Elizabeth Dettmer

Motivational Interviewing as an intervention to increase adolescent self-efficacy and promote weight loss: Methodology and design

BackgroundChildhood obesity is associated with serious physiological and psychological consequences including type 2 diabetes, higher rates of depression and low self-esteem. With the population of overweight and obese youth increasing, appropriate interventions are needed that speak to the issue of readiness to change and motivation to maintain adherence to healthy behavior changes. Motivational Interviewing (MI) is a method of therapy found to resolve ambivalence, enhance intrinsic motivation and promote confidence in a persons ability to make behavior changes. While MI has shown promise in the adult obesity literature as effecting positive lifestyle change, little is known about the effectiveness of MI with overweight and obese youth. This study aims to: 1) demonstrate that MI is an effective intervention for increasing a persons self-efficacy; 2) demonstrate that exposure to MI will facilitate healthy behavior changes; 3) explore psychological changes related to participation in MI and 4) compare physiological and anthropometric outcomes before and after intervention.Methods/DesignThe current investigation is a prospective study conducted with ongoing participants who regularly attend an outpatient pediatric care center for weight-loss. Overweight youth (BMI > 85th %ile) between the ages of 10 and 18 who meet eligibility criteria will be recruited. Participants will be randomly assigned to a control group (social skills training) or a treatment group (MI). Participants will meet with the therapist for approximately 30 minutes prior to seeing the dietician, over the course of 6 months. Participants will also undergo a full day assessment at the beginning and end of psychology intervention to evaluate body fat, and metabolic risk (screening for diabetes, high cholesterol, high blood pressure and fitness level). The paper and pencil portions of the assessments as well as the clinical testing will occur at baseline and at the conclusion of the intervention (6 months) with a repeat assessment 6 months following the completion of the intervention.DiscussionResults from this study are expected to enhance our understanding of the efficacy of MI with children and adolescents who are overweight or obese.Trial registrationCurrent Controlled Trials #NCT00326404.

Motivational Interviewing to Enhance Self-Efficacy and Promote Weight Loss in Overweight and Obese Adolescents: A Randomized Controlled Trial

OBJECTIVE To evaluate the efficacy of Motivational Interviewing (MI) as an intervention for promoting self-efficacy and weight loss in a sample of overweight and obese youth. METHODS /Design 40 participants (aged 10-18 years) were randomly assigned to control (social skills training) or treatment (MI) group. Both groups received individual therapy (~30 min/month) in addition to usual care of diet/exercise counseling. Pre- and post- (at 6 months follow-up) variables included measures of self-efficacy and anthropometrics. RESULTS Although significant between-group differences were not found, individuals in the MI group attended more sessions. Overall, participants in both groups showed significant increases in self-efficacy and a trend of decreased body mass index z-scores. CONCLUSIONS Health benefits from participation in individual therapy may have been accrued; however, specific benefits attributable to MI were limited. Findings suggest that more than one type of counseling intervention (i.e., MI and social skills training) may be beneficial when providing integrative treatment for obese youth.

Adolescent Bariatric Surgery: The Canadian Perspective

Canada faces a similar epidemic of obesity in their adolescent population as other Western countries. However, the development of programs to treat obesity and manage its sequelae has evolved in a unique way. This is in part due to differences in health care funding, population distribution, public demand, and availability of expertise and resources. In this article, we will describe the evolution of adolescent bariatric care in Canada and describe the current programs and future directions. The focus will be on the province of Ontario, the site of the first adolescent bariatric program in the country.

Adolescent Bariatric Surgery: Current Status in an Evolving Field

Bariatric surgery has been increasingly performed in adolescents over the past decade. Consensus guidelines have been developed to help heath care teams select adolescent candidates for surgery. Reports of short-term outcomes in adolescents have demonstrated similar BMI reduction and safety as in the adult population. There are several issues specific to adolescents that require further consideration, including a lower age limit and BMI at surgery, the optimal choice of bariatric procedure, the potential for the development of disordered eating and weight recidivism after surgery, and the extent of psychological and developmental assessment prior to performing these procedures. With the ongoing increase in the number of adolescent bariatric surgeries performed, it will be essential for high-level evidence with long-term follow-up to be generated to help address these issues and guide health care teams caring for teens with obesity.