Motivational interviewing in internet groups: a pilot study for weight loss

Motivational interviewing for weight management among college students during COVID-19: An exploratory randomized controlled trial

Background

College students encounter challenges in managing their weight. The Coronavirus Disease 2019 (COVID-19) pandemic exacerbated the problem. The purpose of this study was to determine the effect of a motivational interviewing (MI) intervention compared to online education (control) on body composition and self-determination theory constructs among college students with overweight.

Methods

This was a randomized clinical trial of 40 college students comparing an MI versus a control group. The MI group received monthly interviews: three face-to-face interviews before the pandemic, and three video chat interviews after the outbreak of COVID-19 spanning a total of six months. The control group received six, monthly education modules. Body composition was measured by the iDexa and self-determination theory (SDT) variables were assessed with surveys.

Results

Mixed ANOVAs from pre-post revealed significant changes in fat mass (p = .03, η2 = 0.22), lean mass (p < .05, η2 = 0.18), body fat percentage (p < .01, η2 = 0.37), autonomy (p < .01, η2 = 0.38), relatedness (p < .01, η2 = 0.41), amotivation (p = .01, η2 = 0.29), external regulation (p = .02, η2 = 0.23), identified regulation (p = .02, η2 = 0.25), integrated regulation (p < .00, η2 = 0.49), and intrinsic regulation (p = .01, η2 = 0.27).

Conclusions

In this exploratory analysis, MI demonstrated a positive trend in body composition maintenance when compared to online education among overweight college students during a national pandemic. Future studies utilizing MI would enhance the literature by further investigating the relationship between MI and SDT and measuring body composition.Clinicaltrials.gov. identifier: NCT04130386.

Bio-citizens online: A content analysis of pro-ana and weight loss blogs

Current neoliberal ideology in Western society encourages individuals to self-monitor their body to control population health. The resulting self-surveillance includes weight management, promoted as a marker of health. Disordered eating, like anorexia, is framed as a health disorder. However, weight loss is framed as a health initiative; we argue that these framings are engaging with the same body project, encouraging thinness as a marker of health and good bio-citizenry. Using content analysis to compare online blog context created by individuals engaged in weight loss and individuals who identify as pro-anorexia, we argue and evidence that both groups are engaged in body projects with shared parameters. Findings suggest each group is striving to embody a thin ideal through weight management. Specifically, weight loss bloggers and pro-ana bloggers demonstrate similar diet and exercise behaviours in online diaries detailing their weight loss experiences. Thus, weight loss and anorexia exist on the same spectrum of responsible bio-citizenry.

Transitioning a home-based, motivational interviewing intervention among families to remote delivery during the COVID-19 pandemic: Key lessons learned

OBJECTIVE

This study examined the experiences, learnings, and strategies of Health Educators (HE) as they transitioned from a home-based model for motivational interviewing (MI) to remote delivery during COVID-19. The overall goal of this paper is to identify key lessons learned to help inform future delivery of remote MI delivery.

METHODS

HE perceptions and experiences regarding the transition from in-person to remote delivery of MI for 21 families were captured through a video recorded discussion. Thematic analysis was used to identify themes and subthemes and key learnings from the transition experience.

RESULTS

Five themes were identified including: 1) Impact of COVID-19 on families; 2) Scheduling, no-shows, and cancellations; 3) Preference of online video versus phone; 4) Building rapport with remote delivery; 5) HE work satisfaction. Based on these results, several key learnings were identified to improve remote MI-counseling, including using online video platforms versus phone calls, providing families the necessary information and technical support to improve acceptability, using specific strategies to enhance rapport and child engagement, and asking probing questions to elicit deeper reflection.

CONCLUSION

Specific considerations regarding rapport building including more frequent check-ins to demonstrate commitment to the family's success, and effective communication strategies including asking more probing questions that elicit complex reflection can support successful transition of MI-counseling from in-person to remote delivery among families with young children.

PRACTICE IMPLICATIONS

Our practice recommendations based on key learnings from MI practitioners during the transition from in-person to remote MI-counseling can support healthcare professionals looking to transition MI-counseling services to remote delivery.

"C.H.A.M.P. Families": Description and Theoretical Foundations of a Paediatric Overweight and Obesity Intervention Targeting Parents-A Single-Centre Non-Randomised Feasibility Study

Childhood obesity represents a significant global health challenge, and treatment interventions are needed. The purpose of this paper is to describe the components and theoretical model that was used in the development and implementation of a unique parent-focussed paediatric overweight/obesity intervention. C.H.A.M.P. Families was a single-centre, prospective intervention offered to parents of children aged between 6–14 years with a body mass index (BMI) ≥85th percentile for age and sex. The intervention included: (1) eight group-based (parent-only) education sessions over 13-weeks; (2) eight home-based activities; and (3) two group-based (family) follow-up support sessions. The first section of the manuscript contains a detailed description of each intervention component, as well as an overview of ongoing feasibility analyses. The theoretical portion details the use of evidence-based group dynamics principles and motivational interviewing techniques within the context of a broader social cognitive theory foundation. This paper provides researchers with practical examples of how theoretical constructs and evidence-based strategies can be applied in the development and implementation of parent-focussed paediatric obesity interventions. Given the need for transparent reporting of intervention designs and theoretical foundations, this paper also adds to the areas of implementation science and knowledge translation research.

Discrepancy in Motivation for Weight Loss and Exercise in Rural Patients

OBJECTIVES

We explored the extent to which discrepancy between motivation for weight loss and exercise is related to obesity among rural patients with chronic disease, and identified the psychosocial correlates of this discrepancy.

