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Motivational Interviewing and Childhood Obesity

August 25, 2010


In “What is MI?,” Stephen Rollnick, Ph.D., and William R. Miller, Ph.D., talk about the spirit of motivational interviewing, which tends to downplay formal technique. The authors summarize it in seven key points, which are also briefly summed up here, but explored much more fully in their article. Drs. Rollnick and Miller explain the usefulness of MI for trainers, researchers, and clinicians. In their words,

Motivational interviewing is a directive, client-centered counseling style for eliciting behavior change by helping clients to explore and resolve ambivalence. Compared with nondirective counselling, it is more focused and goal-directed. The examination and resolution of ambivalence is its central purpose, and the counselor is intentionally directive in pursuing this goal.

So, what is meant by the spirit of MI? First, it relies on the person’s own values and goals to stimulate changes in behavior. This means being non-coercive: no confrontation, no threats, and even no persuasion. The person’s job is to figure out what’s going on with her or his own ambivalence. Often, someone who realizes that help is needed will still feel tugged in two different directions. The authors give this example:

If I stop smoking I will feel better about myself, but I may also put on weight, which will make me feel unhappy and unattractive.

The therapist needs to realize that being helpful doesn’t always work, and may be frustrated by a feeling that this motivational interviewing stuff is all too slow and passive. But the true motivational interviewer realizes that change can only come at the client’s own pace, and that ambivalence is not resolved overnight. In fact, resistance and denial from the client are seen as a sign that the therapist is pushing too hard, and needs to fall back and regroup.

The therapist isn’t seen as an expert or leader, or even a helper, but as a partner and companion in the client’s journey. MI is more a style or a mindset than a technique. It means listening attentively enough to understand the troubled person’s own frame of reference, as well as affirming the person’s freedom of choice and self-direction.

Here is the interesting thing about motivational interviewing in our context. MI originated in classical addiction treatment, with the old familiar substances that we’ve acknowledged are addictive. MI also works well in treating obesity. So, logic would indicate that eating disorders that lead to obesity are, indeed, addiction-driven behaviors. In other words, rather than stay up all night arguing over whether food addiction is “real,” it makes a lot of sense to just cut to the chase: MI works to help people overcome obesity, so let’s use it. And, increasingly, this is happening.

Word comes from the Boston University School of Medicine that motivational interviewing is one of the modalities being employed for many community health problems, especially in pediatrics. Mary Hopkins tells us of the various conditions being treated, including asthma, maternal depression, chronic pain, and childhood obesity.

One of her sources, John Cook, an associate professor of pediatrics, is also a research scientist and investigator for the Children’s Health Watch, which advises legislators on public health policy, especially in the area of nutrition for low-income children.

Thanks for the inspiration!

Dr. Pretlow recently heard from a Consultant Dietician and doctoral student in behavioral sciences, Maria Chang, who expressed appreciation for his work, and mentioned that she is working on incorporating motivational interviewing techniques into nutrition consultations. Unlike many nutritionists who focus only on healthy eating, Chang and her colleagues are willing to look at the psychological basis for obesity. This is very heartening.

Your responses and feedback are welcome!

Source: “What is MI?,” Motivational Interview
Source: “Pediatric Researchers: On the frontlines of healthy outcomes for children,” Boston University School of Medicine, 07/23/10
Image by alancleaver_2000, used under its Creative Commons license.

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