Rates of childhood obesity in the United States remain at historic highs. The pediatric primary care office represents an important yet underused setting to intervene with families. One factor contributing to underuse of the primary care setting is lack of effective available interventions. One evidence-based method to help engage and motivate patients is motivational interviewing, a client-centered and goal-oriented style of counseling used extensively to increase autonomous motivation and modify health behaviors. This article summarizes the methods and results from a large trial implemented in primary care pediatric office and concludes with recommendations for improving the intervention and increasing its dissemination.
Key points
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Rates of childhood obesity in the United States remain at historic highs.
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The pediatric primary care (PC) office represents an important yet still underused setting to intervene with families.
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Motivational interviewing (MI) is an evidence-based method to help engage and motivate patients.
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The Brief Motivational Interviewing to Reduce Body Mass Index (BMI 2 ) study tested 2 MI interventions of varying intensity compared with a minimal intensity/usual care group. Group 1 (usual care) measured body mass index (BMI) percentile at baseline and at 1-year and 2-year follow-up with routine care by a PC provider (PCP). Group 2 included the same assessments as group 1. In addition, group 2 PCPs received 1.5 days of training in MI and behavior therapy (BT) as well as an MI booster training DVD. Group 2 PCPs were asked to schedule 3 MI sessions with a parent of the index child in year 1 and 1 additional booster visit in year 2, although they were given latitude in appointment scheduling. Group 3 (PCP + registered dietitians [RDs] added MI counseling from trained RDs linked to each practice, who were asked to deliver 6 MI counseling sessions over 2 years.
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The BMI 2 intervention achieved statistically significant and clinically meaningful reductions in BMI percentile between groups 3 and 1.
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Key improvement for future related interventions may include centralized delivery of the RD counseling, supplementing counseling with short message service (SMS) (ie, text messaging), and automated systems to provide clinicians with real-time feedback.
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