DOES MOTIVATIONAL INTERVIEWING HELP DECREASE BMI IN OVERWEIGHT ADOLESCENTS

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DOES MOTIVATIONAL INTERVIEWING HELP DECREASE BMI
IN OVERWEIGHT ADOLESCENTS?

• Amalia Guardiola, MD
• Pediatric Joint Primary Care Fellow
• University of Texas Houston Health Science Center

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Abstract

• Background No primary pediatric care office
  interventions have been proven effective to treat
  childhood or adolescent obesity. Motivational
  interviewing (MI) is a brief counseling technique
  that appears promising as an intervention to
  change adolescent behavior its usefulness in
  adolescent obesity has not been reviewed.
• Objective To systematically review the
  literature on MI and adolescent obesity.
• Methods PubMed (National Library of Medicine)
  and the Cochrane Library databases were
  systematically searched for relevant articles.
  The following Medical Subject Headings (MeSH)
  were included MI, childhood obesity, obesity,
  motivational counseling, brief intervention, and
  overweight. PubMed searches were limited to
  humans, and English only. Inclusion criteria
  randomized controlled trials (RCT), systematic
  reviews of RCTs of MI in children for any
  behavior and randomized controlled trials,
  systematic reviews of RCTs and observational
  studies of MI in obesity all ages.

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Abstract

• Summary of Results A total of 75 articles were
  found, of which 10 met the inclusion criteria.
  There were two Cochrane reviews, one
  observational study, one systematic review, one
  review of literature, one RCT of brief
  intervention and children, one clinical trial in
  adults, and 3 RCT of MI and adult obesity. MI has
  been shown to have a modest effect in changing
  behavior of adolescents about substance use,
  diabetes, dietary adherence, contraceptive use,
  and HIV/AIDS prevention as well as changing
  lifestyle in adults. There were no studies
  addressing the use of MI in adolescent obesity.
• Conclusions MI has a modest effect in modifying
  behavior in adolescents. It has been shown to be
  effective in adults. It may be promising as an
  intervention to change adolescent lifestyle and
  help decrease BMI in adolescents. Clinical trials
  of MI in adolescent obesity are justified

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Background

• No primary pediatric care office interventions
  have been proven effective to treat childhood or
  adolescent obesity. Motivational interviewing
  (MI) is a brief counseling technique that appears
  promising as an intervention to change adolescent
  behavior. MI usefulness in adolescent obesity has
  not been reviewed

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What is MI?

• MI is a counseling technique that assists
  individuals in working through their ambivalence
  about behavior change. MI appears effective for
  individuals who are initially less ready to
  change. MI was initially developed to treat
  addictions and has increasingly been used to
  modify diet and physical activity behaviors. MI
  is based on the following concepts
• individuals are more likely to accept and act
  upon behavior changes that are negotiated and
  not prescribed
• encourages approach where patients feel
  comfortable expressing both the positive and
  negative aspects of any behavior
• the patient is expected to do much of the work
  and talking
• Some of the specific techniques include
  reflective listening, shared decision making,
  agenda setting, rolling with resistance, building
  discrepancy, and eliciting change talk.

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Focused Question

• Among obese adolescents 1318 years old, with
  BMI equal to or above the 85 percentile for age
  and gender, does motivational interviewing,
  compared to conventional counseling, decrease or
  stabilize BMI percentile?

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Methods

• Systematic review of published literature
• Databases searched
• PubMed (National Library of Medicine)- searched
  limited to humans and English only
• Cochrane Library
• Medical Subject Headings (MeSH) used
• MI, childhood obesity, obesity, motivational
  counseling, brief intervention, and overweight
• Other Methods
• After relevant articles were identified a hand
  search of the references was performed

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Methods (Cont.)

• Inclusion criteria
• Randomized controlled trial (RCT) and systematic
  reviews of RCTs of MI in children for any
  behavior
• Randomized controlled trials, systematic reviews
  of RCTs and observational studies of MI in
  obesity in all ages

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Summary of Results

• A total of 75 articles were found, of which 10
  met the inclusion criteria
• MI in Children
• Cochran Review- Interventions for preventing
  obesity in children (1) Studies of children (
  under 18 years) that focused on combining dietary
  and physical activity approaches did not
  significantly improve BMI, but some studies that
  focused on dietary or physical activity
  approaches showed a small but positive impact on
  BMI status

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Results (Cont.)

• MI in Children
• Randomized Controlled Trial- School-based
  interventions improve heart health in children
  with multiple cardiovascular disease risk factors
  (5) 422 children age 9 0.8 years with at least
  two CVD risk factors were randomly selected to
  receive either a classroom-based intervention in
  the 3rd and 4th grades or physical activity
  classes. Both interventions produced large
  reduction in cholesterol compared with a small
  drop in the controls. Both intervention groups
  had a small reduction in body fat and higher
  health knowledge.

