brief motivational interviewing to reduce child body mass index

Conditions: Childhood Obesity

Summary: bmi 2 is a study that tests a behavioral counseling approach to reduce obesity in children. practitioners (pediatricians, nurse practitioners) were randomly assigned to one of three groups. the first group continued with standard care; in group 2, each practitioner delivered four study motivational interviewing visits with the parent/caregiver, and in group 3 in addition to the practitioner, a registered dietitian delivered 6 motivational interviewing visits. the primary outcome will be the child's percentile bmi change between the baseline and 2-year follow-up. secondary outcomes will include behavior change around fruits and vegetables, sweetened beverages and exercise. our hypothesis is that there will be a larger decrease in bmi percentile for children in group 3 than in group 2, and that children in group 2 will have a decrease in bmi percentile when compared to group one.

the study is a cluster-randomized intervention trial with clinical practices serving as the unit of randomization and analysis. the investigators are testing two increasingly intensive interventions compared to a minimal intensity/usual care group. group 1 (usual care) includes determination of bmi percentile at baseline, 1-year, and 2-year follow-up. usual care (uc) practitioners provide parents with educational materials and routine care. uc pediatricians and their study staff received a ½ day study orientation session which included a brief cme-type workshop addressing obesity treatment.. group 2 (pediatric practitioner only) includes the same assessment points as uc. in addition, group 2 pediatric practitioners (pps) received 2 days of in-person training in motivational interviewing (mi) and behavior therapy (bt) as well as an interactive dvd mi booster training system focusing on pediatric obesity. pps in group 2 are asked to schedule 3 proactive counseling sessions with a parent of the index child in year 1 and one additional "booster" visit in year 2. to guide their counseling they are provided with a food and activity screening tool. in addition, group 2 practices are provided with educational materials written in a style consistent with motivational interviewing and self determination theory. unlike in group 1, where all of the educational materials are provided proactively to each parent, in groups 2 and 3, materials are distributed on a more selective tailored basis depending on parent needs. group 3 (pp+rd) includes the same intervention components as group 2, but adds mi-based counseling from a trained and registered dietitian (rd) who is linked to that practice. rds deliver 6 mi-based counseling sessions over 2 years. the intervention is front loaded with 4 sessions in year 1 and the remaining 2 in year 2. the rd sessions are delivered both in-person (required for visit 1) and optionally by telephone or in-person, subsequently. similar to mds, rds received 2.0 days of in-person mi and bt training, and the interactive dvd mi booster training system.

Eligibility criteria:
inclusion criteria: * 85th - 97th percentile bmi * parent/care giver ability to converse in english * working telephone exclusion criteria: * child under current subspecialty care for overweight/obesity * child currently taking weight-altering medication (at enrollment)

Keywords: pediatric obesity motivational interviewing overweight behavior change