METHODS

497 patients with diabetes and/or hypertension were recruited from a network of Federally Qualified Health Centers in the rural South and completed a battery of assessments.

RESULTS

Most persons in the sample (83.1%) were overweight and 65.0% were obese. For motivation for change, 70.8% reported being in the Action stage or higher for weight loss, whereas only 24.9% reported being in the Action stage or higher for motivation for exercise. When controlling for age, education level, income, sex, and race/ethnicity, individuals who were motivated for weight loss but not exercise were twice as likely to be obese (p = .005). Race and sex were significantly associated with this discrepancy, with African-American patients 1.7 times as likely (p = .05) and women 2.3 times as likely to be discrepant (p = .001).

CONCLUSIONS

Findings underscore the importance of focusing not simply on weight loss among rural patients with chronic disease, but rather to incorporate specific activities designed to build simultaneous motivation for engaging in exercise.

Racial and ethnic minority enrollment in randomized clinical trials of behavioural weight loss utilizing technology: a systematic review

Many racial and ethnic minority groups (minorities) are disproportionately affected by overweight and obesity; however, minorities are often under-represented in clinical trials of behavioural weight loss (BWL) treatment, potentially limiting the generalizability of these trials' conclusions. Interventions involving technology may be particularly well suited to overcoming the barriers to minority enrollment in BWL trials, such as demanding or unpredictable work schedules, caregiving responsibilities and travel burdens. Thus, this systematic review aimed to describe minority enrollment in trials utilizing technology in interventions, as well as to identify which form(s) of technology yield the highest minority enrollment. Results indicated relatively low enrollment of minorities. Trials integrating smartphone use exhibited significantly greater racial minority enrollment than trials that did not; trials with both smartphone and in-person components exhibited the highest racial minority enrollment. This review is the first to explore how the inclusion of technology in BWL trials relates to minority enrollment and can help address the need to improve minority enrollment in weight loss research.

HomeStyles, A Web-Based Childhood Obesity Prevention Program for Families With Preschool Children: Protocol for a Randomized Controlled Trial

Background

The home environment is where young children spend most of their time, and is critically important to supporting behaviors that promote health and prevent obesity. However, the home environment and lifestyle patterns remain understudied, and few interventions have investigated parent-led makeovers designed to create home environments that are supportive of optimal child health and healthy child weights.

Objective

The aim of the HomeStyles randomized controlled trial (RCT) is to determine whether the Web-based HomeStyles intervention enables and motivates parents to shape the weight-related aspects of their home environments and lifestyle behavioral practices (diet, exercise, and sleep) to be more supportive of their preschool children’s optimal health and weight.

Methods

A rigorous RCT utilizing an experimental group and an attention control group, receiving a bona fide contemporaneous treatment equal in nonspecific treatment effects and differing only in subject matter content, will test the effect of HomeStyles on a diverse sample of families with preschool children. This intervention is based on social cognitive theory and uses a social ecological framework, and will assess: intrapersonal characteristics (dietary intake, physical activity level, and sleep) of parents and children; family interpersonal or social characteristics related to diet, physical activity, media use, and parental values and self-efficacy for obesity-preventive practices; and home environment food availability, physical activity space and supports in and near the home, and media availability and controls in the home.

Results

Enrollment for this study has been completed and statistical data analyses are currently underway.

Conclusions

This paper describes the HomeStyles intervention with regards to: rationale, the intervention’s logic model, sample eligibility criteria and recruitment, experimental group and attention control intervention content, study design, instruments, data management, and planned analyses.

Do individual, online motivational interviewing chat sessions enhance weight loss in a group-based, online weight control program?

OBJECTIVE

To examine whether the addition of online motivational interviewing (MI) chats to a Web-based, group behavioral obesity treatment program augments weight loss outcomes relative to the Web-based weight control program alone.

METHODS

Healthy individuals (N = 398, 24% minority) with overweight/obesity were randomized to a 36-session group Internet behavioral weight control treatment (BT) or the same group Internet treatment plus six individual MI chat sessions (BT + MI). Both conditions received weekly synchronous online chat group sessions for 6 months followed by 12 monthly group chats. Participants in both groups received identical behavioral lessons and individualized therapist feedback on progress toward meeting exercise and calorie goals. BT + MI also received six individual MI sessions delivered by a separate MI counselor via Web chat. Weight loss was measured at 6 and 18 months.

RESULTS

There were no significant differences in weight loss between BT (-5.5 ± 6.0 kg) and BT + MI (-5.1 ± 6.3 kg) at 6 months or at 18 months (-3.3 ± 7.1 kg vs. -3.5 ± 7.7 kg for BT and BT + MI, respectively). Attendance at group chats did not differ between groups, nor did self-monitoring patterns, suggesting comparable engagement in the weight control program in both conditions.

CONCLUSIONS

Online MI chat sessions were not a viable strategy to enhance Web-based weight control treatment outcomes.

Teaching Physicians Motivational Interviewing for Discussing Weight With Overweight Adolescents

PURPOSE

We tested whether an online intervention combined with a patient feedback report improved physicians' use of motivational interviewing (MI) techniques when discussing weight with overweight and obese adolescents.

METHODS

We randomized 46 pediatricians and family physicians and audio recorded 527 patient encounters. Half of the physicians received an individually tailored, online intervention. Then, all physicians received a summary report detailing patient's weight-related behaviors. We coded MI techniques and used multilevel linear mixed-effects models to examine arm differences. We assessed patients' motivation to change and perceived empathy after encounter.

