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Motivational Interviewing Effect on Overweight Children's Diet, Activity and Media Use at 2 Year Follow-up


Authors

Alison Bocian, MS1, Ken Resnicow, PhD2, Donna Harris, MA1, Robert Schwartz, MD3, Linda Snetselaar, PhD, RD4, Esther Myers, PhD, RD5, Jacqueline Gotlieb, MD1, Susan Woolford, MD, MPH2 and Richard Wasserman, MD, MPH1, 6. 1Pediatric Research in Office Settings (PROS), American Academy of Pediatrics, Elk Grove Village, IL, United States; 2University of Michigan, Ann Arbor, MI, United States; 3Wake Forest University, Winston-Salem, NC, United States; 4University of Iowa, Iowa City, IA, United States; 5Academy of Nutrition and Dietetics, Chicago, IL, United States and 6University of Vermont, Burlington, VT, United States.

Background

Primary care interventions to address lifestyle behaviors related to pediatric overweight and obesity have had limited success. It is unclear whether Motivational Interviewing (MI) could impact behavioral outcomes in the long-term.

Objective

Assess the impact of brief MI counseling on family diet, activity and media use for overweight and obese children during a 2-year period.

Design/Methods

Data were collected as part of a 2-year national randomized controlled trial in 41 PROS practices to test use of MI vs. usual care among children ages 2-8 with BMI percentiles ranging from the 85th-97th. The 3-arm design included a usual care group (G1) (n=10 practices; n=198 parent/child dyads); MI delivered by pediatricians (PED; G2) (n=16; n=212); or MI delivered by PED plus registered dietitians (RD; G3) (n=15; n=235). After 2 years, 70.6% patients were retained and 457 included in the analysis. Analysis compared the post-intervention levels of parent-reported behaviors for their children's daily: fruit/vegetable servings; sweetened beverages servings, hours of physical activity and hours of screen time. Data were analyzed using logistic regression adjusting for cluster randomization practice effects and baseline covariates.

Results

Fruit/vegetable intake at post-intervention was significantly greater (p <.05) for G3 (MI delivered by PED/RD) than G1 (usual care). G3 also had significantly less (p <.05) daily screen time compared to both G1 and G2 (MI delivered by PED only). No significant differences were observed between groups for the sweetened beverage or physical activity behaviors.

​​Impact of Brief MI on Behavioral Outcomes at 2-year Follow-up
​Study Group (G)Fruit/Vegetable Servings p/daySweetened Beverage Servings p/day​​Physical Activity Hours p/dayScreen Time Hours p/day​
​G1 Usual Care​3.8§​1.3​2.1​2.5
​G2 Pediatricians​4.1​1.3​1.9​2.4†
​G3 Pediatricians & Dietitians​4.3§​1.0​2.1​2.2¶†
§¶†Groups with matching superscript significantly differ p<.05; ^ Adjusted means for age, race, sex, baseline value and practice effects (clustering) ​ ​ ​ ​


Conclusions

A brief MI intervention delivered by primary care pediatricians and dietitians was associated with positive changes to selected health behaviors at 2 year post-intervention follow-up. Results suggest that MI may promote healthier habits among overweight and obese children.