Pediatric BMI improves with motivational counseling.
"This is among the first counseling interventions using MI [motivational interviewing] and delivered in primary care to yield significant effects on adiposity," reported Kenneth Resnicow, Ph.D., of the University of Michigan in Ann Arbor, and his associates.
"Research is needed to determine the clinical significance and persistence of the BMI effects observed. Given the relatively modest dose, the intervention appears to have considerable dissemination potential, which can be explored in future studies," they wrote (Pediatrics 2015 March 30 [doi:10.1542/peds.2014-1880]).
The researchers randomly assigned 42 pediatric practices to either usual care (n = 198) or one of two interventions for treating patients aged 2-8 years with a BMI between the 85th and 97th percentile. Only children without diabetes, prior specialist weight loss treatment, or chronic medical conditions, disorders, or syndromes were included. Practices were compensated with reimbursement and incentives for their participation. They were part of the American Academy of Pediatrics' Pediatric Research in Office Settings Network, composed of 1,676 practitioners from 712 practices with nationally representative patient populations.
Both interventions included the primary care providers' receiving 2 days of in-person training in motivational interviewing and behavior therapy and then scheduling four counseling sessions with children's parents.
These providers also received a DVD training system focused on pediatric obesity. The second intervention group (n = 235) included a registered dietitian trained in motivational interviewing who scheduled six counseling sessions, in person or by phone with the parents.
Average baseline BMI percentile across all participating children was 91.9, with 60% white, 22% Hispanic, 7% black, and 6% Asian ethnicities. The 2-year follow-up data available for 71% of the children showed, after adjustment for confounders, an average BMI percentile of 90.3 in the usual care group, 88.1 in the group with motivational interviewing from providers only, and 87.1 in the group with providers' and dietitians' motivational interviewing. Mean changes from baseline in BMI percentile were 1.8, 3.8, and 4.9 across groups 1, 2, and 3.
However, only the difference between the group with dietitians and the usual care group was statistically significant, even though few dietitians succeeded in completing all six counseling sessions with families. Difficulties encountered by the dietitians included family scheduling challenges and inadequate integration into the practice's care team.
"One somewhat surprising finding was the relatively large BMI reduction in the usual care group: 1.8 BMI units.
"Although the effects on BMI observed in group 2 [physicians only providing motivational interviewing] were slightly better than the usual care group, they were not statistically significant.
"Had the usual care group exhibited the degree of change we expected, then these effects would have achieved statistical significance," the investigators said.
BY TARA HAELLE
Key clinical point: Counseling with motivational interviewing improved pediatric body mass index.
Major finding: BMI percentile dropped 3.8-4.9 points with motivational interviewing, compared with 1.8 points with usual care.
Data source: A 2-year randomized controlled trial involving 42 pediatric practices treating 645 children, aged 2-8, with BMIs between the 85th and 97th percentiles.
Disclosures: The National Heart, Lung and Blood Institute; the U.S. Health Resources and Services Administration Maternal and Child Health Bureau; and the American Academy of Pediatrics funded the research. The authors reported no relevant financial disclosures.
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|Title Annotation:||NEWS; Body mass index|
|Publication:||Family Practice News|
|Date:||Apr 15, 2015|
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