RESULTS

We found arm differences in the Intervention Phase and the Summary Report Phase: Empathy (p < .001), MI Spirit (p < .001), open questions (p = .02), and MI consistent behaviors (p = .04). Across all three phases (Baseline, Intervention, and Summary Report), when physicians had higher Empathy scores, patients were more motivated to change diet (p = .03) and physical activity (p = .03). In addition, patients rated physicians as more empathic when physicians used more MI consistent techniques (p = .02).

CONCLUSIONS

An individually tailored, online intervention coupled with a Summary Report improved physicians' use of MI, which improved the patient experience.

Design and Methods of a Synchronous Online Motivational Interviewing Intervention for Weight Management

Background

While Internet-based weight management programs can facilitate access to and engagement in evidence-based lifestyle weight loss programs, the results have generally not been as effective as in-person programs. Furthermore, motivational interviewing (MI) has shown promise as a technique for enhancing weight loss outcomes within face-to-face programs.

Objective

This paper describes the design, intervention development, and analysis of a therapist-delivered online MI intervention for weight loss in the context of an online weight loss program.

Methods

The MI intervention is delivered within the context of a randomized controlled trial examining the efficacy of an 18-month, group-based, online behavioral weight control program plus individually administered, synchronous online MI sessions relative to the group-based program alone. Six individual 30-minute MI sessions are conducted in private chat rooms over 18 months by doctoral-level psychologists. Sessions use a semistructured interview format for content and session flow and incorporate core MI components (eg, collaborative agenda setting, open-ended questions, reflective listening and summary statements, objective data, and a focus on evoking and amplifying change talk).

Results

The project was funded in 2010 and enrollment was completed in 2012. Data analysis is currently under way and the first results are expected in 2016.

Conclusions

This is the first trial to test the efficacy of a synchronous online, one-on-one MI intervention designed to augment an online group behavioral weight loss program. If the addition of MI sessions proves to be successful, this intervention could be disseminated to enhance other distance-based weight loss interventions.

Trial Registration

Clinicaltrials.gov NCT01232699; https://clinicaltrials.gov/ct2/show/NCT01232699

Using synchronous distance education to deliver a weight loss intervention: A randomized trial

OBJECTIVE

To implement a randomized trial to evaluate the effectiveness of a weight loss program delivered using synchronous distance education compared with a wait-list control group with 6-month follow-up.

METHODS

Adults with a body mass index (BMI) ≥25 were randomized to the intervention (n = 42) or wait-list control group (n = 38). The intervention group participated in a synchronous, online, 15-week weight loss program; weight loss was the primary outcome. Secondary measures included height, BMI, and confidence in ability to be physically active and eat healthy. Assessments occurred at three and four time points in the intervention and control group, respectively.

RESULTS

Participants who completed the program lost significantly more weight (1.8 kg) than those in the wait-list control group (0.25 kg) at week 15 [F(1,61) = 6.19, P = 0.02] and had a greater reduction in BMI (0.71 vs. 0.14 kg/m(2) ), [F(1,61) = 7.45, P = 0.01]. There were no significant differences between the intervention and the wait-list control groups for change in confidence in ability to be physically active or eat healthy. Weight loss was maintained at 6 months.

CONCLUSIONS

Use of synchronous distance education is a promising approach for weight loss. The results of this study will help to inform future research that employs Web-based interventions.

Technology-delivered adaptations of motivational interviewing for health-related behaviors: A systematic review of the current research

OBJECTIVES

The aims of this paper were to describe and evaluate the methods and efficacy of technology-delivered motivational interviewing interventions (TAMIs), discuss the challenges and opportunities of TAMIs, and provide a framework for future research.

METHODS

We reviewed studies that reported using motivational interviewing (MI) based components delivered via technology and conducted ratings on technology description, comprehensiveness of MI, and study methods.

RESULTS

The majority of studies were fully-automated and included at least one form of media rich technology to deliver the TAMI. Few studies provided complete descriptions of how MI components were delivered via technology. Of the studies that isolated the TAMI effects, positive changes were reported.

CONCLUSION

Researchers have used a range of technologies to deliver TAMIs suggesting feasibility of these methods. However, there are limited data regarding their efficacy, and strategies to deliver relational components remain a challenge. Future research should better characterize the components of TAMIs, empirically test the efficacy of TAMIs with randomized controlled trials, and incorporate fidelity measures.

PRACTICE IMPLICATIONS

TAMIs are feasible to implement and well accepted. These approaches offer considerable potential to reduce costs, minimize therapist and training burden, and expand the range of clients that may benefit from adaptations of MI.

Changes in Physical Activity and Psychological Variables Following a Web-Based Motivational Interviewing Intervention: Pilot Study

Background

Web-based interventions for enhancing physical activity participation are in demand for application in health care settings. Recent research suggests Web-based interventions that are based on motivational interviewing are effective to increase physical activity. It is unclear whether motivational interviewing can influence targeted psychological variables such as perceived readiness, willingness, and ability to participate in physical activity.

Objective

The aims of this study were to determine whether there were changes in physical activity and psychological variables associated with readiness, willingness, and perceived ability to participate in physical activity following completion of a novel Web-based intervention. The goal of the motivational interviewing–based intervention was to increase physical activity.

Methods

Twenty-three underactive or inactive urban dwelling adults were recruited at a medical office for participation in a 4-session Web-based intervention lasting approximately 15 minutes per week. Sessions were based on principles of motivational interviewing. Assessment of physical activity was conducted using pedometers immediately prior to intervention participation (pre) and immediately post intervention (post1). Self-report assessments of physical activity and psychological variables were conducted using online surveys at pre, post1, and again at one month following intervention participation (post2).

