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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

1
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.