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Obesity is one of today’s most diffused and severe public health problems worldwide. It affects both adults and children with critical physical, social, and psychological consequences. The aim of this review is to appraise the studies that investigated the effects of motivational interviewing techniques in treating overweight and obese children. The electronic databases PubMed and PsychINFO were searched for articles meeting inclusion criteria. The review included studies based on the application of motivational interviewing (MI) components and having the objective of changing body mass index (BMI) in overweight or obese children from age 2 to age 11. Six articles have been selected and included in this review. Three studies reported that MI had a statistically significant positive effect on BMI and on secondary obesity-related behavior outcomes. MI can be applicable in the treatment of overweight and obese children, but its efficacy cannot be proved given the lack of studies carried out on this specific sample.
Obesity is a complex disorder that involves an excessive amount of body fat, generally caused by the lack of balance between energy intake and energy expenditure (
Overweight and obesity is measured referring to the BMI, defined as the weight in kilograms divided by the square of the height in meters (kg/m2) (
Worldwide childhood obesity rates increased substantially from 1990 to 2010, with an increase of 60% children suffering from obesity both in developing and developed countries; such rates are expected to keep growing all around the world and reach a total number of about 60 million overweight and obese preschool children in 2020 (
The obesity widespread among the young people is generating significant social concern for public health, not only for the number of children affected but also because of its consequences. Overweight condition in children is likely to be maintained in adulthood (
Given the dimension of the problem, treatments of childhood obesity are recognized as of extreme importance. Fundamental is to produce a change of food intake and quality (
The use of MI has been reported as a promising approach in the treatment of obesity (
Despite conventional more directive approaches based on clinicians’ prescriptions and on confrontation, MI is centered on supporting the client’s autonomy and collaboration as well as on evocating her/his motivation to change making the person actively taking part in the caring and changing process. The counselor does not establish any goal for the client nor imposes his/her own point of view but, through the use of a “guiding style”, the professional helps the client developing both new coping strategies and future plan of action (
Following the four processes (engaging, focusing, evoking, and planning), practitioner leads the patient to autonomously individuate and choose the best way to proceed in change (
MI has been used with good results in different health domains such as substance abuse, smoking, diabetes, and weight loss (e.g.,
The majority of studies investigating the use of MI in reducing weight among overweight an obese people, typically consider adult populations (e.g.,
In order to maximize its efficacy, MI is flexibly adapted to characteristics and needs of the patient (
This review focuses on studies investigating the application of MI for the treatment of obese children up to 11 years-old and, differently from previous ones (
A broad literature search has been conducted in July 2014 to identify studies based on interventions with a MI component to change BMI in the treatment of overweight or obese children aged 2–11 years-old.
Two electronic databases were searched, PubMed and PsychINFO, using the following keywords: “motivational interviewing”, “childhood obesity”, “children overweight”, “pediatric obesity”.
Additional inclusion criteria were: publication between 2007 and June 2014, inclusion of overweight (BMI at or above the 85th percentile and lower than the 95th percentile for children of the same age and sex) or obese (BMI at or above the 95th percentile for children of the same age and sex) children, experimental, or quasi-experimental design, articles written in the English language.
Studies that included parents were considered only if the primary target of the motivational intervention was the child.
Six articles were finally included.
An overview of participants’ characteristics of each included study is provided in
Selected article characteristics of the sample.
Article | Sample age | Sample weight | |
---|---|---|---|
91 | 3–7 | 85th percentile ≤ BMI ≤ 95th percentile or 50th percentile ≤ BMI ≤ 85th percentile with at least 1 parent’s BMI ≥ 30 | |
475 | 2–6 | BMI ≥ 95th percentile or 85th percentile ≤ BMI ≤ 95th percentile if at least one parent was overweight | |
372 | 4–7 | 85th percentile ≤ BMI ≤ 95th percentile | |
60 | 4–8 | Overweight or obese children according to BMI percentile | |
637 | 5 | Overweight not obese children | |
185 | 9–11 | Obese children according to the Hong Kong Growth Survey (HKGS) sex specific reference charts of medium weight-for-height |
Selected article intervention description and main results.