Results

Comparisons of pre and post1 pedometer recordings revealed significant increases in steps per day (t₂₂=2.09, P=.049). There were also significant changes in total physical activity energy expenditure per week (χ²₂=8.4, P=.02) and in moderate intensity physical activity energy expenditure per week (χ²₂=13.9, P<.001) over time following participation in the Web-based intervention. Significant changes in psychological variables following participation in the Web-based intervention included: (1) change in stage classification over time (χ²₂=21.5, P<.001), where the percentage of participants classified in the action or maintenance stages of change in physical activity increased over time (pre=25% [6/24], post1=71% [17/24], post2=68% [15/22]); (2) decreases in self-reported decisional balance cons (F_2,42=12.76, P<.001); (3) increases in self-reported decisional balance pros (F_2,42=16.19, P<.001); (4) increases in physical activity enjoyment (F_2,20=3.85, P=.04); and (5) increases in self-efficacy (F_2,42=3.30, P=.047).

Conclusions

The Web-based intervention piloted in this study shows preliminary promise as a tool to promote physical activity in health care settings. Additional research is needed to test the effectiveness of motivational interviewing compared to a control condition and to refine content by considering mediation by psychological variables in a larger sample.

Face-to-face individual counseling and online group motivational interviewing in improving oral health: study protocol for a randomized controlled trial

BACKGROUND

Motivational interviewing (MI) has great potential in changing health-related behaviors. In addition to delivery in face-to-face individual counseling, MI can be delivered through online groups, a method that is particularly appealing to adolescents and may offer several benefits. This randomized controlled trial compares the effectiveness of prevailing health education (HE), face-to-face individual MI and online group MI in improving adolescents' oral health behaviors (diet and toothbrushing) and in preventing dental caries and periodontal diseases.

METHODS/DESIGN

In each of Hong Kong's main districts (Hong Kong Island, Kowloon and the New Territories), three secondary schools will be recruited and randomly assigned to three groups (HE, face-to-face individual MI, and online group MI). A total of 495 adolescents (aged 12 to 13 years) with unfavorable oral health behaviors ("snacking twice or more a day" and/or "brushing teeth less than twice a day") will be recruited: 165 in each group. Two dental hygienists will be trained to deliver the interventions. HE will be provided through an oral health talk. Participants in the "face-to-face individual MI" group will join a one-on-one counseling session. For "online group MI," participants will form groups of 6 to 8 and join a synchronous text-based online counseling session. At baseline and after 6, 12 and 24 months, clinical outcomes (caries increment and gingival health) and oral health self-efficacy and behaviors (toothbrushing and snacking) will be recorded through an oral examination and a questionnaire, respectively. Effectiveness of the interventions will be evaluated and compared. The primary outcomes will be the "number of new carious surfaces" and "gingival bleeding score" (% of surfaces with gingival bleeding). The secondary outcomes will be changes in oral health self-efficacy and behaviors (toothbrushing and snacking frequencies). A preliminary economic evaluation and a process evaluation will be included to analyze the cost of the interventions and the interactions in MI sessions.

DISCUSSION

Since online group MI is expected to be more convenient, accessible, and time efficient, it might address the practicality issues and pave the way for the application of MI in dental practice. The findings will assist public health workers and dental practitioners to choose effective and viable approaches in delivering behavioral interventions. Since unhealthy diet and poor personal hygiene are common risk factors accountable for many systemic diseases, the intervention scheme identified in this study can also contribute to advancing general health.

TRIAL REGISTRATION

The HKU Clinical Trial Register #HKCTR-1852 (registered on 13 November 2014).

Development of the Intervention Materials for the HomeStyles Obesity Prevention Program for Parents of Preschoolers

Home environment is key to the development of obesity-preventing behaviors during childhood, yet few resources help preschool parents address factors at home associated with obesity risk. This paper describes creation of materials for an in-home intervention (HomeStyles) with this population. An advisory group of stakeholders and target audience members determined salient factors affecting childhood obesity to address in-home and developed program materials. The Social Cognitive Theory, Faith's Core Behavior Change Strategies to Treat Childhood Obesity, Adult Learning Theory and motivational interviewing techniques guided development of 12 guides targeting strategies parents can use to shape the home environment. Interviews were conducted to determine effectiveness of the guides. Cognitive testing of guide design (n = 251) and content (n = 261) occurred in English and Spanish in New Jersey and Arizona with parents and home visitation staff who would present the guides. Interviews investigated perceptions of content usefulness and parent comprehension. Findings were also examined in light of theoretical underpinnings. Both home visitation staff and parents felt the guides were very readable and useful. Parents appreciated use of motivational interviewing techniques and Adult Learning Theory. Current research is testing these guides through an in-home, randomized control trial.

Effect of bariatric surgery on cardiometabolic risk in elderly patients: A population-based study

AIM

Obesity is a major cardiovascular (CV) risk factor. Bariatric surgery (BSx) is an approved therapeutic alternative for class II-III obesity, but little evidence focuses on older adults. We assessed the effect of BSx on cardiometabolic variables and long-term CV risk in older adults.

METHODS

We carried out a population-based, observational study from 1990-2009, of 40 consecutive elderly (age ≥60 years) residents of Olmsted County, MN, USA, with class II-III obesity treated with BSx at a University-based, academic health center. Data were obtained from the Rochester Epidemiology Project. Metabolic syndrome (MetS) was defined using American Heart Association/National Heart, Lung, Blood Institute (AHA/NHLBI) criteria (increased triglycerides, low high-density lipoprotein, increased blood pressure, increased glucose and body mass index as a modified measure of obesity instead of waist circumference). Change in CV risk factors, MetS prevalence, and impact on predicted CV risk using the Framingham risk score was ascertained at 1 year postoperatively and assessed statistically.

