Motivational interviewing effective for reducing childhood obesity

By Will Boggs MD

NEW YORK (Reuters Health) - Motivational interviewing (MI) delivered by providers and registered dietitians reduces body mass index (BMI) in obese children, according to a study from the Pediatric Research in Office Settings (PROS) network.

Motivational interviewing, a client-centered counseling style widely used to modify health behavior, is recommended for pediatric obesity, but its efficacy in this setting has been examined only in a few, small-scale studies.

Dr. Kenneth Resnicow, from the University of Michigan, Ann Arbor, and colleagues from 42 practices in the PROS network examined the efficacy of moderate-intensity (four sessions) of primary care provider MI-based counseling and the effect of adding six MI-based sessions by trained dietitians to parents of overweight youth aged two to eight years.

Group 1 (n=198) received usual care provided by the primary care provider (PCP). Group 2 (n=212) received four sessions of MI from the primary care provider, whereas Group 3 (n=235) received four sessions of MI from the PCP plus six additional MI sessions from a registered dietitian.

The mean dose of MI by PCPs was 3.4 and 3.3 for Groups 2 and 3, and the mean dose of MI by registered dietitians for Group 3 was well short of that planned (2.7/6). About 70% of Groups 2 and 3 received all four PCP MI sessions, but only 12% of Group 3 received all six registered dietitian MI sessions.

Compared with Group 1, there was a 2.0 BMI percentile unit difference in favor of Group 2 and a 3.1 BMI percentile unit difference in favor of Group 3 at 2 years. Group 3 fared better than Group 1 regardless of the number of MI sessions they actually received.

In terms of raw BMI units, Group 3 averaged 0.6 unit lower than Group 1, and Group 2 averaged 0.4 unit lower than Group 1 at the 2-year follow-up, according to the March 30 Pediatrics online report.

"This is among the first counseling interventions using MI and delivered in primary care to yield significant effects on adiposity," the researchers note.

"Research is needed to determine the clinical significance and persistence of the BMI effects observed," the authors conclude. "Given the relatively modest dose, the intervention appears to have considerable dissemination potential, which can be explored in future studies. How the intervention can be brought to scale (in particular, how to train physicians to effectively use MI and how best to train registered dietitians and integrate them into primary care settings) merits future research."

Dr. Amy L. Christison, from the University of Illinois College of Medicine at Peoria, who has studied MI for weight management in children and adults, told Reuters Health by email, "In my own experience with our obesity prevention study using MI during pediatric well-child checkups (WCC), it took an average of seven minutes to review screening tools and develop a plan. This is perceived as 'too long' for some during a '15 minute' appointment . . . though some providers schedule 30 minutes for their WCC appointments. We have changed to a shorter, more scripted MI action planning conversation known as Brief Action Planning, which takes about three to five minutes to do. Outcomes pending."

"There is promise that this is feasible in the real world for many primary care providers," Dr. Christison said. "There is some evidence that patient-centered conversations make more impact on weight change and behaviors, so that if one were to invest time into education and action planning, one would assume that it would be more desirable to know that the time spent made a difference."

"Using patient-centered language is useful in improving weight status of overweight pediatric patients," Dr. Christison concluded. "Having registered dietitians as a part of one's treatment team can further improve the weight status of overweight patients."

"Consideration should be made for systems support for training in MI (it has a positive effect on other health-related behaviors) and advocating for reimbursement for effective weight-management services in the primary care setting for pediatric patients," Dr. Christison added.

Dr. Resnicow did not respond to a request for comments by deadline.

The National Heart, Lung, and Blood Institute and the American Academy of Pediatrics supported this research. The authors made no disclosures.

SOURCE: http://bit.ly/1Es6fTN

Pediatrics 2015.

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