Study | Design | Objective | Outcomes | Comparison groups (N) | Intervention description | Training MI | Results |
---|---|---|---|---|---|---|---|
NRS | To implement an office-based obesity prevention |
Change in the BMI for age percentile. | (1) Control (21) |
Minimal intervention group received one MI session for 10–15 min. Intensive intervention group received 2 MI sessions, one of 10–15 min duration and of 45–50 min long. | 2 days session before the intervention. Audiotapes for clinical supervision with telephone feedback and coaching. | Decrease of BMI percentiles in the control (0.6), minimal (1.9), and intensive (2.6) groups. BMI differences between the three groups were non-significant ( |
|
RCT | To examine the effectiveness of a primary care-based obesity intervention. | Change in BMI and obesity-related behaviors. | (1) usual care (204) |
Use MI for four sessions in person for 25 min and three telephone calls for 15 min. | Pediatric nurse practitioners trained in MI. | Intervention participants had a smaller, non-significant increase in BMI (-0.21 kg/m2; |
|
RCT | To evaluate the effect of family |
BMI score variation, |
(1) usual care (185) |
Five MI meetings based on the Transtheoretical model. | 20-h |
There was a significant difference in BMI between intervention and control groups (difference = -0.30, |
|
RCT | To determine the feasibility and preliminary effects of a theoretically based, primary care |
BMI percentile, waist circumferences, waist by height ratio. | (1) control group (33) |
Four brief MI sessions. | Not specified. | In treatment group reduced waist circumference and waist-by-height ratio immediately after the intervention that persisted for 3 ( |
|
RCT | To assess the effectiveness of a prevention protocol among 5-year-old overweight children. | BMI and |
(1) usual care (349) |
Three structured lifestyle counseling sessions using a MI approach, if needed. | 1-day |
There was no overall difference between intervention and control condition. Mildly overweight children (baseline BMI 17.25 and 17.50) in the intervention condition showed a significantly smaller increase in BMI at follow-up (estimated adjusted mean difference -0.67, |
|
Pre-post quasi-experimental study | To assess the effects of motivational interviewing for obese children and telephone consultation for |
Change in weight for-height percentage, |
(1) control (49) |
Children in MI group received five MI sessions. Children in the MI+ group received five MI sessions and five telephone consultation calls for their parents. | Training in MI skills. | Children in both the MI and MI+ groups showed significant improvement in their weight-related behaviors and obesity-related anthropometric measures. |
The total number of participants across the studies was 1820 children of which 44,4% were males and 55,6% were females with participants’ mean age equal to 6,21 years of age. Five interventions recruited participants through the health care system and one study through primary schools. One research included children aged between 8 and 11, all other works also involved pre-school aged children.
Overweight children were included in the sample population of each study except for one that solely involved obese children. Three studies excluded obese children from their sample. There is only one research involving normal-weight children on condition that one of its parents is obese.
MI is used as a stand-alone treatment in all analyzed studies. In all selected studies MI sessions were provided to parents of overweight and obese children, in one study the MI sessions were directed to children.
Four intervention used MI as it is described by
In
In the High Five for Kids study (
In
Children in the experimental group studied by
After a 2-years follow up
Significant improvements have been found comparing anthropometric measures between the control group and the MI and the MI+ group, respectively. Children belonging to MI+ group have reported a significant higher change in calories consumed compared with the MI group. A significant improvement in eating habits and an increase in physical activity with subsequent increase of calories consumed has also been reported for both experimental groups.
Among the studies reported so far in this review, three show that MI intervention is more effective than the usual care for changing BMI in children enrolled in obesity treatments.
Relevant results have been reported on secondary behavioral outcomes. Statistically significant variations were found on food calories intake and calories consumption from physical exercise (
The analysis presented in this review evidences some methodological issues that might have negatively influenced the results of the reported studies, such as non-randomization of patients or practitioners, small sample size, unbalanced sample characteristics, low attendance to intervention activities, the absence of MI training and supervision evidence.
The studies analyzed provide very few details regarding MI practitioners’ training and none of them included the proficiency of counselors who delivered the motivational intervention. Only
Considering the importance for each reviewed study on the assessment of MI interventions efficacy, it is essential to evaluate if the counselor was actually delivering an “MI treatment” (
The collected and analyzed data show that MI may be a method applicable in the treatment of overweight and obese children in the pediatric setting. Three studies come out with positive results on BMI, eating habits and lifestyles change. Overall, the efficacy of MI in the treatment of obese children cannot be empirically evidenced so far, given the insufficient data and the paucity of studies carried out on the focused age-group.
Further research is needed to provide more and useful data to better demonstrate the efficacy of MI interventions overcoming the methodological issues formerly reported. New protocols assessing the effects of MI on overweight and obese children have already been published and results will be soon issued, for instance
It seems necessary to carry out researches aimed at clarifying the effects of MI interacting with the children’s characteristics (e.g., baseline BMI, gender, family education level, household income) to understand with whom MI works better and how it can promote behavior changes.
MI application on children has still some unanswered questions, mainly directed to investigate whether it is better to involve children alone and/or with his/her parents to promote lifestyle changes and how MI should be tailored to favor behaviors that may lead to a healthier weight-levels.
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.