RESULTS

Mean age and body mass index were 64.4 ± 3.7 and 45.0 ± 6.3 kg/m(2) , respectively, and 28 out of 40 (70%) were women. One participant died during the 11-month study period after BSx from respiratory complications related to BSx, and one participant died at 2 years. Percentage of excess weight loss decreased by 57.5% at 1 year. Prevalence 1 year after BSx decreased for diabetes (57.5% to 22.5%; P < 0.03), hypertension 87.5% to 73.7% (P = 0.003), dyslipidemia (80% to 42.5%; P < 0.001) and sleep apnea (62.5% to 23.7%; P < 0.001).MetS prevalence decreased from 80% to 45% (P < 0.002). Baseline risk was 14.1%, which changed at follow up at 8.2%.

CONCLUSIONS

In older adults, BSx induces considerable weight loss, improves CV risk factors, decreases MetS prevalence and is an effective treatment in this population. Geriatr Gerontol Int 2016; 16: 618-624.

eHealth interventions for the prevention and treatment of overweight and obesity in adults: a systematic review with meta-analysis

A systematic review of randomized controlled trials was conducted to evaluate the effectiveness of eHealth interventions for the prevention and treatment of overweight and obesity in adults. Eight databases were searched for studies published in English from 1995 to 17 September 2014. Eighty-four studies were included, with 183 intervention arms, of which 76% (n = 139) included an eHealth component. Sixty-one studies had the primary aim of weight loss, 10 weight loss maintenance, eight weight gain prevention, and five weight loss and maintenance. eHealth interventions were predominantly delivered using the Internet, but also email, text messages, monitoring devices, mobile applications, computer programs, podcasts and personal digital assistants. Forty percent (n = 55) of interventions used more than one type of technology, and 43.2% (n = 60) were delivered solely using eHealth technologies. Meta-analyses demonstrated significantly greater weight loss (kg) in eHealth weight loss interventions compared with control (MD -2.70 [-3.33,-2.08], P < 0.001) or minimal interventions (MD -1.40 [-1.98,-0.82], P < 0.001), and in eHealth weight loss interventions with extra components or technologies (MD 1.46 [0.80, 2.13], P < 0.001) compared with standard eHealth programmes. The findings support the use of eHealth interventions as a treatment option for obesity, but there is insufficient evidence for the effectiveness of eHealth interventions for weight loss maintenance or weight gain prevention.

Long-term effect of motivational interviewing on dietary intake and weight loss in Iranian obese/overweight women

BACKGROUND

This study aimed to determine whether motivational interviewing (MI) could change dietary habit and body mass index (BMI) in obese/overweight women.

METHODS

A cluster-randomized controlled study was performed in four health centers in Qazvin, central Iran. In total, 327 obese/overweight women were selected by a multi-stage sampling method and randomly assigned into control and experimental groups. Food frequency (using questionnaire; FFQ), BMI, and metabolic markers including blood pressure, total serum cholesterol and fasting blood glucose levels were measured in all participants. Data were collected twice (before and one year after the MI interventions). Data were analyzed using student t-test, and Stepwise Linear Regression.

RESULTS

There was a significant increase in daily consumption of dietary fiber, whole grain products, fruits and vegetables in the MI group (P<0.05). The consumption of meat product, total fat, saturated fat, carbohydrate and total energy intake were also significantly reduced after MI intervention (P<0.05). As a result, body weight and BMI were significantly reduced in the intervention group compared to the control group (P<0.05).

CONCLUSION

MI is suggested to be an effective strategy to change life style and reduce BMI in overweight/obese women in the long term. This effect needs to be further investigated in different gender and age populations.

Motivational interviewing interventions in graduate medical education: a systematic review of the evidence

BACKGROUND

Motivational interviewing (MI) is a patient-centered method of behavior change counseling. It has shown promise in enabling patients to identify and improve problem health behaviors. Incorporating MI education into residency training may be beneficial.

OBJECTIVE

To review the current evidence regarding the impact of MI education in graduate medical education.

RESULTS

Of the 9 studies of MI education in graduate medical education training, most noted favorable outcomes after MI education. Outcomes included improvements in residents' view of MI, MI skill use and competency, and resident satisfaction with MI interventions. Of the 5 studies that looked at residents' views of MI, 3 found improvements in resident assessments of the importance of and confidence in using MI. Of the 4 studies of MI skills, 3 reported improvements in residents' use of and competency in the MI skill. The quality of MI education in the graduate medical education literature is limited by overreliance on preintervention and postintervention analysis as a study design, the variable intensity of educational interventions, and limited use of validated assessment tools and quantitative outcome measures.

CONCLUSIONS

Review of the literature shows that MI education can be successfully implemented within the residency education environment. The intensity of MI interventions, coupled with experiential learning and feedback, correlated with favorable outcomes in terms of resident use of MI skills and resident satisfaction. Further study is needed to determine which MI skills are most effectively taught to residents, the impact of MI training on resident behavior in clinical settings, and the impact on clinical outcomes.

Testing the effectiveness of motivational interviewing as a weight reduction strategy for obese cardiac patients: a pilot study

BACKGROUND

Obesity has reached epidemic proportions in the USA and is a particular threat to those with coronary disease. Motivational interviewing (MI) is a client-centered, directive method for enhancing intrinsic motivation to change by exploring and resolving ambivalence about altering behavior.

PURPOSE

This study examined the efficacy of MI compared to nutritional counseling for weight loss in a small sample of obese cardiac patients.

METHOD

Participants were assigned to either MI or to nutrition counseling and followed up over 3 months. Trained undergraduate students delivered the MI intervention.

RESULTS

There were significant reductions in weight in women in the MI intervention, but not in men.

