THE HEALTHY LIFESTYLES PILOT STUDY
Robert P. Schwartz, Kenneth A. Resnicow, Robin Hamre, William H. Dietz, Eric Slora, Esther F. Myers, Susan Sullivan, Kathy Thoma, Richard C. Wasserman.. Pediatrics, Wake Forest University School of Medicine, Winston-Salem, NC; School of Public Health, University of Michigan, Ann Arbor, MI; Division of Nutrition and Physical Activity, Centers for Disease Control and Prevention, Atlanta, GA; American Academy of Pediatrics, Elk Grove Village, IL; American Dietetic Association, Chicago, IL; Pediatrics, University of Vermont College of Medicine, Burlington, VT.

BACKGROUND: The epidemic of childhood obesity has prompted a search for effective interventions. Motivational interviewing (MI) is one promising approach.

OBJECTIVE: To determine the impact of MI on: 1) body mass index (BMI) in children ages 3-7 at risk for overweight; 2) diet and activity.

DESIGN/METHODS: 15 pediatricians belonging to Pediatric Research in Office Settings (PROS) were asked to enroll 10 patients per practice. Children 3-7 years of age seen at well child visits were eligible if they had a BMI-for-age percentile =85th <95th, or were normal weight but had a parent with a BMI>30. The practices were assigned to: 1) Control; 2) Minimal (MD only); or 3) Intensive (MD+RD) groups. Clinicians in the Minimal and Intensive Intervention groups attended a two day MI training. Patients in the Minimal group received one MI session from the MD. Those in the Intensive group received two MI sessions from the MD+RD. Behavior patterns were assessed by having the parents complete a food/activity survey. Weight, height, and BMI were obtained for children in all three groups at baseline and six months.

RESULTS: 66% of the 93 patients enrolled completed the study. At 6 months patients showed a decrease of 0.4, 1.7, and 3.1 BMI percentile points in the Control, Minimal, and Intensive groups respectively. Decreases were seen for dining outside the home and consumption of high calorie snacks in the Minimal and Intensive groups. Over 90% of the parents reported that the pediatrician and dietitian helped them think about changing their family's food habits.

CONCLUSIONS: This pilot study demonstrates that pediatricians can implement an office-based obesity prevention program using MI. A dose-related trend of decreasing BMI-for-age percentiles was observed in the Minimal and Intensive groups. Decreases were seen in dining out and eating high calorie snacks. MI represents a promising strategy for office-based obesity intervention.