesity
Obes Res
Management of child and adolescent obesity: Attitudes, barriers, skills, and training needs among health care professionals
Pediatrics
Preventing and treating obesity: Pediatricians’ self-efficacy, barriers, resources, and advocacy
Ambul Pediatr
Survey of physician attitudes and practices related to pediatric obesity
Clin Pediatr
Motivational interviewing with problem drinkers
Behav Psychother
Motivational Interviewing: Preparing People to Change Addictive Behavior
Development of a short “readiness to change” questionnaire for use in brief, opportunistic interventions among excessive drinkers
Br J Addict
Effects of brief counselling among male heavy drinkers identified on general hospital wards
Drug Alcohol Rev
Project MATCH: Treatment main effects and matching results
Alcohol Clin Exp Res
The efficacy of motivational interviewing: A meta-analysis of controlled clinical trials
J Consult Clin Psychol
The use of brief interventions adapted from motivational interviewing across behavioral domains: A systematic review
Addiction
Brief motivational interviewing in a hospital setting for adolescent smoking: A preliminary study
J Consult Clin Psychol
Innovation in clinical method: Diabetes care and negotiating skills
Fam Pract
Application of motivational interviewing to prenatal smoking cessation: Training and implementation issues
Tob Control
A brief motivational intervention to improve dietary adherence in adolescents
Health Educ Res
Motivational interviewing to improve adherence to a behavioral weight-control program for older obese women with NIDDM
Diabetes Care
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.