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Results (Cont.)

• MI in Children
• Systematic Review- Measurement of outcomes,
  mediators, and moderators in behavioral obesity
  prevention research (4) A systematic review of 17
  studies that used different measures (weight,
  skinfolds, behavioral scales, health knowledge,
  self-efficacy, etc.) to evaluate target behaviors
  (increase healthier choices in diet and physical
  activity, reduce saturated fat intake, etc.)
  found that the poor quality of measurements may
  be the cause of not detecting changes in the
  target outcome. It included children 6-14 years
  old.

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Results (Cont.)

• MI in Children
• Observational Study- A brief motivational
  intervention to improve dietary adherence in
  adolescents (2) Adolescents aged 13-17 years that
  participated in the Dietary Intervention Study in
  Children (DISC) Research Group (N127) were
  selected to received motivational intervention of
  dietary change. Results showed mild decrease in
  the total of calories consumed by the
  participants as well as decrease in the amounts
  of calories from fat and total cholesterol
  consumed.

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Results (Cont.)

• MI in Children
• Review of Literature- An integrative research
  review effective school-based childhood
  overweight interventions (3) Of the 10 articles
  reviewed, 8 found that social cognitive theory
  was stated or implied as an intervention for
  decreasing BMI or weight in children 4-14 years
  old. All of the studies showed statistically
  significant outcomes.

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Results (Cont.)

• MI in Adults
• Cochran Review- Psychological interventions for
  overweight or obesity (6) Adults (18 years or
  older) who are overweight or obese benefit from
  psychological interventions, particularly
  behavioral and cognitive-behavioral strategies,
  to enhance weight reduction. Predominantly useful
  when combined with dietary and exercise strategies

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Results (Cont.)

• MI in Adults
• Clinical Trial
• Implementation of a primary care physician
  network obesity management program (7) Among
  adults, a 10 minute intervention delivered by the
  primary care physician was coupled with
  individual dietary counseling sessions delivered
  by a registered dietician via telephone. Patients
  completing 6 months in the program lost an
  average of 19 4 lb for women and 15.5 8.2 lb
  for men.

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Results (Cont.)

• MI in Adults
• Randomized Controlled Trials
• The impact of behavioral counseling on stage of
  change in fat intake, physical activity, and
  cigarette smoking in adults at increased risk of
  coronary heart disease. (8)Twenty general
  practices were randomized to lifestyle counseling
  by behavioral methods or to usual health
  promotion. 883 adult patients participated. Brief
  behavioral counseling based on advice matched to
  stages of change may be valuable in encouraging
  healthy lifestyles among patients in primary care
  at risk of cardiovascular disease.

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Results (Cont.)

• MI in Adults
• Randomized Controlled Trials (Cont.)
• Improving management of obesity in primary care
  cluster randomized trial (9) 44 general practices
  attending obese adult recruited 843 patients. A
  training package promoting a brief prescriptive
  approach to the treatment of obesity through
  lifestyle modification, intended to be
  incorporated into routine clinical practice, did
  not ultimately affect the weight of the
  participants.

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Results (Cont.)

• MI in Adults
• Randomized Controlled Trials (Cont.)
• MI to improve adherence to a behavioral
  weight-control program for older obese women with
  NIDDM A pilot study (10)Twenty-two older women
  (55-67 years old) with NIDDM were randomly
  assigned to a standard 16-week group behavioral
  weight-control program or the same group
  behavioral program with three individualized MI
  sessions added. The MI group significantly
  enhanced their adherence to the program
  recommendations and glycemic control. There was
  no difference is weight loss between the groups.

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Discussion

• Due to the small number of articles initially
  found during the literature search, the focused
  question was broadened to include MI in obesity
  in all ages.
• Studies have shown that behavioral interventions
  are effective in changing childrens and
  adolescents behavior toward food and exercise.
• Motivational interviewing is considered a
  behavioral brief intervention that can be
  performed by primary care physicians but training
  is required to apply this methodology.
• Training for a physician can take from 18 hours
  to 2 days workshop followed by monthly
  reinforcement.

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Discussion (Cont.)

• Once learned, MI has been shown to have a modest
  effect in changing the behavior of adolescents
  about substance use, diabetes, dietary adherence,
  contraceptive use, and HIV/AIDS prevention as
  well as changing lifestyle in adults.
• There were no studies specifically addressing the
  use of MI in adolescent obesity

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Conclusions

• MI has a modest effect in modifying behavior in
  adolescents. It has been shown to be effective in
  adults. It may be promising as an intervention to
  change adolescent lifestyle and help decrease BMI
  in adolescents. Clinical trials of MI in
  adolescent obesity are justified.

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Acknowledgement

• I would like to acknowledge my mentors Drs.
  Virginia Moyer and Mona Eissa for assistance with
  this project.