CONCLUSION

The results suggest that MI may be effective for obese female cardiac patients, in particular, even when delivered by nonprofessional interviewers. Limitations of the study include a small sample size, nonrandomized assignment to conditions, and attrition over time.

The potential for motivational interviewing to improve outcomes in the management of diabetes and obesity in paediatric and adult populations: a clinical review

Having good intentions to engage in healthy behaviours, to change our lives in a positive direction and make substantial, lasting changes may not always translate into actions or behaviour that is maintained. Motivational Interviewing is a directive person-centred approach designed to explore ambivalence and activate motivation for change [Miller WR, Rollnick S. Motivational Interviewing: Preparing People to Change Addictive Behaviour. London: Guilford Press, 1991]. A key component of a motivational interviewing conversation is to acknowledge that clients have every right to make no change. It uses a guiding communication style which invites people to consider their own situation and find their own solutions to situations that they identify as problematic that are preventing change. Motivational Interviewing was first introduced in adult health addiction services in the early 1980s. It has developed in the physical health specialties, and in the last 20 years or so attention has turned to the potential of Motivational Interviewing in the paediatric setting and the challenges of using it in families with children at differing ages and developmental stages. This article summarizes studies published from 2006 to 2011 of Motivational Interviewing in individuals across the lifespan with type 1 and type 2 diabetes and obesity.

Mobile apps for pediatric obesity prevention and treatment, healthy eating, and physical activity promotion: just fun and games?

Mobile applications (apps) offer a novel way to engage children in behavior change, but little is known about content of commercially available apps for this population. We analyzed the content of apps for iPhone/iPad for pediatric weight loss, healthy eating (HE), and physical activity (PA). Fifty-seven apps were downloaded and tested by two independent raters. Apps were coded for: inclusion of the Expert Committee for Pediatric Obesity Prevention's (ECPOP) eight recommended strategies (e.g., set goals) and seven behavioral targets (e.g., do ≥1 h of PA per day), utilization of gaming elements, and general characteristics. Most apps lacked any expert recommendations (n = 35, 61.4 %). The mean number of recommendations among apps that used recommendations was 3.6 ± 2.7 out of 15, 56.1 % (n = 32) apps were classified as games, and mean price per app was $1.05 ± 1.66. Most apps reviewed lacked expert recommendations and could be strengthened by addition of comprehensive information about health behavior change and opportunities for goal setting.

A pilot Internet-based behavioral weight loss intervention with or without commercially available portion-controlled foods

OBJECTIVE

To evaluate the short-term impact of portion-controlled food provision in combination with an Internet behavioral weight loss program on weight, blood cholesterol, and blood glucose levels.

DESIGN AND METHODS

Fifty participants, mean age 46 ± 10.7 years and mean body mass index 35.1 ± 3.8 kg/m2 , were randomized to one of two study groups, an Internet behavioral weight loss program (Internet-alone; n = 25) or an Internet behavioral weight loss program plus a commercially available portion-controlled diet (Internet + PCD; n = 25) for 12 weeks.

RESULTS

An intent-to-treat analysis found that the mean weight change in the Internet + PCD group was -5.7 ± 5.6 kg and in the Internet-alone group (n = 25) was -4.1 ± 4.0 kg (P = 0.26). Participants in the Internet + PCD group achieved significantly greater improvements in blood glucose (-2.6 ± 5.7 vs. 1.4 ± 11.0 mg/dl; P = 0.05) and LDL cholesterol (-8.2 ± 18.0 vs. -0.6 ± 21.0 mg/dl; P = 0.04), compared with Internet-alone group.

CONCLUSIONS

These data suggest that there may be short-term clinical benefit in using a PCD in conjunction with a behavioral Internet-based weight loss program to enhance weight loss and improve health indicators.

Interactive computer-based interventions for weight loss or weight maintenance in overweight or obese people

BACKGROUND

The World Health Organization (WHO) estimates that the number of obese or overweight individuals worldwide will increase to 1.5 billion by 2015. Chronic diseases associated with overweight or obesity include diabetes, heart disease, hypertension and stroke.

OBJECTIVES

To assess the effects of interactive computer-based interventions for weight loss or weight maintenance in overweight or obese people.

SEARCH METHODS

We searched several electronic databases, including CENTRAL, MEDLINE, EMBASE, CINAHL, LILACS and PsycINFO, through 25 May 2011. We also searched clinical trials registries to identify studies. We scanned reference lists of included studies and relevant systematic reviews.

SELECTION CRITERIA

Studies were included if they were randomized controlled trials or quasi-randomized controlled trials that evaluated interactive computer-based weight loss or weight maintenance programs in adults with overweight or obesity. We excluded trials if the duration of the intervention was less than four weeks or the loss to follow-up was greater than 20% overall.

DATA COLLECTION AND ANALYSIS

Two authors independently extracted study data and assessed risk of bias. Where interventions, control conditions, outcomes and time frames were similar between studies, we combined study data using meta-analysis.

