Pediatric patients who received dietary counseling and motivational interviewing from both primary care providers and registered dietitians had significantly reduced body mass index (BMI) compared to those receiving counseling from pediatricians alone and those who received routine care.
Evidence Rating Level: 1 (Excellent)
Study Rundown: Obesity in the pediatric population is a significant problem in the United States, and pediatricians play an important role in the prevention, detection, and treatment of this disease. Previously studied family-based pediatric weight control interventions have not shown significant effects on BMI. Researchers of the current study sought to evaluate the efficacy of a primary care, motivational interviewing-based counseling intervention delivered by physicians and dieticians to parents of overweight children. Significant reductions in BMI percentiles were seen after 2 years when motivational interviewing counseling sessions were delivered by both providers and registered dieticians. In contrast, there were no significant differences in BMI when counseling was provided by pediatricians alone. Study results may lack generalizability as the included pediatric practices had experience with previous research protocols. Nevertheless, these results may influence physicians to improve their motivational interviewing skills and to encourage overweight pediatric patients to meet with a registered dietician.
Relevant Reading: An overview of pediatric obesity.
Study Author, Dr. Ken Resnicow, PhD, talks to 2 Minute Medicine: Department of Health Behavior & Health Education, University of Michigan School of Public Health.
“Our study is amongst the first conducted in primary care and using Motivational Interviewing to achieve a significant effect on child adiposity. The effect size achieved, whilst modest, is in the range where other biologic effects might be expected (although we did not measure biomarkers such as lipids, blood pressure, or blood glucose in this study). The dose used, 4 PCP contacts and up to 6 RD contacts, we feel is achievable in primary care, and is consistent with the dose recommended by the Healthier Generation Benefit. A key challenge in disseminating the BMI2 approach is how best to train PCPs in Motivational Interviewing and how best to link dietitians or other behavioral counselors to PC practices to provide the supplemental counseling that appeared to be important in our study.”
In-Depth [randomized controlled trial]: Participants included a total of 42 pediatric practices and 645 overweight pediatric patients (2 to 8 years old) from the American Academy of Pediatrics’ Pediatric Research in Office Settings research network. All practices were randomized to receive 1 of 3 interventions. In Group 1 (n = 198), pediatricians provided routine care according to current treatment guidelines. Group 2 (n = 212) practices provided 4 total counseling sessions by pediatricians through motivational interviewing to parents of overweight children. Group 3 (n = 235) practices provided 4 physician-led and 6 registered dietician-led counseling sessions using motivational interviewing techniques. Mean BMI percentile for all participants at the start of the study period was 91.9%. At the conclusion of the 2-year study period, BMI percentiles for groups 1, 2, and 3 were 90.3%, 88.1%, and 87.1%, respectively. Group 3 mean BMI percentile was significantly lower than Group 1 (p = .02). There were no significant interactions of intervention group by child gender, child age, baseline BMI, parent income, parent education, or parent BMI.
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