L’entretien motivationnel auprès de parents prévient l’obésité de leur enfant

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A clinical trial testing the effectiveness of a program based on motivational interview with parents of overweight children aged 2 to 8 years on the prevention of obesity. This non-drug intervention is performed by general practitioners or not associated with dieticians.

A US randomized controlled trial of Resnicow and colleagues, published in the journal Pediatrics in 2015, tested the effectiveness of four sessions of motivational interviewing combined or not with six sessions of dietary advice to parents of overweight children aged 2 to 8 years. The results show that motivational interviewing combined with dietary counseling significantly reduce the body mass index of children in the two years following the program.

The Study Rationale

In the US, the rate of obesity in children is very important. We know that being overweight or obese in childhood likely to continue into adulthood and cause serious health problems and disability situations.

To curb this risk, primary care is a way of intervention in which children have the opportunity to be in regular contact with medical specialists of the child, pediatricians. However, these preventive care are underutilized. Pediatricians believe they should have a place in the detection, prevention and treatment of overweight and obesity in the United States. Managed care models also dieticians recommend to engage more in primary care. These two businesses sometimes lack interventional tools to act effectively in the prevention of obesity.

An innovative method that has shown significant results is called motivational interviewing. It is based on an active discourse that strengthens the motivation of a person to engage in behavior change. The interview focuses on the specific needs of the individual and is based on his preferences, knowledge and beliefs.

This technical assistance, counseling and support could be recommended as part of pediatric obesity. It is necessary for it to test its effectiveness in primary care for obesity in young children.

The Question

The motivational technical maintenance conducted by a pediatrician or not associated with a dietician conducted with her parents reduced-Index Body Mass children 2 to 8 years overweight?

The Method

The American randomized controlled trial of Resnicow and colleagues compared three different groups of children 2 to 8 years on the Body Mass Index (BMI). 457 children participated in the study. The measures of BMI were performed preoperatively and at 1 year and 2 years follow-up.

The control group had access to descriptive routine care delivered by doctors and an education and prevention booklet. This included information for adopting a balanced diet and practicing regular physical activity.

The group “pediatrician” enjoyed four motivational interview sessions from a pediatrician with parents of children overweight or obese.

The group “pediatric + dietician” also followed the four sessions of the pediatrician over six sessions dietary advice from a dietician trained in motivational interviewing.

The Non-Pharmacological Intervention (NPI) assessed

INM implemented in this study is aimed at reducing the BMI of overweight children over 2 years of follow-up. The technique of motivational interviewing is to increase motivation to change eating behavior and in respect of physical activity. It uses strategies such as active listening, support for autonomy, shared decision making and speech modification. Doctors and dieticians participants were trained in this technique.

Parents of “pediatrician” program attended four sessions motivational interview with a pediatrician.

The parents of the “pediatric dietician +” program have received the same response over six sessions also dietary advice based on motivational interviewing. These six additional sessions could take place face to face or by phone. They were focused on an analysis of parental behaviors that may aggravate the weight of their children: fast foods, soft drinks, lack of fruits and vegetables, time spent watching television, weekly physical activity. The doctors realized positive feedback for healthy behaviors and the behaviors identified may be changed in consultation with parents.

Main Results

The study shows, after 2 years of follow-up, as adjusted percentile BMI was 90.3 for the control group, 88.1 for the group “pediatrician” and 87.1 for the group “pediatric dietician + “. The BMI for the last group was further reduced as the control group.

What it means for Parents of Children Overweight

A program combining sessions from 4 to 6 sessions pediatrician dietitian using the technique of motivational interview with parents reduces Body Mass Index (BMI) of children aged 2 to 8 years. It is important that parents are involved in the health education of their children.

What it means for Healthcare Professionals

The technique of motivational interviewing is useful for pediatricians and dietitians. This technique integrated in their consultation parents of overweight aged 2 to 8 years is effective in reducing the BMI of the latter. An effective strategy for preventing obesity happening here by parents.

What it means for Researchers

This study is one of the first to demonstrate the efficacy of the technique of motivational interview with parents in the primary care setting to reduce body fat of children under 9 years.

What it means for Policymakers

This clinical trial is one of the first to show a BMI reduction using the technique of motivational interviewing. It is effective when it combines a pediatrician and a dietician and not only with the intervention of a single pediatrician. It would be interesting to further develop this type of intervention, particularly by training doctors and dietitians to motivational interviewing and integrating primary care devices.

The Reference

Resnicow K, McMaster F, Bocian A, Harris D, Zhou Y, Snetselaar L, Schwartz R, Myers E, Gotlieb J, Foster J, Hollinger D, Smith K, Woolford S, Mueller, Wasserman RC (2015). Motivational interviewing and dietary counseling for obesity in primary care: An RCT. Pediatrics, 135, 649-657.

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To reference this Blog en Sante © article

Ninot G (2015). The motivational interview with the parents prevents obesity of their children. Blog en Sante, A54.

© Copyright 2015 Gregory Ninot. All rights reserved.