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Pediatric Office-Based Brief Motivational Interviewing: Diet, Activity and Media Use

Alison Bocian1, Eric Slora1, Donna Harris1, Jeremy Drehmer1, Fiona McMaster2, Susan Woolford2, Richard Wasserman1,3, Robert Schwartz4, Jaquelin Gotlieb1, Linda Snetselaar5,6, Esther Myers6 and Ken Resnicow2

Pediatric Research in Office Settings (PROS), AAP, Elk Grove, IL; 2Univ of Michigan, MI; 3Univ of Vermont, Burlington, VT; 4Wake Forest Univ, NC; 5Univ of Iowa, IA; 6Dietetics Practice-Based Research Network (DPBRN), ADA, Chicago, IL

Presented at the April 2012 Pediatric Academic Societies Annual Meeting

Background: Primary care interventions to address pediatric obesity have had limited success. It is unclear whether Motivational Interviewing (MI) could impact behavioral outcomes.

Objective: Assess the impact of brief MI counseling on family diet, activity and media use for children at risk for obesity over a 1-year period.

Methods: Data were collected as part of a 2-year national trial in 39 PROS and 15 DPBRN sites to test use of MI vs. usual care of children ages 2-8 in 85th-97th percentile for body mass index (BMI). Endpoints include changes in BMI percentile and parent reported grades of their child’s diet, activity, and media-use (grading on an A-F scale). The 3-arm design include usual care (Group (G) 1; n=150); MI by pediatricians (G2; n=109); or MI by pediatricians plus registered dietitians (G3; n=97).

Analyses compared the 1-year change in parent-reported grades across groups. A positive outcome at 1 year is defined as: 1) positive grade change(s) for those with baseline grades B-F; or 2) maintenance of an A grade, for those with baseline A grades. Data were analyzed using logistic regression adjusting for child age, gender, parent income and education.

Results: G2 MI number of visits ranged from 1-3 (mean=2.4, SD=0.7) and G3 visits ranged from 1-8 (mean=4.2, SD=1.4). For G2, parents indicated positive change in snack foods. G3 parents indicated positive change for snack foods, eating out, fruits and video/computer games. The odds of a positive outcome are presented below.

Group 1=Reference. *p<.05, **p<.01, ***p<.001
​Variable ​Group 2: Pediatricians ​Group 3: Pediatricians & Dietitians
​Eating out ​1.1(0.7,1.9) ​1.9(1.1,3.3)*
​Fruits ​1.6(1.0,2.7) ​2.7(1.5,4.9)**
​Physical activity
​1.2(0.7,2.0) ​1.7(1.0,2.9)
​Snack foods ​2.3(1.4,3.8)** ​2.8(1.6,5.0)***
​Sweetened beverages ​0.9(0.5,1.5) ​1.3(0.7,2.4)
​Screen time ​1.4(0.8,2.3) ​1.4(0.8,2.4)
​Vegetables ​1.2(0.7,2.0) ​1.7(1.0,2.9)
​Video/computer games 1.2(0.7,2.0) ​2.1(1.1,3.8)*
 Group 1 = Reference. *p<.05, **p<.01, ***p<.001

Conclusions: A brief MI intervention was associated with positive changes to selected health behaviors at 1 year. Results suggest MI may hold promise for such changes in overweight children.