Tuesday, March 31, 2015

Being PROS at Motivational Interviewing to Combat Being Overweight in Childhood

By: Lewis First, MD, MS; Editor-in-Chief  
      Motivational interviewing (MI) is a patient-centered counseling style by which you work with a patient to facilitate behavioral change through their recognizing their internal desire to change.  It is used for a variety of behavioral disorders by psychologists. 
      This week we publish a fascinating study by Resnicow et al. ( doi: 10.1542/peds.2014-1880) involving a randomized controlled trial performed by pediatric providers and registered dieticians of children in 42 practices enrolled in the AAP’s Pediatric Research in Office Settings (PROS) Network. Overweight children ages 2-8 were randomized to get (1) usual care, (2) four provider trained MI sessions to parents of an index child and (3), four provider trained MI sessions  plus 6 more MI sessions with a registered dietician with outcome being BMI measured at a two-year follow-up. 
     Without spoiling the richness of the data contained in this study, suffice it say that the groups that received MI showed much more impressive reductions in BMI than the group who got routine care.  Before everyone cheers (and cheering is well deserved here), one still needs to ponder whether this study can be generalized to all of us. Fortunately obesity researcher Dr. Cara Ebbeling (doi: 10.1542/peds.2015-0495) offers a commentary on this study that provides further insight as to what we can learn from it. 
     One thing is certain—before your patients can benefit from an MI approach to losing weight, you would need to learn MI, and perhaps hire dieticians if you don’t have some available to you also facile in MI, —which might not be affordable despite the reduction in up-the-road health care costs due to the weight reduction achieved. 
      Would you or registered dieticians in your community or practice be willing to learn motivational interviewing if it can lead to weight reduction in your overweight patients? Why or why not?  Share your thoughts with us as a response to this blog, via an e-letter or via our Facebook or Twitter sites.

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