MAIN RESULTS

We included 14 weight loss studies with a total of 2537 participants, and four weight maintenance studies with a total of 1603 participants. Treatment duration was between four weeks and 30 months. At six months, computer-based interventions led to greater weight loss than minimal interventions (mean difference (MD) -1.5 kg; 95% confidence interval (CI) -2.1 to -0.9; two trials) but less weight loss than in-person treatment (MD 2.1 kg; 95% CI 0.8 to 3.4; one trial). At six months, computer-based interventions were superior to a minimal control intervention in limiting weight regain (MD -0.7 kg; 95% CI -1.2 to -0.2; two trials), but not superior to infrequent in-person treatment (MD 0.5 kg; 95% -0.5 to 1.6; two trials). We did not observe consistent differences in dietary or physical activity behaviors between intervention and control groups in either weight loss or weight maintenance trials. Three weight loss studies estimated the costs of computer-based interventions compared to usual care, however two of the studies were 11 and 28 years old, and recent advances in technology render these estimates unlikely to be applicable to current or future interventions, while the third study was conducted in active duty military personnel, and it is unclear whether the costs are relevant to other settings. One weight loss study reported the cost-effectiveness ratio for a weekly in-person weight loss intervention relative to a computer-based intervention as USD 7177 (EUR 5678) per life year gained (80% CI USD 3055 to USD 60,291 (EUR 2417 to EUR 47,702)). It is unclear whether this could be extrapolated to other studies. No data were identified on adverse events, morbidity, complications or health-related quality of life.

AUTHORS' CONCLUSIONS

Compared to no intervention or minimal interventions (pamphlets, usual care), interactive computer-based interventions are an effective intervention for weight loss and weight maintenance. Compared to in-person interventions, interactive computer-based interventions result in smaller weight losses and lower levels of weight maintenance. The amount of additional weight loss, however, is relatively small and of brief duration, making the clinical significance of these differences unclear.

Motivation, self-determination, and long-term weight control

This article explores the topics of motivation and self-regulation in the context of weight management and related behaviors. We focus on the role of a qualitative approach to address motivation--not only considering the level but also type of motivation--in weight control and related behaviors. We critically discuss the operationalization of motivation in current weight control programs, present a complementary approach to understanding motivation based on self-determination theory, and review empirical findings from weight control studies that have used self-determination theory measures and assessed their association with weight outcomes. Weight loss studies which used Motivational Interviewing (MI) are also reviewed, considering MI's focus on enhancing internal motivation. We hypothesize that current weight control interventions may have been less successful with weight maintenance in part due to their relative disregard of qualitative dimensions of motivation, such as level of perceived autonomy, often resulting in a motivational disconnect between weight loss and weight-related behaviors. We suggest that if individuals fully endorse weight loss-related behavioral goals and feel not just competent but also autonomous about reaching them, as suggested by self-determination theory, their efforts are more likely to result in long-lasting behavior change.

Dietary intakes associated with successful weight loss and maintenance during the Weight Loss Maintenance trial

BACKGROUND

Dietary components effective in weight maintenance efforts have not been adequately identified.

OBJECTIVE

To determine the effects of changes in dietary consumption on weight loss and maintenance during the Weight Loss Maintenance clinical trial.

DESIGN

Weight Loss Maintenance was a randomized controlled trial. Successful weight loss participants who completed Phase I of the trial and lost 4 kg were randomized to one of three maintenance intervention arms in Phase II and followed for an additional 30 months.

PARTICIPANTS/SETTING

The multicenter trial was conducted from 2003 through 2007. This substudy included 828 successful weight loss participants.

METHODS

The Block Food Frequency Questionnaire (FFQ) was used to assess nutrient intake levels and food group servings. Carbohydrates, proteins, fats, dietary fiber, fruit/vegetable, and dairy servings were utilized as predictor variables. The FFQ was collected on all participants at study entry (beginning of Phase I). Those randomized to Phase II completed the FFQ at three additional time points: randomization (beginning of Phase II), 12 months, and 30 months.

INTERVENTION

The main intervention focused on long-term maintenance of weight loss using the Dietary Approaches to Hypertension diet. This substudy examined if changes to specific dietary variables were associated with weight loss and maintenance.

STATISTICAL ANALYSES PERFORMED

Linear regression models that adjusted for change in total energy examined the relationship between changes in dietary intake and weight for each time period. Site, age, race, sex, and a race-sex interaction were included as covariates.

RESULTS

Participants who substituted protein for fat lost, on average, 0.33 kg per 6 months during Phase I (P<0.0001) and 0.07 kg per 6 months during Phase II (P<0.0001) per 1% increase in protein. Increased intake of fruits and vegetables was associated with weight loss in Phases I and II: 0.29 kg per 6 months (P<0.0001) and 0.04 kg per 6 months (P=0.0062), respectively, per 1-serving increase. Substitution of carbohydrates for fat and protein for carbohydrates were associated with weight loss during both phases. Increasing dairy intake was associated with significant weight loss during Phase II (-0.17 kg per 6 months per 1-serving increase, P=0.0002), but not during Phase I. Dietary fiber revealed no significant findings.

CONCLUSIONS

Increasing fruits, vegetables, and low-fat dairy may help achieve weight loss and maintenance.

Case study: An ethics case study of HIV prevention research on Facebook: the Just/Us study

OBJECTIVE

To consider issues related to research with youth on social networking sites online.

METHODS

Description of the data collection process from 1,588 participants in a randomized controlled trial testing the efficacy of HIV prevention education delivered on Facebook. Using respondent-driven sampling, staff-recruited participants are encouraged to recruit up to three friends to enroll in the study.

RESULTS

Researchers should (a) consider whether an online social networking site is an appropriate place to implement a research study; (b) offer opportunities to review informed consent documents at multiple times and in multiple locations throughout the study; and (c) collect data outside the social networking site and store it behind secure firewalls to ensure it will not be accessible to any person on the social networking site.

CONCLUSIONS

Online social networks are growing in popularity. Conducting research on social media sites requires deliberate attention to consent, confidentiality, and security.

A series of studies examining Internet treatment of obesity to inform Internet interventions for substance use and misuse

The feasibility and efficacy of Internet treatment programs for overweight and obese people have been demonstrated in a series of randomized trials. Initial studies examined various approaches to Internet behavioral treatment. Other studies have examined delivery of group behavioral counseling using Internet chat rooms, using the Internet for long-term maintenance of weight loss, and enhancing motivation in Internet programs. These interventions have produced weight losses of 4-7 kg over 6 months to 1 year when support via e-mail, automated messages, or chat rooms is provided. Outcomes and lessons learned with application to the treatment of substance use and misuse are provided.

Physician communication techniques and weight loss in adults: Project CHAT

BACKGROUND

Physicians are encouraged to counsel overweight and obese patients to lose weight.

PURPOSE

It was examined whether discussing weight and use of motivational interviewing techniques (e.g., collaborating, reflective listening) while discussing weight predicted weight loss 3 months after the encounter.

METHODS

Forty primary care physicians and 461 of their overweight or obese patient visits were audio recorded between December 2006 and June 2008. Patient actual weight at the encounter and 3 months after the encounter (n=426); whether weight was discussed; physicians' use of motivational interviewing techniques; and patient, physician, and visit covariates (e.g., race, age, specialty) were assessed. This was an observational study and data were analyzed in April 2009.

RESULTS

No differences in weight loss were found between patients whose physicians discussed weight or did not. Patients whose physicians used motivational interviewing-consistent techniques during weight-related discussions lost weight 3 months post-encounter; those whose physician used motivational interviewing-inconsistent techniques gained or maintained weight. The estimated difference in weight change between patients whose physician had a higher global motivational interviewing-Spirit score (e.g., collaborated with patient) and those whose physician had a lower score was 1.6 kg (95% CI=-2.9, -0.3, p=0.02). The same was true for patients whose physician used reflective statements: 0.9 kg (95% CI=-1.8, -0.1, p=0.03). Similarly, patients whose physicians expressed only motivational interviewing-consistent behaviors had a difference in weight change of 1.1 kg (95% CI=-2.3, 0.1, p=0.07) compared to those whose physician expressed only motivational interviewing-inconsistent behaviors (e.g., judging, confronting).

CONCLUSIONS

In this observational study, use of motivational interviewing techniques during weight loss discussions predicted patient weight loss.

Motivation and its relationship to adherence to self-monitoring and weight loss in a 16-week Internet behavioral weight loss intervention

OBJECTIVE

To examine changes in motivation and the relationship of motivation to adherence to self-monitoring and weight loss in a 16-week Internet behavioral weight-loss intervention.

DESIGN

Two-group randomized design.

SETTING

This study was conducted over the Internet.

PARTICIPANTS

Sixty-six women, ages 22-65, with a body mass index (BMI) between 25 and 40, and with a home computer with Internet access, participated.

INTERVENTION

These data are from an Internet behavioral weight-loss program in which all participants received a face-to-face initial session followed by the 16-week Internet program.

MAIN OUTCOME MEASURES

Adherence to self-monitoring and weight loss were the main outcome measures.

ANALYSIS

Linear regression and mediation analysis using the Baron and Kenny method were conducted.

RESULTS

Autonomous motivation increased initially and remained high for those who ultimately achieved a 5% weight loss, but declined over time for participants who did not achieve a 5% weight loss. Autonomous motivation at 4 weeks was a predictor of adherence to self-monitoring and 16-week weight loss. Adherence mediated the relationship between autonomous motivation and weight loss.

CONCLUSIONS AND IMPLICATIONS

These results suggest that autonomous motivation may be a promising intervention target for promoting program procedure adherence and weight loss.

Review of Motivational Interviewing in promoting health behaviors

There is considerable evidence for the effectiveness of Motivational Interviewing (MI) in the treatment of substance abuse, as well as a number of other health behavior areas. The present paper summarizes and critically reviews the research in three emerging areas in which (MI) is being applied: diet and exercise, diabetes, and oral health. Although 10 prior reviews focused in part on MI studies in the areas of diet, exercise, or diabetes, the present paper provides an up-to-date review, and includes oral health as another emerging area of MI research. Overall, 37 articles were reviewed: 24 in the areas of diet and exercise, 9 in the area of diabetes, and 4 in the oral health area. Research in these areas suggests that (MI) is effective in all these health domains, although additional research is needed, particularly in the oral health arena. Specifically, future research in the areas of diet and exercise should examine the clinical utility of MI by health care professionals (other than dietitians), studies in the area of diabetes should continue to examine long-term effects of MI on glycemic control, and research in the area of oral health should focus on developing additional trials in this field. Further, future studies should demonstrate improved research methodology, and investigate the effects of possible outcome mediators, such as client change talk, on behavior change.

A randomized comparison of two motivationally enhanced Internet behavioral weight loss programs

PURPOSE

Sixty-six women participated in this study, which compared two 16-week motivationally enhanced weight loss interventions. Both intervention groups, which are entitled "Minimal" and "Enhanced" throughout the description that follows, received a motivationally enhanced initial face-to-face weight loss session. The initial session was followed by a 16-week Internet behavioral weight loss program, which included a study website with weekly lessons, an online self-monitoring diary form, web links to related sites, and separate message boards. The Enhanced group also received weekly moderated online chat group sessions led using motivational techniques.

RESULTS

Both groups lost weight over time (p<0.001), however the group by time interaction was non-significant (p=0.19). The Minimal group lost 5.22+/-4.72 kg and the Enhanced group lost 3.71+/-4.46 kg. In the Enhanced group, online chat session attendance averaged 8.0 of the 16 chats offered. Greater program utilization was associated with greater weight loss in both groups.

CONCLUSIONS

The addition of weekly motivationally enhanced online chats did not increase weight loss in this study. Further research is needed on the type and frequency of group support that is most desirable and beneficial in Internet weight loss interventions and could also explore building motivation for program utilization.